What dispute deadlines should providers track in Colorado?

Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Insurer Payment Window: Prompt adjudication upon complete proof of loss (C.R.S. § 10-3-1115). Verify the trigger date, current agency notices, and any extension before acting.

Which agencies administer these rules in Colorado?

The guide identifies Colorado Department of Regulatory Agencies (DORA) - Division of Insurance (DOI). The correct agency depends on the plan and claim jurisdiction.

Auto Accident, PIP & Medical Billing State Guides

Colorado Auto Accident, PIP & Medical Billing Laws

Colorado operates an At-Fault automobile insurance framework under Title 10 of the Colorado Revised Statutes (C.R.S.). Insurers must include $5,000 in Medical Payments (MedPay) in every policy under C.R.S. § 10-4-635 unless rejected in writing. Unreasonable claim delays trigger two times the covered benefit plus attorney fees under C.R.S. § 10-3-1116, and subrogation is strictly controlled by C.R.S. § 10-1-135.

Accountability & Review

Reviewed by Millennova Legal Operational Integrity Team, Senior Audit and Arbitration Analysts

Last Reviewed

2026-03-01

Plain-language overview

At-Fault / Traditional Tort (Mandatory $5,000 MedPay Offering & Statutory Bad-Faith Penalties)

Colorado combines an at-fault tort liability framework with a mandatory offering of first-party Medical Payments (MedPay) coverage. Under C.R.S. § 10-4-635, every automobile liability policy issued in Colorado must provide at least $5,000 in MedPay coverage unless the named insured rejects it in writing. The first $5,000 of MedPay is primary over private health insurance for trauma or medical care. Subrogation by auto or health insurers against third-party liability proceeds is strictly restricted under C.R.S. § 10-1-135 (Colorado's codified Made-Whole statute). Hospitals enforce statutory liens under C.R.S. § 38-27-101, subject to strict in-network billing prerequisites.

PIP and MedPay coverage

Mandatory Med Pay Offering

$5,000 statutory minimum per person for medical, surgical, dental, hospital, and ambulance expenses (C.R.S. § 10-4-635), with higher optional limits available

Opt Out Requirement

Coverage is automatically included in every auto policy unless the named insured affirmatively opts out by signing a written rejection

Codified Made Whole Statute

Under C.R.S. § 10-1-135, an insurer has no right of subrogation or reimbursement against a third-party recovery unless the injured person is fully compensated for all economic and non-economic damages, and the insurer must share attorney fees and litigation costs pro-rata

Assignment Of Benefits

Healthcare providers routinely obtain patient assignments of MedPay benefits for direct claims submission

Medical fee schedule and reimbursement rules

Name

Reasonable and Customary Fee Standard

Rules

Colorado does not maintain a statutory fee schedule table for motor vehicle accident medical billing outside of workers' compensation. Providers bill standard reasonable and customary charges prevailing in the local medical community for comparable care.

Cpt Basis

CPT/HCPCS itemized coding on standard CMS-1500 or UB-04 billing claims

Preauthorization and utilization review

Requirement

Preauthorization is not required by statute for emergency medical stabilization or initial acute trauma care. Elective surgical interventions and prolonged physical therapy regimens are evaluated under insurer medical necessity guidelines.

Carrier Examinations

Under standard policy terms, insurers may request medical records or independent physician reviews to evaluate causal relationship to the motor vehicle crash.

Appeals and dispute resolution

Statutory Bad Faith Penalties

Under C.R.S. § 10-3-1115 and § 10-3-1116, an insurer that unreasonably delays or denies payment of a covered first-party claim is liable for two times the covered benefit, in addition to the benefit itself, plus reasonable attorney fees and court costs.

Hospital Lien Statute

Under C.R.S. § 38-27-101 et seq., a hospital has a statutory lien upon damages recovered by an injured patient. Under Colorado law, a hospital cannot assert a lien if the patient has private commercial health insurance that the hospital is in-network with, unless the hospital timely bills the health plan first or the patient specifically requests lien billing. The lien attaches only to net settlement proceeds remaining after deducting attorney fees and litigation costs.

Dispute Forum

Colorado District Court (or County Court for claims up to $25,000) for civil contract and statutory bad-faith actions.

Claim and dispute deadlines

Deadlines can depend on the trigger event and may be affected by agency relief notices. Confirm the live rule before filing.

Event	Timeframe
Accident Notice	Notice to insurer as soon as reasonably practicable
MedPay Claim Submission	Submission within standard policy billing deadlines (typically 1 to 3 years)
Insurer Payment Window	Prompt adjudication upon complete proof of loss (C.R.S. § 10-3-1115)
Hospital Lien Notice	Notice served on liability insurer prior to disbursement of settlement proceeds (C.R.S. § 38-27-102)
Statute of Limitations	3 years from accident date for motor vehicle personal injury tort claims (C.R.S. § 13-80-101); 3 years for contract claims

Documentation checklist

Colorado MedPay Claim Application Form
Executed Assignment of Benefits (AOB) and medical records authorization
Itemized CMS-1500 or UB-04 billing form with CPT/HCPCS codes and ICD-10 diagnostic coding
Contemporaneous medical records, emergency trauma notes, operative reports, and imaging findings
Written Notice of Hospital Lien served in compliance with C.R.S. § 38-27-102 (for hospital claims)
Insurer Explanation of Benefits (EOB) or written explanation of claim determination

Responsible agencies

Colorado Department of Regulatory Agencies (DORA) - Division of Insurance (DOI)Statewide Regulation of Auto Insurers, Rate Filings & Consumer Protection

Primary legal and regulatory sources

Colorado Revised Statutes Title 10, Article 4, Section 10-4-635 (Medical Payments Coverage)Colorado General Assembly · 2024
Colorado Revised Statutes Title 10, Article 1, Section 10-1-135 (Subrogation and Reimbursement Standards)Colorado General Assembly · 2024
Colorado Revised Statutes Title 38, Article 27 (Hospital Liens)Colorado General Assembly · 2024

This operational reference is educational, is not legal advice, and does not create an attorney-client relationship.

Common questions

What rules govern auto accident, pip & medical billing state guides in Colorado?: Colorado operates an At-Fault automobile insurance framework under Title 10 of the Colorado Revised Statutes (C.R.S.). Insurers must include $5,000 in Medical Payments (MedPay) in every policy under C.R.S. § 10-4-635 unless rejected in writing. Unreasonable claim delays trigger two times the covered benefit plus attorney fees under C.R.S. § 10-3-1116, and subrogation is strictly controlled by C.R.S. § 10-1-135.
What dispute deadlines should providers track in Colorado?: Accident Notice: Notice to insurer as soon as reasonably practicable; MedPay Claim Submission: Submission within standard policy billing deadlines (typically 1 to 3 years); Insurer Payment Window: Prompt adjudication upon complete proof of loss (C.R.S. § 10-3-1115). Verify the trigger date, current agency notices, and any extension before acting.
Which agencies administer these rules in Colorado?: The guide identifies Colorado Department of Regulatory Agencies (DORA) - Division of Insurance (DOI). The correct agency depends on the plan and claim jurisdiction.