CHA Claim Status Form Email Form Claim Status Request Form Please use this secure form to request claim status, or use one of these additional options: Email: claimstatus@cha.faith Fax: 888-977-8826 Your Name * Your Email * Provider Name * CHA Coverage Type Primary Secondary Note: Please submit Primary and Secondary Requests separately, Thank you! Comments In the section below, please enter each member's information for which the status is being requested: Member Information Member Name * Member ID # * Member DOB * Date of Service * Billed Amount * plus1 Add minus1 Remove Captcha Submit Clear If you are human, leave this field blank.