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How to bill is outlined in Rule 16. All professional services must be billed on a CMS-1500 using the CPT codes adopted in Rule 18 (usually the prior year). Providers must submit their bill to the payer with supporting documentation within 120 days of the date of service. The Division also establishes a fee schedule and payment policies which are outlined in Rule 18.
Prior authorization is required for services when treatment exceeds the recommended limitations in the Medical Treatment Guidelines (Rule 17), when a treatment is not identified in the Fee Schedule or when otherwise required by Rule 17 or 18. The process is outlined in Rule 16-10 and requests may be made to the payer by phone or by using Division Form WC 188.
You can find all related forms on our forms page.
Impairment Rating Information
Level I accreditation program is designed to assist in understanding the administrative, legal and medical role in the Colorado Workers’ Compensation system for all medical providers.
Level II accreditation teaches participants how to perform impairment ratings using the AMA Guides to the Evaluation of Permanent Impairment, 3rd Edition (revised). Both levels of accreditation spans for three years and must be renewed every three years.
Level I accreditation includes licensed chiropractors, dentists, podiatrists, physician assistants, MDs and DOs.
Level II accreditation is for licensed MDs and DOs who would like to perform impairment ratings for injured workers. Please refer to the following links for Level I Accreditation and Level II Accreditation
Chiropractors who are Level I accredited are assured of payment for treating workers' compensation patients beyond ninety days after the first treatment, or in excess of twelve treatments, whichever occurs first.
Physicians who are Level II Accredited can extend their practice to determine impairment ratings for injured workers and conduct independent medical examinations that include calculating impairment ratings.
In order for providers to become members in some insurance networks, the insurer may require medical providers to be trained by the Division through the Level I Accreditation course. Not only will the medical provider obtain necessary information for treating in the workers’ compensation system, but the provider will be placed on a “Division trained” list on our website.
No, Colorado law requires that only licensed physicians with Level II accreditation may provide impairment ratings of injured workers. C.R.S. 8-42-101 (3.6)(b). This includes only licensed medical doctors and doctors of osteopathy.
No, but if an impairment rating is needed for the IME, it must be referred to a Level II Accredited physician.
The Division holds stakeholder meetings every year for input regarding revisions of Rule 16 (Utilization Review) and Rule 18 (Medical Fee Schedule). The Division also holds a task force for the revisions of Rule 17 (Medical Treatment Guidelines). Stakeholders are also invited to public hearings regarding the adoption of new or updated Division Rules.
The Division’s Dispute Resolution process is outlined in Rule 16-13. Disputes can be submitted by using Form WC 181 and are typically resolved within 30 days. Division staff are able to assist by contacting them at 303-318-8765.
The Division’s Independent Medical Examination Program (DIME) program provides an independent review of workers’ compensation cases in which their is a dispute concerning an injured worker’s date of maximum medical improvement or an impairment rating. Because impairment ratings are involved, only Level II-accredited physicians may participate on the IME panel of physicians.
Some of the benefits of becoming a physician on the DIME panel include: elevating your status as an expert for performing IMEs, serving the citizens of Colorado by protecting the integrity of the workers’ compensation system and reducing litigation costs for employers and injured workers, and the ability to serve on the task force for the Medical Treatment Guidelines.
The purpose of the Utilization Review program is to provide a mechanism to review and remedy services that may not be reasonably necessary or reasonably appropriate according to professional standards. Section 8-43-501 of the Colorado Revised Statutes governs utilization review and Colorado Division of Workers’ Compensation Rule 10. A Utilization Review on a case is performed by a panel of Colorado licensed medical providers. The panel is convened by the Division to conduct a “paper” review of the case and evaluate the services provided. The outcome of such proceedings may require a change of provider in that case, no change of provider, retroactive denial of fees, and/or revocation of accreditation (if applicable).
Provider Education: 303-318-8754 or firstname.lastname@example.orgMedical Treatment Guidelines: 303-318-8760Medical Fee Schedule: 303-318-8761Utilization Standards / Billing Dispute Resolution: 303-318-8765Division IME Program: 303-318-8655 or IMEUnit@state.co.usMedical Utilization Review: 303-318-8767General Customer Service: 303-318-8700 or toll free 1-888-390-7936