Medical Service Providers

• If the victim has no medical insurance or other collateral source for payment, UOVC shall pay the PEHP allowable rate for the service or 50% of the billed charges for eligible medical bills if there is no PEHP allowable rate for that service
If the victim has medical insurance or other collateral source for payment, UOVC shall pay the portion of the eligible medical bills that the victim is obligated to pay according to the insurance agreement
Crime-related medications dispensed by a pharmacy shall be paid at the PEHP allowable rates
Payment made by UOVC on behalf of a victim, when accepted by the provider, is considered payment in full

If the victim has no medical insurance or other collateral source for payment, UOVC shall pay 60% of the billed charges for eligible medical bills
If the victim has medical insurance or other collateral source for payment, UOVC shall pay the portion of the eligible medical bills that the victim is obligated to pay according to the insurance agreement
Crime-related medications dispensed by a pharmacy shall be paid at the PEHP (Public Employees Health Plan) allowable rates
Payment made by UOVC on behalf of a victim, when accepted by the provider, is considered payment in full

Submit a preauthorization request that includes the procedure coding, costs of the procedure, and treatment notes indicating crime-relatedness

Submit either a UB-04 or a CMS-1500 billing form, along with the insurance Explanation of Benefits, if applicable
If there may be a question of crime relatedness, please include the medical records

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