Provider Education FAQs

Rule 16 outlines how to bill. All professional services must be billed on a CMS-1500 using the Current Procedural Terminology (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 of Workers' Compensation (DOWC) 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 the WC 188 Authorized Treating Provider's REquest for Prior Authorization Form.

You can find all related forms on the DOWC forms page.

You can find all related forms on our Impairment Rating Information page.

Level 1 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 2 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 span three years and must be renewed every three years.

Level 1 accreditation includes licensed chiropractors, dentists, podiatrists, physician assistants, nurse practitioners, MDs, and DOs.

Level 2 accreditation is for licensed MDs and DOs who would like to perform impairment ratings for injured workers.

Accreditation benefits all medical providers by expanding their practice and partnering with other providers or networks. It also educates providers about all aspects of the workers’ compensation system.

Chiropractors who are Level 1 accredited are assured of payment for treating workers' compensation patients beyond 90 days after the first treatment, or in excess of 12 treatments, whichever occurs first.

Physicians who are Level 2 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 DOWC through the Level 1 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 2 accreditation may provide impairment ratings of injured workers. 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 2 accredited physician.

The DOWC holds stakeholder meetings every year for input regarding revisions of Rule 16 (Utilization Review) and Rule 18 (Medical Fee Schedule). The DOWC 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 rules.

The DOWC's dispute resolution process is outlined in Rule 16-13. Disputes can be submitted using the WC 181 Medical Billing Dispute Resolution Intake Form and are typically resolved within 30 days. DOWC staff are also available to assist; you can contact them at 303-318-8765. 

The DIME program provides an independent review of workers’ compensation cases in which there is a dispute concerning an injured worker’s date of maximum medical improvement or an impairment rating. Because impairment ratings are involved, only Level 2 accredited physicians may participate on the DIME 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 Rule 10: Medical Utilization Review. A panel of Colorado licensed medical providers perform a utilization review on a case. The panel is convened by the DOWC 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).