What is a claim history report?

A claim history report, or verification, is a historical record of claim activity for a given insurance policy.

Who can request claim history reports?

Routinely hospitals, managed care organizations (HMOs, PPOs, etc.), individual policyholders, insurance companies, insurance agents, brokers, state licensing boards and employers of medical and healthcare professionals (e.g. branches of the military, correctional facilities) request claim history reports. As long as it is properly authorized by the practitioner, anyone can request a claim history report.

What are claim history reports used for?

Hospitals, managed care organizations and others use the reports during the hiring, credentialing and privileging processes. State licensing boards may request claim history reports on professionals under investigation. Individual policyholders may request their own report.

What information must I give Princeton in order to receive a claim history verification?

Princeton requires a signed authorization form be completed, which gives us permission to release the claim data. Anyone may acquire a release by contacting the Verification Unit or by going to our Web site at http://www.princetoninsurance.com/.  Once on the Web site, follow the link under Services to the Verification Unit and then select the link, “How to request a claim history.” To go there directly from here, follow this link.

In order for us to compile a claim history, you must complete all sections of the form, to include the professional’s name, address, policy number(s)*, social security and/or license number. If you are requesting a claim history for a doctor who is insured under a group policy, it is helpful to provide the approximate dates of coverage as well.

*Princeton Insurance will supply a claim history on all policies a practitioner is linked to, regardless of what policy number is put on the release.

Authorization forms must be signed and dated by the practitioner in question.  Stamped signatures are not accepted. The authorization must also include the professional’s name (typed or printed legibly) and the name and address of the organization to which the information is being sent. Supplying an attention name is helpful.

Authorization forms are valid for one year. Requests for claim history verifications will not be processed without proper authorization.

How can I submit an authorization form to request a claim history verification?

A completed authorization form can be submitted by fax (609-452-2893) or by mail to:

Verification Unit

Princeton Insurance

PO Box 5322

Princeton, NJ 08543-5322

Is there a fee for claim history reports?

Princeton Insurance does charge $35 for claim history reports, regardless of how many policies a practitioner has. All of our insureds, currently insured or not, may request one free claim history per calendar year. They may authorize their yearly free report, be sent to a third party, by completing an Authorization to Release Claim History Information form. 

In addition, as a courtesy, currently insured New Jersey hospitals, State Boards and any branch of the military may request claim history reports directly from us, at no charge.

Can requests be processed over the phone?

To protect the confidential nature of the information contained in claim histories, Princeton cannot accept requests or provide such claim information over the phone. While we do encourage you to call our Verification Unit (609-452-9404) for more information, we can only issue a claim history in response to a written and properly authorized request.

What information is included in the claim history report?

The claim history report is a ten-year record of the claim activity on a given insurance policy. The report includes:

•          Name of individual for whom the claim history is being reported on.

•          Policy information – policy number, dates of coverage, retro date, policy limits and type of policy.

•          Information about all open claims and those that have been closed within the past ten years. The ten-year period encompasses the previous ten years, up to and including the date of the request. The claim history report contains the claim number (Princeton’s internal tracking number), claimant’s name, date on which the incident occurred, the claim’s status (open or closed), the date on which it was closed (if applicable) and the amount paid for damages (indemnity), regardless of whether the claim was tried to conclusion or settled prior to trial.

If there are no open claims or claims closed prior to the ten-year window, the report will state “no claims.”

How long does it take to process a request for a claim history?

It takes one week to ten days to process a request.

How are claim history reports given to requestors?

Claim histories are mailed to requestors at the address provided in an envelope marked “confidential.”

Can claim history reports be received via fax?

Because of confidentiality concerns, we do not routinely transmit claim history reports over the fax machine. For urgent requests, please call the Verification Unit (609-452-9404) and we’ll do our best to accommodate your need.

What if the report contains a discrepancy?

Doctors and other medical or healthcare professionals who believe their claim history report contains an error should call the Verification Unit immediately (609-452-9404). Our staff will investigate the item(s) in question and correct the report, if necessary.

Can agents provide claim history verifications?

Agents do not have the capability to provide claim history reports. Written requests for claim history verifications should be sent direction to Princeton’s Verification Unit. All requests received by agents are forwarded to the company for completion.

What is the difference between a claim history verification and a certificate of insurance?

A claim history verification is a record of claim activity and policy information on a particular insurance policy. A certificate of insurance is simply a statement that verifies the named individual has an active insurance policy. Certificates of insurance also confirm the policy number, coverage type, coverage dates and limits of liability. Your independent insurance agent can provide a certificate of insurance.

How may I contact someone in the Verification Unit by phone?

You may call our Verification Unit during the hours of 8:30 a.m. to 4:30 p.m., Monday through Friday. Our phone number is 609-452-9404 and the fax line is 609-452-2893.