Code R Service Providers

Payment Information Tables
  • Please review the tables linked here based on date of service.
Required Documentation for Payment Review and Payment Information
  • Submit a Fast Track Reimbursement Form
  • Either the Fast Track Reimbursement Form or Code R related billing must be submitted within ONE YEAR from the date of the sexual assault forensic exam
  • Submit either a UB-04 or a CMS-1500 billing form, along with the insurance Explanation of Benefits, if applicable
  • Payment made by UOVC on behalf of a victim, when accepted by the provider, is considered payment in full
How to Submit Documents

FAX:  (801)533-4127


Mail:    Utah Office for Victims of Crime
             350 E. 500 S. Suite 200
             Salt Lake City, UT 84111

For additional questions

Contact the UOVC Provider Liaison

Amy Armstrong