Colorado workers' compensation claim handling guidelines 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Date of Injury' and 'Patient’s DOB' in the designated fields. Ensure accuracy as this information is crucial for processing your claim.
3. Fill in the 'Carrier Claim #' and 'Date Sent' to keep track of your submission timeline.
4. Complete the patient’s name fields: First, Last, and M.I. This identifies the individual associated with the claim.
5. Provide the Insurance Carrier’s/Agent’s Name along with their address, city, state, and zip code to ensure proper communication.
6. Input details for the Authorized Treating Provider including their name, contact number, fax/email, address, NPI/FEIN. This verifies who is submitting the notification.
7. Specify treatment/service(s) and billing codes along with Dx/ICD-10 Code. This section is vital for determining coverage under medical guidelines.
8. Identify the specific Medical Treatment Guideline applicable to your treatment/service by filling out the guideline and section fields.
9. Attach any supporting documentation that may assist in validating your request for treatment.
10. Finally, certify that all information provided is accurate by signing and dating where indicated before submission.

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