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
Email: crimevictims@utah.gov
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
(801)238-2377
aarmstrong@utah.gov