PREVIEW · Not yet the live site · For internal review Figures marked “illustrative” are simulated
Talk to us
Form

Claim verification

Give us the claim details we need to verify coverage for a prescription. If you would rather speak to someone, call 844.263.2832.

Fields marked with an asterisk are required.

About you
We send you a receipt here.
The claim

These details identify the injured worker. We store them encrypted and use them only to verify this claim.

We use what you send only to act on this request. See our Privacy Notice, Terms of Use and HIPAA Notice.