Dental Providers

Billing

This page explains how dental providers can submit billing to the Utah Office for Victims of Crime (UOVC) for eligible crime-related medical services.

Reminder: Providers must bill all available insurance or other payment sources before submitting claims to UOVC.

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Payment Information

A dental service provider who accepts payment from UOVC agrees to accept that payment as payment in full on behalf of the patient and may not attempt to collect additional payment from the patient.

Preauthorization for Dental Services

Some dental procedures require preauthorization. Submit a request using an ADA Dental Claim Form that includes:

  • Procedure coding
  • Estimated cost of the procedure
  • Treatment notes showing the services are crime-related
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Submitting Billing for Payment Review

Submit the following:

  • ADA Dental Claim Form
  • Treatment notes showing crime-relatedness
  • Insurance Explanation of Benefits (EOB), if applicable

ADA Dental Claim Form

PDF

Submit Billing Documents

Choose a submission method:

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