1 POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

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POP QUIZ:POP QUIZ:

What MTC is used What MTC is used to retract an EDI to retract an EDI DWC-1 filed in DWC-1 filed in

error with DWC?error with DWC?

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ANSWER:ANSWER:

FROI MTC 01FROI MTC 01

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Cancel / Cancel /

Jurisdiction Jurisdiction Transfer Transfer

RulesRulesSee Rule 69L-56.307, See Rule 69L-56.307, F.A.C.F.A.C.

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FROI MTC 01FROI MTC 01is required to be filed is required to be filed with DWC to report the with DWC to report the cancellation of the claim cancellation of the claim in its in its entirety.entirety.

• It is It is not not used to cancel an used to cancel an individual MTC sent in error.individual MTC sent in error.

FROI 01 - Cancel Rules FROI 01 - Cancel Rules

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FROI FROI 0101 (Cancel) (Cancel) should be sentshould be sent iiff a a First Report of Injury First Report of Injury or Illness has been or Illness has been filed with DWC (paper filed with DWC (paper or EDI), but the claim or EDI), but the claim is subsequently is subsequently determined to be determined to be ‘non-reportable’ ‘non-reportable’ because…because…


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...... t the claim is actually a he claim is actually a Medical Only CaseMedical Only Case..

• In this case, the In this case, the FROI 01 FROI 01 should should report report Claim Type Claim Type “B” (“B” (Became Medical Became Medical OnlyOnly).).


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FROI 01FROI 01 should also be should also be sent if:sent if:

• The claim was reported The claim was reported multiple times under multiple times under different SSN’s/DOI’s & different SSN’s/DOI’s & the claim filed with the the claim filed with the incorrect SSN/DOI incorrect SSN/DOI needs to be cancelled needs to be cancelled (i.e., duplicate (i.e., duplicate submission), in which submission), in which case…case…


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… … you will probably want you will probably want to keep the one filed with to keep the one filed with DWC the earliest & file DWC the earliest & file MTC 02 to correct SSN/DOI MTC 02 to correct SSN/DOI as applicable; then file the as applicable; then file the FROI 01 to cancel the FROI 01 to cancel the other one.other one.


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FROI 01 should also be FROI 01 should also be sent if the claim was sent if the claim was transferred to another transferred to another jurisdiction and jurisdiction and no no indemnity benefits were indemnity benefits were ever paid/reported to ever paid/reported to DWCDWC because… because…


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… … • Claim was initially Claim was initially denied denied (FROI 04, (FROI 04, 00/PD),00/PD), or or

•Claim was reported Claim was reported as compensable as compensable death, no dependents death, no dependents or volunteer or volunteer (00/CD, (00/CD, 00/VE).00/VE).


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Under these Under these circumstances, SROI circumstances, SROI S8 S8 (Jurisdiction Change)(Jurisdiction Change) is is not applicable because not applicable because there are no indemnity there are no indemnity benefits being suspended.benefits being suspended.

FROI 01 - Cancel RulesFROI 01 - Cancel Rules

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Per IAIABC standard Cancel Per IAIABC standard Cancel Rules, when FROI Rules, when FROI 0101 is filed, DWC is filed, DWC will flag the associated claim in will flag the associated claim in its database as “cancelled”. its database as “cancelled”.

• This means the claimThis means the claim

is no longer considered is no longer considered to be “on file” with to be “on file” with DWC. DWC.


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• As such, the claim As such, the claim will be removed will be removed from DWC’s from DWC’s onlineonline Claims Database on Claims Database on the web.the web.


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• ‘ ‘Match Data’ keys Match Data’ keys (including JCN) so DWC (including JCN) so DWC can locate the correct can locate the correct claim in its database. claim in its database. (Designated as “M” – Mandatory on (Designated as “M” – Mandatory on FL’s ERT.)FL’s ERT.)

• Fatal technical data Fatal technical data elements elements (Designated as (Designated as “F” - Fatal on FL’s ERT.)“F” - Fatal on FL’s ERT.)

FROI FROI 0101 requires limited requires limited data:data:


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Caveats Caveats and Tips for and Tips for Successfully Successfully

Filing FROI 01 – Filing FROI 01 – Cancel Cancel

TransactionsTransactions

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Caveats and Tips for Filing Caveats and Tips for Filing FROI 01FROI 01

FROI FROI 0101 should should not not be used to be used to cancel a claim due to a cancel a claim due to a deficiency in a Claim Admin.’s deficiency in a Claim Admin.’s system that doesn’t allow system that doesn’t allow changes to key data (e.g., SSN, changes to key data (e.g., SSN, DOI, Claim #, etc.), and instead DOI, Claim #, etc.), and instead requires the establishment of requires the establishment of another file under the correct key another file under the correct key information.information.

• MTC 02 should be used to MTC 02 should be used to correct keys.correct keys.

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FROI FROI 0101 should also should also not not be used be used to cancel a claim when the wrong to cancel a claim when the wrong MTC was sent (e.g., 00/PD sent MTC was sent (e.g., 00/PD sent when really a FROI 04 should have when really a FROI 04 should have been sent or 00/EP was sent when been sent or 00/EP was sent when 00/IP was sent). 00/IP was sent).

• Solution will vary depending Solution will vary depending on what MTC was sent on what MTC was sent incorrectly. Sometimes EDI incorrectly. Sometimes EDI Team intervention is required to Team intervention is required to “push through” the subsequent “push through” the subsequent MTC.MTC.

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To “un-cancel” a previously To “un-cancel” a previously accepted FROI accepted FROI 0101, the Claim , the Claim Admin. must file a new Admin. must file a new Electronic First Report or Electronic First Report or Injury or Illness via:Injury or Illness via:

•FROI MTC 00 (or AU) + SROI, or FROI MTC 00 (or AU) + SROI, or •FROI 04, FROI 04, depending on the depending on the

situation.situation.


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Caveats and Tips for Filing FROI Caveats and Tips for Filing FROI 0101

After cancellation/re-After cancellation/re-establishment, establishment, the Claim Admin. the Claim Admin. will NOT receive credit for the will NOT receive credit for the original filing date for the claim original filing date for the claim that was cancelled.that was cancelled.

• The new FROI/SROI filing will be The new FROI/SROI filing will be evaluated for timeliness by DWC. evaluated for timeliness by DWC.

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If the FROI 01 was If the FROI 01 was filed filed in errorin error and the entire and the entire claim was never intended claim was never intended to be cancelled, contact to be cancelled, contact the Claims EDI Team for the Claims EDI Team for assistance.assistance.

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• If the 01 was filed in error If the 01 was filed in error and SROI’s are now and SROI’s are now rejecting, depending on the rejecting, depending on the circumstances, DWC may circumstances, DWC may be able to remove the be able to remove the ‘cancel’ status so SROI’s ‘cancel’ status so SROI’s can be re-loaded.can be re-loaded.

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If a claim is cancelled If a claim is cancelled in DWC’s system, no in DWC’s system, no further transactions can further transactions can be accepted be accepted unless the unless the claim is re-claim is re-established with DWC established with DWC or “un-cancelled” by or “un-cancelled” by DWC.DWC.

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Do Do notnot send FROI send FROI 0101 when:when:•All indemnity benefits have All indemnity benefits have been been voided/cancelled/returned voided/cancelled/returned because EE can not be because EE can not be located;located;

•Instead send Instead send MTC “S6”, MTC “S6”, Suspension - Claimant’s Suspension - Claimant’s Whereabouts Unknown.Whereabouts Unknown.

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Caveats and Tips for Filing FROI Caveats and Tips for Filing FROI 0101

Also, Also, do do notnot send FROI send FROI 0101 when:when:•A claim is A claim is transferred transferred fromfrom FLFL to another jurisdictionto another jurisdiction after after indemnity payments have indemnity payments have been made been made on the claim; on the claim;

•Instead send Instead send MTC “S8”, MTC “S8”, Suspension - Jurisdiction ChangeSuspension - Jurisdiction Change..

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If a claim is being If a claim is being transferredtransferred TOTO FL FL ….….

Cancel/Transfer Cancel/Transfer RulesRules

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The FROI/SROI or FROI 04 sent to establish The FROI/SROI or FROI 04 sent to establish the claim with FL should include the claim with FL should include Late Reason CodeLate Reason Code "L4" "L4" (Late (Late Notification, Jurisdiction Transfer).Notification, Jurisdiction Transfer).


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If filing a 00/IP to If filing a 00/IP to report the claim, the report the claim, the Payment Issue DatePayment Issue Date in in the Payment segment the Payment segment on the SROI IP should on the SROI IP should reflect the date reflect the date associated with the associated with the first payment first payment in FLin FL..


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SROI MTC “S8”SROI MTC “S8”Suspension,Suspension, Jurisdiction Jurisdiction

ChangeChange

SROI MTC “S8” SROI MTC “S8” Suspension,Suspension, Jurisdiction Jurisdiction

ChangeChangeMTC “S8”MTC “S8” is used to report the is used to report the suspension of all indemnity suspension of all indemnity benefits when a claim is transferred benefits when a claim is transferred to another jurisdiction after to another jurisdiction after indemnity benefits have been indemnity benefits have been initiated, i.e.,initiated, i.e., Another state’s workers’ comp Another state’s workers’ comp

Act, Act,

Or ,Or , U.S. Longshoremen’s and U.S. Longshoremen’s and Harbor Workers’ Compensation Harbor Workers’ Compensation

Act, Act,

Or ,Or ,

SROI MTC “S8” SROI MTC “S8” Suspension,Suspension, Jurisdiction Jurisdiction

ChangeChange Federal Employers’ Liability Federal Employers’ Liability

Act,Act,

Or,Or,

Federal Employees’ Federal Employees’ Compensation Act,Compensation Act,

Or,Or,

Jones Act. Jones Act.

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No further EDI filings No further EDI filings

(e.g., SROI MTC FN) are (e.g., SROI MTC FN) are required to be sent to required to be sent to the Division after the the Division after the acceptance of MTC “S8”.acceptance of MTC “S8”.

SROI MTC “S8”SROI MTC “S8”

Suspension,Suspension, Jurisdiction Jurisdiction ChangeChange

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Reminder:Reminder: Jurisdiction Jurisdiction Transfer Transfer

Claim administrator then Claim administrator then sends the following to the sends the following to the appropriate state (if appropriate state (if applicable):applicable):

FROI MTC FROI MTC “00”“00” SROI MTC SROI MTC “IP”“IP” (or other applicable SROI)(or other applicable SROI)

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If a claim is If a claim is transferred transferred TOTO FL FL fromfrom another another jurisdiction (i.e., a jurisdiction (i.e., a different state, or different state, or compensation act, compensation act, etc.)… etc.)…


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The claim administrator The claim administrator should send should send FROI 00 and FROI 00 and SROI IPSROI IP (or other (or other FROI/SROI filing FROI/SROI filing equivalent), equivalent), and and

Report Report Late Reason Code Late Reason Code “L4” – Late Notification, “L4” – Late Notification, Jurisdiction TransferJurisdiction Transfer . .


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If no indemnity was paid If no indemnity was paid (e.g., 04, 00/PD, 00/CD, or (e.g., 04, 00/PD, 00/CD, or 00/VE on file), 00/VE on file), or indemnity or indemnity was paid but check(s) was was paid but check(s) was returned/voided/cancelled returned/voided/cancelled prior to the change in prior to the change in jurisdiction, the Claim Admin. jurisdiction, the Claim Admin. should send:should send:MTC MTC 0101 to Cancel the claim to Cancel the claim with the Division (since with the Division (since indemnity is not being indemnity is not being suspended) and not an S8.suspended) and not an S8.

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Questions?Questions?

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Other Helpful Other Helpful Hints and Hints and

“Lessons “Lessons Learned”Learned”

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OTHER HELPFUL OTHER HELPFUL HINTSHINTS

Numeric fields that are Numeric fields that are not populated on a not populated on a transaction, should be transaction, should be sent as sent as spacesspaces and not and not zeros. zeros.

• Zero is a valid value Zero is a valid value for some numeric fields.for some numeric fields.

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Upper or Lower Case?Upper or Lower Case?

• Data can be sent in Data can be sent in mixed case format; mixed case format; however, however,

• DWC’s ‘match criteria’ DWC’s ‘match criteria’ requires case be the same requires case be the same between FROI & SROI between FROI & SROI combos combos (either all upper case, (either all upper case, or all lower, or identical mixed or all lower, or identical mixed text.) text.)

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DWC has aDWC has a “relational “relational database”database” and storesand stores one EE one EE Name, SSN & DOBName, SSN & DOB. . If your If your system stores multiple system stores multiple names for different DOI’s, an names for different DOI’s, an EDI filing could reject if the EDI filing could reject if the EE Name does not match EE Name does not match name on file an earlier filing name on file an earlier filing (or from a different claim (or from a different claim admin.)admin.)

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Note:Note: FL Recently FL Recently relaxed match data relaxed match data requirements on Middle requirements on Middle Initial/Name (i.e., no Initial/Name (i.e., no longer longer requiredrequired if on file if on file or previously sent. If or previously sent. If middle Initial/Name is not middle Initial/Name is not consistent with what is on consistent with what is on file you will receive a TA-file you will receive a TA-FL.FL.

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If DWC receives a If DWC receives a FROI/SROI from one Claim FROI/SROI from one Claim Admin., and afterwards a Admin., and afterwards a FROI 04 denial from a FROI 04 denial from a different Claim Admin., a different Claim Admin., a new JCN is NOT new JCN is NOT established for the denied established for the denied claim. However, …claim. However, …

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… … if two Claim Admin.’s if two Claim Admin.’s pay on the same claim, pay on the same claim, two different JCN’s are two different JCN’s are established. established.

• If FL’s “relational If FL’s “relational database” reflects a database” reflects a different name for the different name for the EE, the EDI team will EE, the EDI team will contact each of the Claim contact each of the Claim Admin’s to reconcile the Admin’s to reconcile the correct EE name.correct EE name.

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Which MTC’s Which MTC’s to Send to Send When…When…

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ScenarioScenario MTC MTC Claim Admin paid disability Claim Admin paid disability days 1-7 only in first days 1-7 only in first check.check.

EP filed; IP filed; Sx filed; EP filed; IP filed; Sx filed; and now the Employer is and now the Employer is paying IB’s.paying IB’s.

IP filed; Sx filed; and now IP filed; Sx filed; and now the Employer is paying IB’s.the Employer is paying IB’s.

EP filed; IP filed; and now EP filed; IP filed; and now the Employer is paying IB’s.the Employer is paying IB’s.

NONENONE

ERER

EPEP

CBCB

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ScenarioScenario MTCMTCDWC1 filed (paper); CA filed DWC1 filed (paper); CA filed (R3) with incomplete (R3) with incomplete benefit picture; SA filed & benefit picture; SA filed & rejected because “# rejected because “# Benefits > than what is on Benefits > than what is on file”.file”.

CB rejects because “No CB rejects because “No SROI ER or RB on file” SROI ER or RB on file” (previously filed Sx )(previously filed Sx )

IP filed with TT; TT ended IP filed with TT; TT ended due to rls to RTW; TP to be due to rls to RTW; TP to be determineddetermined

Incorrect MTC filed (Do NOT Incorrect MTC filed (Do NOT file FROI 01 Cancel)file FROI 01 Cancel)

CB then CB then re-file re-file SA SA (non-(non-standarstandard)d)ER or ER or RBRB02 to 02 to rpt rpt RTWRTWCONTACCONTACT EDI T EDI TeamTeam

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ScenarioScenario MTCMTCFROI 04 filed with Denial FROI 04 filed with Denial Narrative incomplete (per Narrative incomplete (per EAO)EAO)

IP filed with TT; TT ended & IP filed with TT; TT ended & TP started and new TP started and new AWW/Comp Rate which AWW/Comp Rate which affected TT & TPaffected TT & TP

IP filed with TT; CB filed to IP filed with TT; CB filed to change from TT to TP; Sx change from TT to TP; Sx filed; MMI reached & IB filed; MMI reached & IB benefits to be commenced benefits to be commenced weekly.weekly.

… … (after above situation) IB (after above situation) IB paid in full.paid in full.

0202

CBCB

RBRB

S7S7

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ScenarioScenario MTCMTCPaying TP; reached MMI Paying TP; reached MMI and given PI%; actually and given PI%; actually RTW w/Restrictions; need to RTW w/Restrictions; need to pay IB pay IB

Filed FROI 04; and now Filed FROI 04; and now realized should’ve been realized should’ve been “indemnity only” denial. “indemnity only” denial.

SA filed; and now realized SA filed; and now realized Weeks and Benefit Amount Weeks and Benefit Amount reported incorrectly.reported incorrectly.

FN filed; SA filed to reopen; FN filed; SA filed to reopen; ongoing indemnity benefits ongoing indemnity benefits to pay.to pay.

CB if CB if paying paying wkly, or wkly, or PY if lump PY if lump sumsumPD PD

SASA

RBRB

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ScenarioScenario MTCMTCIP filed with wrong BTC IP filed with wrong BTC

PT awarded during period PT awarded during period TT was already paid, plus TT was already paid, plus JCC revised AWW/CR.JCC revised AWW/CR.

Benefit Period Start Date Benefit Period Start Date of a BTC was reported in of a BTC was reported in error in the past.error in the past.

CB with CB with RBAC ‘R’, RBAC ‘R’, no CA no CA needed needed

MTC 02, or MTC 02, or CB with CB with RBAC ‘R’ RBAC ‘R’ will also will also work work

MTC 02 (CB MTC 02 (CB or RB is not or RB is not required) required)

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ScenarioScenario MTCMTCSx already filed; previously Sx already filed; previously reported BTC info (type and reported BTC info (type and period paid) now period paid) now determined to be incorrect.determined to be incorrect.

IP reported TT; CB filed to IP reported TT; CB filed to add TP paid for waiting add TP paid for waiting week. What MTC is filed to week. What MTC is filed to show the continuation of show the continuation of TT? TT?

NoneNone

TT is TT is already already ‘on file’.‘on file’.

MTC 02, MTC 02, but but can’t add new can’t add new BTC or advance BTC or advance

Thru Date. Thru Date. (Do (Do Not Send Not Send RB)RB)

1 POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

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