The Code of Colorado Regulations Utilization Standards require authorized treating physicians managing an injured worker’s claim to sign and submit a completed Physician’s Report of Workers’ Compensation Injury on Form WC 164 following an injured worker’s initial visit.
Rule 16-7 on Required Billing Forms and Accompanying Documents specifies that this report must be marked as “Initial” on Item 1 of the form. The rule further specifies that items 1-7 and 11 shall be completed and notes that certain information in item 2 (such as Insurer Claim #) may be omitted if unknown.
Additionally, Rule 16-7 requires the physician to supply this report to the injured worker at the time the form is completed and that the report be submitted to the payer along with its billing no later than 14 days from the date of service.
Report Form
Form WC 164 is required by the Code of Colorado Regulations 1101-3 Workers’ Comp Rules of Procedure Rule 16 for any Physician’s Report of Worker’s Compensation Injury.
Form WC 164 for Physician’s Report of Worker’s Compensation Injury
For additional information on medical billing please refer to DaisyBill’s Colorado Billing Guide.
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