Dental Care Benefit Information
If the Crime Victims’ Compensation (CVC) Program determines the claim is eligible, certain benefits for injuries may be paid to the provider or reimbursed to the victim. All dental treatment must be necessary, reasonable and directly related to the crime injury. All resources for payment, such as Medicaid, dental insurance or dental maintenance plans must be utilized prior to CVC payment. Payment will not be considered for services for pre-existing dental problems or conditions.
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As required by statute (Texas Code of Criminal Procedure Article 56.34 (c)). CVC pays only for the amount the victim is responsible for up to the dental fee guideline.
How does CVC determine available Benefits?
A victim is required to utilize all of the health care benefits and other collateral sources that are available to them before seeking payment by CVC. These collateral sources include auto insurance, Medicaid, medical or dental insurance, and dental maintenance plans. A dental service provider must ensure that the victim uses their available health insurance plan and that if a network exists, that the dental service provider is a member of the victim’s dental network.
When medical or dental insurance is used, the dental service provider must submit the Explanation of Benefits (EOB) form from the insurance company with the remaining patient responsibility for payment to CVC. CVC recommends that the victim notify the dental provider of any insurance coverage before receiving treatment and that the dental provider is encouraged to inquire with the victim regarding the dental coverage.
Does CVC require dental pre-estimates?
The CVC program prefers in most situations that dental providers communicate with CVC prior to providing treatment. Dental providers should submit to CVC the billing for initial x-rays and evaluation including American Dental Association (ADA) codes and tooth numbers if applicable. If the dental provider submits their proposed treatment plan with the appropriate ADA codes, the CVC program will apply the dental fee reimbursement amount allowed for each ADA code. The CVC program will return via fax the treatment plan and estimated reimbursement to the dental office, usually within 10 business days.
How do dental service providers submit dental bills to CVC?
A dental provider is strongly advised to provide an evaluation and treatment plan to CVC prior to treating the victim. CVC recommends that the dental provider obtain knowledge of any collateral source dental or medical insurance, and provide the plan and billing to the collateral source prior to sending to CVC for review and possible payment. If there is no dental insurance, the provider should submit the evaluation and treatment plan to CVC for pre-estimate.
The treatment plan must have the providers’ tax identification number, ADA codes, and tooth numbers. Additionally, the dental provider should submit a narrative describing the dental injuries and the treatment recommended.
Dental bills are normally submitted on ADA Dental Claim forms. (View a sample claim form.) These forms can be obtained at many office supply stores or ordered via internet suppliers. It is recommended that a copy of the approved dental treatment plan with CVC reimbursement amounts be submitted with the bill after the dental service has been provided.
Once the service is provided by the dental provider to the patient, the dental provider may submit the bill for payment to CVC. Interim payments that are consistent with the treatment plan can be made. However, payments to the dental provider are considered payment in full. Billing the victim for any balance that exceeds the dental fee reimbursement guideline is not allowed.
Dental service providers may fax treatment plans to CVC at 512-936-1792. Please include the patient’s CVC claim number on any faxed information.
If you have any dental service provider questions, please call the CVC program at 800-983-9933.