State of Idaho
Crime Victims Compensation

Sexual Assault Examination Reimbursement Requirements

Reimbursement will be made ONLY when the following conditions are met:


• The crime was committed in Idaho.
• The sexual assault examination was performed at a licensed medical facility and by a practitioner who has been trained to gather the forensic evidence.
• Third-party payment sources must pay prior to the program. Examples of these sources include: private health insurance, Medicaid, Indian Health Services, TriCare, and any other source that provides payment for medical services.
• TheSexual Assault Examination Reimbursement Form must be signed by the victim, parent, or legal guardian of a minor victim.
• The billing for the sexual assault examination must include the following documentation: completed itemized billing (HCFA or UB 04 form); completed Sexual Assault Examination Reimbursement Form; insurance explanation of benefits (EOB); and medical records.
• Sexual Assault Forensic Examinations performed on or after January 1, 2009 will not require law enforcement authorization, and will be reimbursed at 100% of reasonable and customary charges. Victims should not be charged for the cost of the exam.