Billing for Forensic Providers

 

The SAFE Payment Program pays for costs associated with the collection evidence through a medical forensic examination conducted on victims of sexual assault per § 19.2-165.1. Forensic exams conducted for any other purpose or crime should be submitted to the Supreme Court of Virginia. Please contact Fiscal Services within the Office of the Executive Secretary of the Supreme Court of Virginia at 804.786.6455 for further information.

SAFE Payment Program Eligibility Requirements:

  • The crime occurred within the Commonwealth of Virginia.
  • Collection of evidence took place as outlined in §19.2-165.1 of the Code of Virginia.
    • Patients are not required to report the crime to law enforcement, nor cooperate with an investigation in order to request a Physical Evidence Recovery Kit (PERK) exam or for that exam to be paid per §19.2-165.1 (B).
    • If the patient declines evidence collection, the claim is not eligible for reimbursement. The SAFE Payment Program does not reimburse for consults, only for collection of medical forensic evidence.
  • Medical forensic examinations for non-acute (more than 120 hours after the crime) and/or chronic sexual abuse cases require authorization by law enforcement officer or prosecutor for payment per §19.2-165.1 (A).
    • Referrals from physicians, parents, and social workers do not meet the authorization requirements outlined in §19.2-165.1 (A) of the Code of Virginia.
  • Required documentation is submitted within one year from the date of service.

Required Documentation:

  • Completed 2-page Request for Payment Form.
  • Insurance explanation of benefits paid and/or denied, if applicable. If the patient is covered by a federally funded insurance such as Medicaid, Medicare, Tricare, etc., insurance must be billed primary. Billing private health insurance primary is not required unless requested by the patient. The SAFE Payment Program will pay any eligible remaining patient responsibility.
  • Itemized, detailed billing statement. Health insurance claim forms may not be considered alone.

Please submit the required documentation via one of the following:

IMPORTANT: Per §19.2-368.5:2 and §19.2-368.11:1(F) of the Code of Virginia, the patient may not be placed into collections once this form is filed with VVF.

Helpful Information

Please see the SAFE Payment Program Procedures and Guidelines for further information regarding eligibility and payment, or contact us at 800-552-4007 or safe@virginiavictimsfund.org.

Please see the How to Submit a SAFE Claim for information regarding the SAFE Payment Program and submitting a claim for processing.

Pre-paid PERK Shipping Labels

The SAFE Payment Program will provide a pre-paid PERK shipping label to send anonymous PERKs to the Division of Consolidated Laboratory Services (DCLS) in accordance with §19.2-11.6.

To obtain a pre-paid label, forensic providers should send an email request to safe@virginiavictimsfund.org. The return mailing address must be included in the email. Printing and other instructions will be sent with the label.

Label requests will be responded to Monday through Friday during normal business hours. This excludes weekends, holidays and closings for inclement weather or other reasons.

Instructions and forms for shipping PERKs to DCLS may be found at http://www.dgs.state.va.us/DivisionofConsolidatedLaboratoryServices/PER….