Assisting crime victims

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.
  • The Sexual 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 Examinations will be reimbursed based on rates established under the CVCP Medical Fee Schedule.  Victims should not be charged for the cost of the exam.
If you have further questions, contact the claims department.