Medical Service Providers
The Crime Victims’ Compensation (CVC) Program can pay for crime related medical expenses calculated by using the Texas Department of Insurance Division of Workers’ (DWC) Compensation Medical Fee Guidelines and according to the date that the service is provided. Types of medical expenses that are covered by the program include, but are not limited to:
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- Medical services including hospitalization, surgery, physician, psychiatric and mental health care, ambulance transportation, chiropractic care, dental care, physical therapy, and prescriptions.
- Medically necessary items, such as eyeglasses, hearing aids, dentures, and prosthetic devices that are lost, stolen, or broken during the crime or that become necessary due to the crime.
- Up to six months of physical therapy treatment.
The Texas Code of Criminal Procedure Article 56.34 (c) requires the OAG to award compensation for health care services according to the medical fee guidelines prescribed by the Texas Department of Insurance, Division of Worker's Compensation. These fee schedules change frequently and providers are encouraged to review the Texas Department of Insurance, Division of Worker's Compensation web site for the most current information.
As required by Texas law, CVC can only pay after all other collateral sources are used, and if a collateral source is available, the explanation of benefits (EOB) showing the utilization of the collateral source must be attached to the medical bill. With some bills, a Documentation of Procedure (DOP) may also be required. Submitting the EOB or DOP with the bill allows CVC to audit without the delay of requesting these documents. Some examples of collateral sources include:
- Primary Health Insurance
- Workers’ Compensation
- Auto Insurance
CVC does not maintain a “preferred provider list” that providers need to apply for eligibility or request to be added.
Bills should be submitted after the medical service has been rendered and after available collateral sources have paid. Please include the victim’s CVC claim number on all bills.
CVC does not pre-authorize medical procedures; however, if the treatment is crime related, in most cases the charges will be reimbursed according to DWC medical fee guidelines.
Medical bills must be submitted on either a Center for Medicare and Medicaid Services (CMS 1500) claim form or a Uniform Billing (UB04) claim form with a copy of the Explanation of Benefits from the primary insurance. The CMS 1500 or UB04 must include:
- A patient’s name and address
- Date(s) of service
- Type(s) of service(s) provided (diagnosis and procedure codes)
- A billed amount
- A provider’s license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing dates.
- Primary collateral source information
You may view a sample of The Center for Medicare and Medicaid Services (CMS 1500) claim. Or see more information and a sample of the Uniform Billing claim form (UB04).
For complete instructions on proper submission of a medical bill, please refer to the Texas Department of Insurance web site.
Incomplete or summary bills will be returned to the provider with a request for a complete itemized bill.
A medical service provider may be asked by CVC to submit an itemized bill even though the balance on the account is zero. Access to this information may allow CVC to reimburse the victim for payments that were previously collected by the medical provider.
If an overpayment is identified by CVC staff or the service provider, the provider is obligated to refund the overpayment as soon as possible. Common examples are payments to the provider by collateral sources that are unknown by CVC which create duplicate payments for the same service.
Additional information for mental health providers can be found on our mental health page.
Questions regarding Durable Medical Equipment (DME) such as prosthetic devices, home assistance equipment, or mobility assistance such as wheel chairs can be answered by calling 800-983-9933.
How do Medical Providers submit bills?
Crime Victim Services
P O Box 12198
Austin, Texas 78711-2198
If you have any questions, please call the CVC program at 800-983-9933 or send your question via email@example.com.