Dental Service Providers

If the victim has no dental insurance or other collateral source for payment, UOVC shall pay the PEHP (Public Employees Health Plan) allowable amount for eligible dental services
If the victim has dental insurance or other collateral source for payment, UOVC shall pay the portion of the eligible dental bills that the victim is obligated to pay according to the insurance agreement
Payment made by UOVC on behalf of a victim, when accepted by the provider, is considered payment in full

Submit a preauthorization request on an ADA Dental Claim Form that includes the procedure coding and costs of the procedure, as well as treatment notes indicating crime-relatedness

Submit an ADA Dental Claim Form and treatment notes, along with the insurance Explanation of Benefits, if applicable
If the provider has never been paid by the state of Utah, please submit a W-9 form

FAX: (801)533-4127

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

Contact the UOVC Provider Liaison

Amy Armstrong
(801)238-2377
aarmstrong@utah.gov

Utah Office
for Victims of Crime