Medical Dispute Resolution Intake Form Forms
| Form Name | Medical Dispute Resolution Intake Form |
| Form # | WC 181 |
| Form Revision | Rev 10/24 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | This form is used to initiate medical payment disputes between parties. The dispute will be reviewed by the Medical Policy Unit to determine compliance with Rules 16 and 18. |
| Claimwire Description | n/a |