Dispute Resolution Information

Medical Billing Disputes

 

When parties have followed the contesting payment process as outlined in Rule 16-11(A)-(D) and a payment dispute still exists, or a party is unable to contest a payment because the other party has not satisfied the 30-day notice requirements, the parties should follow dispute resolution.  Either party may initiate a dispute by completing and submitting a MEDICAL BILLING DISPUTE RESOLUTION INTAKE FORM (WC 181) to the Division’s Medical Policy Unit (MPU).  The Intake Form provides guidance on the information the MPU will require in order to properly review your request.   We ask that all applicable information be provided at the time of submission including all relevant supporting documentation as outlined at the bottom of the form. 
 
The Intake Form (WC 181) and all supporting documentation can be submitted to the MPU by fax (303) 318-8758, encrypted email to the Medical Policy Unit or mail to:
 
Division of Workers’ Compensation
Medical Policy Unit
633 17th Street, Suite 400
Denver, CO 80202-3626
 
Once a completed request has been received, you will receive a Confirmation of Receipt and your case will be assigned to an MPU staff member.   The dispute will be reviewed to determine compliance with Rules 16 and 18. Communication between parities will ensue as needed until a determination is reached.  Disputes resulting from violation of Rules 16 and/or 18, may result in a Director’s Order that cites the specific violation and failure to respond or cure said violations may result in penalties.  Resolution of disputes not pertaining to Rule violations will be facilitated by the MPU to the extent possible.  Typical review time is within 30 days and parties will be notified in writing once the case is closed.

 

What is an Administrative Hearing?

A hearing is a formal legal proceeding where an administrative law judge decides what benefits, if any, must be paid, and decides any other issues. All parties may present evidence, including documents and sworn testimony of witnesses. A court reporter makes a record of the hearing. There is no jury. There is no charge for the hearing. Your failure to attend may result in an unfavorable decision, a delay in a decision on your claim, or the dismissal of your claim. To request a hearing, you must file an Application for Hearing with the Office of Administrative Courts and send a copy to the insurance company. You may request this form by calling the Adjudication Docket. If you qualify for an expedited hearing, your hearing will be scheduled within 45 days of the date of the application. All other hearings are scheduled within 80-100 days. Office of Administrative Courts has two docket offices, one in Denver and one in Grand Junction. You may ask for a hearing in Denver, Boulder, Colorado Springs, Durango, Fort Collins, Glenwood Springs, Grand Junction, Greeley or Pueblo. Call the Office of Administrative Courts docket section for current information on locations.

For the Office of Administrative Courts' website, please click here.