Mental health and medical related bills should be submitted on a CMS form. The two most common CMS forms are the 1450 in-patient hospitalization) and the 1500 (mental health and out-patient medical charges.)

All bills must include:

• The patient’s or client’s name.
• The payee’s name, address and tax ID.
• Dates of service.
• CPT codes.
• The payee’s or treating therapist’s license number (Include supervisor’s name and license number if the treating therapist is an intern.)

Include at least four dates of service on each CMS 1500 form. Providers must include the explanation of benefits with the billing, and the compensation claim number (if known). Providers must bill a client’s insurance first.

Dental bills may be submitted on any standard dental form, as long as the necessary billing information is provided.

Mail:

CalVCB
P.O. Box 3036
Sacramento, CA 95812-3036

To see the bill status, login to CalVCB Online and navigate to Application Search or Bill Search tab.

As of January 1, 2017, the maximum reimbursement per claim, including dental, medical and mental health treatment expenses, is $70,000.00. Certain benefits have individual limits.

CalVCB typically applies a fee schedule when paying medical expenses.

To dispute a payment amount. follow the instructions printed on the warrant or call Customer Service at 800-777-9229 before cashing the warrant.

A provider who cashes a warrant for payment from the California Victim Compensation Board for a service accepts CalVCB’s rates as payment in full and cannot bill a claimant any more for that service. Government Code § 13957.2(a)

If CalVCB pays a reduced rate because treatment is only partly related to the crime, the patient is liable for the remaining amount not related to the crime.

If the mental health treatment is paid at 100% and it is later determined the treatment was partially related to the crime, then future bills will be offset by that amount or repayment to CalVCB will be required.

Under most circumstances, CalVCB cannot pay a bill that is more than three years old. Providers should call Customer Service at 800-777-9229 if submitting a bill more than three years old.

CalVCB cannot pay any expenses incurred while a person is on parole, probation or post-release community supervision for a violent felony, incarcerated or required to register as a sex offender.

CalVCB notifies the claimant when an application or bill is denied. The claimant must inform the provider.

Only a claimant can appeal a denied application or bill.

Providers who receive a warrant in error should not cash it or sign it over to someone else.

Return it to:

CalVCB
Attn: Accounting
P.O. Box 1348
Sacramento, CA 95812-1348