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Colorado WC195: ATP Notification of Treatment

Colorado authorized treating providers use WC195 to notify the insurer of prescribed treatment that is consistent with the Medical Treatment Guidelines, rather than requesting prior authorization. The ATP lists the treatment, billing codes, ICD-10 diagnosis and the specific guideline section that applies, attaches support, and certifies the care is medically necessary and within the guidelines.

Who completes it

The authorized treating provider completes and signs the notification; the carrier completes the gray response section.

Submitting and payment

How to submit it
Send it to the insurance carrier or its agent with supporting documentation. Under Rule 16 the carrier responds within 5 business days of receipt, marking it incomplete, confirmed with an authorization number, or denied.
Who pays
A confirmed notification comes back with an authorization number for the listed treatment; the form itself sets no fee.

Good to know

  • Allowed denial reasons include no admission of liability or compensability order, treatment unrelated to the admitted injury, or no entitlement under statute or settlement.
  • The carrier can also deny when the submitter is not an ATP, the care would be performed by a non-eligible ATP, or the ATPs' records conflict on the proposed treatment.
  • If the carrier finds the treatment falls outside the guidelines, the notification is reviewed as a prior authorization request instead.
  • Missing information may delay processing, so complete every required field. The current version is Rev 02/19.

Get the official form

Download the current version from the source each time; forms change without notice.

Notification by an Authorized Treating Provider

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

What is the difference between WC195 and WC188?

WC195 notifies the carrier of treatment that the ATP certifies is within the Medical Treatment Guidelines, citing the guideline section. WC188 requests prior authorization for treatment beyond the guidelines, care the guidelines or fee schedule say needs authorization, or unpriced services.

How long does the carrier have to respond to WC195?

Five business days from receipt of the provider's notification, under Rule 16. The carrier marks the form incomplete, confirms it with an authorization number, or denies it for one of the listed reasons, and certifies that a copy was sent to the provider.

What must the ATP include on WC195?

Patient and claim details, the treatment or services with billing codes, the ICD-10 diagnosis, the specific Medical Treatment Guideline and section that applies, and any supporting documentation. The ATP signs a certification that the treatment is medically necessary and within the guidelines.