Last updated: 12/19/2024
Medical Billing Dispute Resolution Form {WC181}
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Description
WC 181 - MEDICAL DISPUTE RESOLUTION INTAKE FORM. This form is used by providers, employers, or claimants to initiate a medical dispute resolution process with the Colorado Division of Workers' Compensation. This form is submitted when there is a disagreement related to medical billing or payment issues, such as no response to a bill submission or denied payment/underpayment. It requires the submission of supporting documents, including original bills, medical documentation, explanation of benefits (EOB), and any appeal correspondence. The form also includes additional requirements for disputes involving items like durable medical equipment (DME), mileage, or contractual discounts. www.FormsWorkflow.com
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