Virginia Payment Resources
Summary of payment program
Billing for Forensic Providers
The SAFE Payment Program pays for costs associated with the collection evidence through a medical forensic examination conducted on victims of sexual assault per § 19.2-165.1. Forensic exams conducted for any other purpose or crime should be submitted to the Supreme Court of Virginia. In the State of Virginia, the Supreme Court will only pay if it is authorized first by law enforcement. Please contact Fiscal Services within the Office of the Executive Secretary of the Supreme Court of Virginia at 804.786.6455 for further information.
SAFE Payment Program Eligibility Requirements:
- The crime occurred within the Commonwealth of Virginia
- Collection of evidence took place as outlined in § 19.2-165.1 of the Code of Virginia
- Patients are not required to report the crime to law enforcement, nor cooperate with an investigation in order to request a Physical Evidence Recover Kit (PERK) exam or for that exam to be paid per § 19.2-165.1 (B)
- All medical fees expended in the gathering of evidence through physical evidence recovery kit examinations conducted on victims complaining of sexual assault under Article 7 (§18.2-61 et seq.) of Chapter 4 of Title 18.2 shall be paid by the Commonwealth pursuant to subsection F of § 19.2-368.11:1. Victims complaining of sexual assault shall not be required to participate in the criminal justice system or cooperate with law-enforcement authorities in order to be provided with such forensic medical exams.
Upon conviction of the defendant in any case requiring the payment of medical fees authorized by this section, the court shall order that the defendant reimburse the Commonwealth for payment of such fees.
- If the patient declines evidence collection, the claim is not eligible for reimbursement. The SAFE Payment Program does not reimburse for consults, only for collection of medical forensic evidence
- Medical forensic examinations for non-acute (more than 120 hours after the crime) and/or chronic sexual abuse cases require authorization by law enforcement officer or prosecutor for payment per § 19.2-165.1 (A).
- Referrals from physicians, parents, and social workers do not meet the authorization requirements outlined in § 19.2-165.1 (A) of the Code of Virginia.
- Required documentation is submitted within 1-year from the date of service.
- Completed 2-page Request for Payment Form
- Insurance explanation of benefits paid and/or denies, if applicable. If the patient is covered by a federally-funded insurance such as Medicaid, Medicare, Tricare, etc., insurance must be billed primary. Billing private health insurance primary is not required unless requested by the patient. The SAFE Payment Program will pay any eligible remaining patient responsibility.
- Itemized, detailed billing statement. Health insurance claim forms may not be considered alone.
Please submit the required documentation via one of the following:
- Mail: P.O Box 26927, Richmond, VA 23261
- Fax: 1-877-377-5164
- Email: firstname.lastname@example.org
Please see the SAFE Payment Program Procedures and Guidelines and the Eligibility Flowchart for further information regarding eligibility and payment or contact us at 1.800.552.4007 or email@example.com.
IMPORTANT: Per §19.2-368.5:2 and §19.2-368.11:1(F) of the Code of Virginia, the patient may not be placed into collections once this form is filed with VVF.
SAFE Payment Program
In Virginia, victims of rape or sexual assault have the right to seek evidence collection at no cost; and have the right to have evidence collected through a Physical Evidence Recovery Kit (PERK) without filing a police report. Costs associated with evidence collection may include:
- Emergency room physician fees
- Hospital and forensic examiner fees
- Testing for sexually transmitted infections and/or pregnancy
- Medications to prevent sexually transmitted infections and/or pregnancy
- Ambulance transport from a hospital unable to provide evidence collection to one that can
- Follow-up medical forensic examinations
Healthcare providers should bill the SAFE Payment Program directly. Victims should only receive a bill if they decided not to have evidence collected, or they received care or treatment not included in the list above. For questions about billing or eligibility, please call 1-800-552-4007.
The eligibility criteria are laid out below:
- must cooperate with law-enforcement agencies and the courts
- was not involved in illegal activity which caused the crime
- did not provoke or willingly take part in the crime
- was committed in Virginia, or a country where Virginia residents are not eligible for compensation
- was reported to a law-enforcement agency within 120 hours (5 days), unless there is good reason for the delay
To file an electronic claim:
Virginia Victims Fund WebFile – Provider Portal Login
Virginia Victims Fund Claim Form
Form Instructions: The name of the victim of the crime must appear in the line under the heading “Authorization”. The claimant (the person claiming benefits from VVF) must both print and sign their name in the indicated spaces. Competent adults are their own claimants, but minor children, incapacitated adults, and deceased victims will have another responsible party act as their claimant. A registered notary must sign the Notarized Authorization, including the date and place sworn, the expiration date of their notary commission, and their notary number.
Fax or mail to:
Virginia Victims Fund
P.O. Box 26927
Richmond, VA 23261
Virginia law states that the Virginia Victims Fund is the payer of last resort. This statute requires claimants to exhaust all available collateral resources before VVF can make payment. The resources relevant in each claim depend on both the crime type and the resources available to the victim. Advocates, victims, and Commonwealth Attorneys can use this checklist to help identify relevant insurances and resources in a case. This information will help guide the gathering of claim documentation necessary for payment.
Coordination with healthcare
Virginia Family Violence & Sexual Assault Hotline (24 hrs/ 7 days):
If the healthcare provider determines that a victim should take medication to prevent HIV, the SAFE Payment Program can help by paying for the following:
- The full course (28-day supply) of HIV preventative medication
- Anti-nausea medication (up to a 30 day supply)
- Specific and limited follow-up medical care while taking the medication
The healthcare provider will help the patient locate a pharmacy to obtain the medication and provide a voucher for reimbursement to give to the pharmacy and follow-up medical care provider.
Virginia Department of Forensic Sciences – Physical Evidence Recovery Kit (PERK) Tracking System – system access, survivor portal, login instructions, and contact information
Evidence collection or medical forensic examinations completed more than 3‐5 days after the crime require authorization by law enforcement or a prosecutor. Generally, PERKs are completed within 3‐5 days of the crime.
Testing and Storage of Evidence
If the patient chooses not to report the crime, their Physical Evidence Recovery Kit (PERK) will not be tested and will be stored for a minimum of two years. If and when they choose to report the crime, the police will take custody of their PERK and send it to the forensic lab for testing within 60 days of the request. The patient has the right to check the status and know the results of the testing. Make sure the patients contact information is current with the investigator and/or the Commonwealth’s Attorney assigned to the case.