Tennessee Payment Resources

Summary of payment program


Tennessee Code Annotated, Section 29-13-118 provides that victims of certain sexually-oriented crimes shall be entitled to forensic medical examinations without charge.

No bill shall be submitted to a victim. Claims for forensic medical examinations may include services provided for a sexually-oriented crime by any:

  • Medical facility
  • Sexual Assault Nurse Examiner (SANE) program
  • Child advocacy center
  • Rape crisis center


Sexual Assault Forensic Examination (SAFE) for Medical Providers –  Application for Payment Form

The 105th General Assembly amended the Criminal Injuries Compensation Act in 2007 to provide payment for services related to sexual assault forensic examinations.

The Criminal Injuries Compensation Fund provides reimbursement to a facility that performs sexual assault forensic exams on victims of certain sexually oriented crimes. Facilities must bill the Fund, not the victim, and cannot seek any additional payment from the victim after payment by the Fund.

File a Claim

Do not bill the patient/victim. The facility shall bill the Criminal Injuries Compensation Fund.

The SAFE Program can reimburse medical providers for the examination of victims of sexually oriented crimes under Tennessee Code Annotated, Section 39-13-502—39-13-506, 39-13-522, 39-13-531, 39-13-532, and 39-13-527 that occurred on or after July 1, 2007.

This may include an exam for a crime occurring in Tennessee whether or not it is performed for a Tennessee resident.

Payments for exams arising from crimes occurring outside Tennessee cannot be considered if that state has a forensic exam payment program which would pay any part of the expense.

Please note the following:

  • The facility must provide an itemized bill (or UB-92 or UB-04 form with proper coding) and the Sexual Assault Forensic Examination Reimbursement Form. These items must be legible and complete for consideration.
  • The Division of Claims and Risk Management may request clarifying information from the facility if required for payment of the bill, or may return incomplete documents.
  • In accordance with Tennessee Code Annotated, Section 29-13-118, the amount reimbursed by the Division/Fund must be accepted as payment in full. The facility cannot bill the patient a balance, for any reason.
  • The maximum available for all such examination-related expenses is $1,000 for services performed on or after July 1, 2016.
  • Although the person may elect to report the crime, a report to law enforcement or cooperation with the prosecution is not required for payment of the exam.
  • The documents must be submitted to the Division of Claims and Risk Management within one (1) year of the date of the exam. Payment shall be rendered within ninety (90) days of receipt of request.

Submit itemized bill and the proscribed reimbursement form to:

Tennessee Treasury Department
Criminal Injuries Compensation Fund
SAFE Reimbursement
Division of Claims and Risk Management
502 Deaderick Street
Nashville, TN 37243-0202

Tennessee Criminal Injuries Compensation Application | Spanish
Tennessee Criminal Injuries Compensation Brochure | Spanish

Coordination with healthcare

Tennessee Coalition to End Domestic & Sexual Violence

Our Kids – Pediatric and Adolescent Sexual Assault Medical Forensic Examinations, Nashville, TN