Provider 101: How to Become a CalVCB Authorized Provider

The California Victim Compensation Board assists victims with certain crime-related expenses, including hospitalization, surgery, ambulance transportation, prescriptions, dental x-rays, repair or replacement of broken or damaged teeth and dentures, mental health treatment, funeral or burial expenses, crime scene clean-up and more.

If you are a service provider looking to partner with CalVCB, there are a few things you need to know depending on the type of service you offer. First, all service providers must be authorized before CalVCB can pay a bill. Crime scene clean-up providers must also register with the California Department of Public Health as a trauma-scene waste management practitioner.

Next, you will need to:

• Submit a copy of your practicing license
• Submit a W9 you have signed or dated within the last 30 days; billing name and address (must match the name and address listed in box 33 of the CMS 1500 form)
• Email completed documents to info@victims.ca.gov.

Once CalVCB has the necessary documents, we will add you to the system, and you will receive an email containing your CalVCB Provider ID number and start date.

Providers can opt to manually submit bills or create an account at CalVCB Online to submit them electronically. However, you will first need your CalVCB Provider ID, CalVCB Provider start date, federal tax ID and email address to create an account.

The online portal allows providers to view application and bill status, upload bills and documents, update contact information, upload W-9 and license documentation, access copies of 1099s and set up accounts for your administrative staff.

CalVCB also requires you to complete certain forms to submit bills.

Medical bills must be submitted on a Centers for Medicare & Medicaid Services (CMS) 1500 or 1450 form and must contain:

• Patient name and address
• Date(s) of service
• Type(s) of service(s) provided (ICD-10 and CPT codes)
• Billed amount
• Provider license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing date

Mental health providers must submit treatment bills on CMS 1500 or 1450 forms.

• Providers may be required to submit specified mental health documentation before payment. Depending on the length of the treatment, required documents may include a Treatment Plan (TP), an Additional Treatment Plan (ATP), or session notes.
• Providers are required to complete a Treatment Plan (TP) before the client's 4th session.
• If a therapist believes the claimant needs additional treatment beyond the initial session limits, file an Additional Treatment Plan (ATP) to request treatment beyond the session limitations of 15, 30, or 40.
• CalVCB allows up to five telehealth sessions per application. Once a patient reaches the five sessions, the treating mental health provider must request additional telehealth sessions by submitting a Telehealth Therapy Verification form.

During the COVID-19 pandemic, CalVCB has modified our process to remove all barriers for victims seeking medical and mental health telehealth services consistent with stay at home orders and based on feedback we received from providers. CalVCB will now allow all medical and mental health telehealth sessions billed while stay at home orders remain in effect.

• During this time, Mental Health providers will not be required to submit the Telehealth Therapy Verification form and a Treatment Plan (TP). However, when billing mental health telehealth sessions, please note the following:
• Reimbursement for telehealth is limited to only the cost of therapy
• Telehealth sessions do count against the claimant's session limit
• On the CMS 1500 billing form, indicate "GT" for Audio and Video Telecommunications as the technology used to facilitate the telehealth session in box 24 D "Modifier.
• Use the following CPT Codes for mental health telehealth sessions:
• 98968:  Telehealth, non-psychiatrist
• 99443:  Telehealth, psychiatrist

At any time, Medical and Mental Health providers can also enroll in a CalVCB eLearning course to better understand the process.

Dental providers do not need to use a CMS form; most submit bills on an ADA Dental Claim Form with the following information:

• Patient name and address
• Date(s) of service
• Type(s) of service(s) provided (diagnosis and procedure)
• CDT (Current Dental Terminology) code(s)
• Tooth number (if applicable)
• Charges for each procedure
• Total charges
• Provider name, license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing date

Dentists may be able to obtain pre-authorized approval for treatment. Dentists must submit a pre-treatment estimate on an approved American Dental Association (ADA) Claim Form to the Board for review; however, the Board will only issue payment for preauthorized treatment after the dentist provides services.

To receive compensation for funeral and burial expenses, the person responsible for paying for funeral arrangements should apply for funeral and burial benefits. The Board cannot accept applications filed directly by a service provider such as a mortuary, funeral home or cemetery.

You can find information on CalVCB’s current reimbursement rates in the Providers section of the CalVCB website.

Providers may wish to contact the Victim/Witness centers in the counties surrounding their practice. Some Victim Witness Centers maintain referral lists that they give to victims.