Medical Providers

The Criminal Injuries Compensation Fund (CICF) is Virginia’s crime victim compensation program. CICF assists victims of violent crime with out-of-pocket expenses, including crimerelated medical treatment. We are administered by the VA Workers’ Compensation Commission.

Documentation needed from medical providers

Upon filing, claimants provide CICF with a list of their medical providers. CICF sends a written request for information needed, which includes:

• Medical records pertaining to crime-related injury / treatment for each date of service
  
  
• Itemized billing information for each date of service
  
  
• Physician Certification form (not relevant for hospitals, but sent to treating doctors/dentists – the form, for the physician to complete and sign, accompanies our request letter)
  
  Requested information should be submitted to CICF promptly even if the patient has a zero balance.

Additional information needed from counselors/therapists

• Diagnostic information
  
  
• Session notes or date-specific session summaries
  
  
• Treatment plan with goals, objectives, and target dates if treatment is anticipated to last longer that six months.
  
  Please note that in order for CICF to consider payment, counseling must be provided by a licensed professional (ie.
  LCSW, LPC, PhD, or MD).
  
  CICF can only pay for crime-related treatment. If the patient addresses non-related issues during the course of therapy, the provider should provide percentage estimates to CICF as to how much of treatment is related to the crime.

Submission of required documentation

§ 19.2-368.6 of the Virginia Code directs that
Health care providers, as defined in § 8.01-581.1, shall provide medical and hospital reports relating to the diagnosis and treatment of the injury upon which the claim is based to the Commission, upon request.

• CICF has the authority to request hearings which medical providers or their records custodian are required to attend to give testimony, but finds it easier for all involved if medical documentation is submitted in writing. CICF shall not be billed for records requests, nor shall providers bill patients for records requested by CICF on the patient’s behalf.
  
  
• Information that is not promptly submitted upon request will be subpoenaed. Subpoenaed information that is not received by the deadline will result in the scheduling of a show cause hearing where a provider or his/her records custodian must appear to explain why the subpoena was disregarded.
  
  
• Information may be faxed to 804.367.1021 or mailed to CICF, P.O. Box 26927, Richmond, VA 23261.
  
  
• CICF CANNOT CONSIDER PAYMENT if medical records, itemized billing information, and health insurance explanation of benefits statements (if applicable) have not been received!
  
  
  

Negotiation Agreements

CICF does not receive tax payer dollars, instead relying on offender fees and restitution payments for funding. For this reason, controlling costs is critical to ensure that the needs of both current and future victims will be met. The 2010 General Assembly session included legislation that requires health care providers to establish standing negotiation agreements with the Criminal Injuries Compensation Fund (CICF) for payment of crime victim compensation claims at reduced rates(§ 19.2-368.3). Further, this law requires that health care providers accept payment from CICF as payment in full without billing the patient for any remaining balances. Signed into law by Governor McDonnell, this law goes into effect July 1, 2010. Please note that after July 1, CICF will only issue payments to providers with whom memoranda of agreement have been signed designating established rate reductions. If your facility/office does not have a negotiation agreement in place with CICF, please contact Shannon Freeman, CICF Ombudsman, at shannon.freeman@vwc.state.va.us as soon as possible to avoid payment disruption.

Collections

§ 19.2-368.5:2 of the Virginia Code prohibits healthcare providers from pursuing debt collection activities against CICF claimants until an award decision has been made:
For the purpose of this section, "debt collection activities" means repeatedly calling or writing to the claimant and threatening either to turn the matter over to a debt collection agency or to an attorney for collection, enforcement or filing of other process. The term shall not include routine billing or inquiries about the status of the claim.

If a claimant has been placed in collections by a medical provider, the account should be removed from collections immediately upon notification that a CICF claim is pending.

Health insurance and EOBs

If the patient has health insurance, including Medicare or Medicaid, insurance must be billed. CICF cannot consider payment until other payment sources, including health insurance, have been exhausted (see “Payer of last resort” ). For insured claimants CICF must have a copy of relevant insurance explanation of benefits statements for
each crime-related date of service. These may be submitted by the claimant or the medical provider; however, providers should note that submitting EOBs along with records and itemized billing information is highly encouraged, as it may expedite claims processing and payment.

Release of Information

CICF is a division of the VA Workers’ Compensation Commission and a payer: as such, CICF is exempt from HIPPA. Nonetheless, CICF submits a notarized release of information form signed by the patient (or parent/legal guardian of the patient in minor cases) with our written requests for information as a courtesy.

Payer of last resort status

Both state and federal law recognize CICF as the payer of last resort, meaning that other collateral resources, including health insurance, State and Local Hospitalization (SLH), and hospital charity care, when applicable, must be exhausted before CICF can consider payment. CICF is only able to consider the claimant’s ultimate out-of-pocket expense and only upon notification of decisions made regarding eligibility for other resources.

Charity Care

If a patient is uninsured, they are required to complete the hospital’s financial screening process for charity care consideration before their bill can be considered by CICF. Please note that a patient’s financial screen must be processed without regard to CICF’s involvement in their case. Per state and federal law (which supercedes hospital policy) CICF is the payer of last resort. Written verification of the patient’s charity care outcome should be submitted to CICF. CICF will hold a claim as pending until charity care verification is received. During that time, collections activity against the claimant may not take place.

Payment

• VA Code specifically prohibits payment prior to services being rendered. CICF can only consider payment once required documentation has been received.
  
  
• Because CICF checks are dispersed by the Department of Treasury, it may take up to thirty days from the time of award for a provider to receive a reimbursement check or electronic payment.
  
  
• CICF does not notify medical providers automatically of claim decisions (awards or denials). Award notifications are sent to the patient, who is instructed to notify medical providers of the claim outcome.
  
  

Follow-up visits / ongoing treatment

When CICF requests medical information from a provider, we may only reference the date of crime in our request. However, if there are additional dates of service related to the crime, that information (records, billing info, etc.) should be submitted as well. If a provider is rendering ongoing treatment to a CICF claimant (counseling, physical therapy, orthodontia, etc.), it is important that the provider routinely provide CICF with updated billing information and medical records for subsequent dates of service. CICF does not automatically request this information. Many providers find that monthly or quarterly submission of this information is easiest, while other providers fax the information to CICF after each session. For counselors providing long-term therapy, quarterly treatment plan updates should be submitted with session summaries/notes and updated itemized billing information.

Checking status of a claim

Due to the volume of phone calls CICF receives from victims of crime, criminal justice professionals, and others, CICF is unable to provide status updates on claims to medical providers by phone. Medical providers seeking claim status may email CICFstatus@vwc.state.va.us or fax the request to 1.877.492.9511. Status requests MUST include the patient’s name and date of birth. IF the CICF claim number is known, please include that as well. Please allow ample time for the file to be pulled and reviewed in order to respond to your request for status. Keep in mind that only providers who have standing negotiation agreements in place with CICF will be provided claim status information.

Most importantly, please do not hesitate to contact CICF staff with general questions or concerns at 1.800.552.4007 or email us at CICFmail@vwc.state.va.us .