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Billing Guidelines for Sexual Assault Examinations: Crime Victims Compensation Program

Provides information health-care providers need to bill the Crime Victims Compensation Program for medical services.



Manual
F800-100-000


 
Crime Victims' Statement for Compound Prescription

Bill form for use by pharmacies and home infusion companies to submit compound drug charges for Crime Victims Compensation. This form is for drug charges only and is filled out by the pharmacist.



Form
F800-067-000


 
Formulario de verificación de empleo

Para ser utilizado por las víctimas de crimen que están solicitando compensación de reemplazo de salario.



Form
F800-110-999



Alt Language(s):
Inglés
 
Victim Verification Form

For use by crime victims requesting wage replacement compensation



Form
F800-110-000



Alt Language(s):
Español
 
Crime Victims Compensation Subacute Opioid Request Form
Use this form for Crime Victims Compensation to request opioid coverage between 6 weeks and 12 weeks from date of injury or surgery.


F800-119-000


 
Helping Providers Understand the Crime Victims Compensation Program
Fact sheet: Answers questions doctors and mental health counselors may have about the Crime Victims Compensation Program and billing for services. Also suggests steps these providers can take to speed up reimbursement.

Publication
F800-102-000


 





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