Dental Service Providers


Payment Information
  • 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
Preauthorization for Dental Services
  • 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
How to Submit Billings for Payment Review
  • 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
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