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Account Resolution & Billing Support Forms

Managing an outstanding account can be stressful, but you don’t have to navigate it alone. This page provides access to secure forms designed to help you request information, submit documentation, or ask questions about your account.

Our team is available to provide billing support and guide you through available account resolution options in a clear and respectful manner.

You can also connect with our virtual assistant 24/7 for quick responses to common questions.

Virtual Agent

Report A Payment

File Number(Required)

If your account is a medical debt, we have previously provided you with the provider’s name, amount and date of service for the balance owed. Our client has billed your insurance and they have deemed it the patient’s responsibility. To expedite the resolution of this debt, please refer to the back of your insurance card and there is a member portal where you can put in the date of service and provider, and it will tell you why the debt is owed by the patient via Explanation of Benefits (EOB). If after you have reviewed your EOB and it is determined that there was an error in billing or the amount of patient responsibility is not correct, please email us a copy of the EOB at contact@crcorp.net and we will handle it accordingly with our client. Duplicate requests for supporting documentation will not be provided.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address(Required)

Phone Number(Required)

Amount Paid to Creditor(Required)

Payment Method(Required)

Date of Payment

Check Number(Required)

Date of Check(Required)

Date Check Cleared Bank(Required)

Type of Credit Card(Required)

Last Four Digits on Credit Card(Required)

File Upload

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, xps, Max. file size: 5 MB, Max. files: 3.

Terms & Conditions(Required)

I have read and accepted the Terms & Conditions stated below.

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Dispute an Account or Claim

CRC Reference Number(Required)

Name(Required)

First Last

Social Security Number

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address(Required)

Phone(Required)

What is your dispute?(Required)

Terms & Conditions(Required)

I have read and accepted the Terms & Conditions stated below.

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Request Documentation Regarding Your Account

Account Number(Required)

If your account is a medical debt, we have previously provided you with the provider’s name, amount and date of service for the balance owed. Our client has billed your insurance and they have deemed it the patient’s responsibility. To expedite the resolution of this debt, please refer to the back of your insurance card and there is a member portal where you can put in the date of service and provider, and it will tell you why the debt is owed by the patient via Explanation of Benefits (EOB). If after you have reviewed your EOB and it is determined that there was an error in billing or the amount of patient responsibility is not correct, please email us a copy of the EOB at contact@crcorp.net and we will handle it accordingly with our client. Duplicate requests for supporting documentation will not be provided.

Name(Required)

First Last

Birth Year(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email Address(Required)

Phone Number(Required)

Requested Documentation(Required)

Terms & Conditions(Required)

I have read and accepted the Terms & Conditions stated below.

CAPTCHA

CR Corp Extended Business Office
POB 4100 Canton,
GA 30114
Phone: 888-925-8150
Fax: 770-216-9353
Email: contact@crcorp.net
To consent to text messaging: text CONTACT to 407-270-0528

TERMS & CONDITIONS:

By checking the “Accept Terms & Conditions” box above, you confirm that you are the named individual associated with this account or are otherwise authorized to review and discuss the information related to it.

You authorize CR Corp Extended Business Office and its representatives to contact you regarding account-related and billing support matters using the contact information you provide. Communications may include phone calls, prerecorded or artificial voice messages, text messages, or electronic messages, including those sent using automated systems, where permitted by law.

You acknowledge that the phone number(s) and email address you provide belong to you, are secure, and are not accessible by unauthorized third parties. Communications will be used solely for account resolution, billing support, and customer service purposes.

COMMUNICATION CONSENT

By submitting this form, you consent to receive communications from CR Corp Extended Business Office related to your account. These communications may be delivered via telephone, email, or text message to assist with account support and resolution.

Message and data rates may apply. Message frequency may vary. You may opt out of text communications at any time by replying STOP.

PRIVACY NOTICE

CR Corp Extended Business Office respects your privacy and does not sell your personal information.

Information collected through this site is used only to provide billing support, respond to inquiries, and assist with account resolution.

To review, update, or change your contact information, please log in to the secure online portal and select “My Account”, then “Update Account Information.”

IMPORTANT NOTICE

This site and its forms are provided for billing support and account resolution purposes only.
No collections-related disclosures or regulatory notices apply to the use of this site.