Medical Providers

Billing

This page explains how medical 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

If the victim does not have insurance or another collateral payment source, UOVC may pay:

  • The PEHP (Public Employees Health Plan) fee schedule rate for the medical service, or
  • 50% of the billed charges if a PEHP fee schedule rate is not available for that service.

If the victim has insurance or another collateral payment source, UOVC may pay the patient responsibility amount according to the insurance agreement.

Crime-related medications dispensed by a pharmacy are paid at PEHP allowable rates.

Payment in Full Requirement

A medical 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 Procedures or Surgery

Some procedures or surgeries require preauthorization. Submit a request that includes:

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

Submit the following:

  • A UB-04 or CMS-1500 billing form
  • Insurance Explanation of Benefits (EOB), if applicable
  • Medical records or treatment notes if crime-relatedness may need verification

CMS-1500 Billing Form

PDF

UB-04 Billing Form

PDF

Submit Billing Documents

Choose a submission method:

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