Division of Workers Compensation E.D.I. Rule 69L-56 Linda Yon, EDI Coordinator E-mail:...
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Transcript of Division of Workers Compensation E.D.I. Rule 69L-56 Linda Yon, EDI Coordinator E-mail:...
Division of Workers’ Compensation
E.D.I. Rule 69L-56
Linda Yon, EDI Coordinator
E-mail: [email protected] Phone: 850-413-1702
Draft Rule proposals
69L-56
Florida Administrative Code
A Draft of the EDI Rule 69L-56 F.A.C. is currently available on the Division’s
Website.
www.fldfs.com/wc/
This rule addresses the EDI requirements of submitting Proof of Coverage data & Claims data to the
Division.
A Workshop on this Rule draft will be held on Tuesday,
September 28, 2004, at 10 a.m. at the Division of Workers’
Compensation, Room 104J, Hartman Building in Tallahassee.
A Draft of the 69L-56 rules will be on the webwww.fldfs.com/wc/
Overview of proposed changes to 69L-56
• Revised EDI Trading Partner Forms. All new form numbers are preceded with
“DFS-F5” per DFS guidelines
• For Proof of Coverage, revised rule to incorporate the IAIABC Release 2 Proof of Coverage Implementation Guide, and
to adopt a revised FL POC EDI Implementation Manual.
• Transferred Proof of Coverage cancellation/non-renewal requirements
from 69L-6.008 to this rule, and added new language to address the recent statutory
change for a cancellation requested by the Insured.
Overview of proposed changes to 69L-56 Proof of Coverage Changes
Overview of proposed changes to 69L-56 Proof of Coverage Changes
Effective 7-1-2004, 627.4133(4) F.S. was amended to read "Notwithstanding the
provisions of s. 440.42(3), if cancellation of a policy providing coverage for workers'
compensation and employers liability insurance is requested by the insured, such cancellation shall be effective on the date the carrier sends the notice of the cancellation to the insured" Rule 69L-56 is being amended to reflect this
statutory change.
Overview of proposed changes to 69L-56 Proof of Coverage Changes
• Transferred Proof of Coverage reporting requirements from 69L-6.014 to this rule, and added new language to address the
cancellation/non-renewal filing requirements when the cancellation/non-renewal is
requested by the Insured.
• As of March 1, 2005, EDI transactions will only be accepted via Secure Socket Layer/File Transfer Protocol (SSL/FTP)
for POC EDI, and via Secure Socket Layer/File Transfer Protocol (SSL/FTP) or the Advantis Value Added Network (VAN)
for Claims EDI.
Overview of proposed changes to 69L-56 For Claims and POC
Overview of proposed changes to 69L-56 For Claims and POC
• If an insurer contracts with a third party vendor to electronically send transactions to the Division on the insurer’s behalf, or uses a third party vendor’s
software product for electronically sending transactions to the Division, the insurer shall
remain responsible for the timely filing of electronic form equivalents and any penalties and fines that
may result from untimely electronic filings.
Overview of proposed changes to 69L-56
Electronic Supplement to the First Report of Injury For Claims EDI
• Insurers presently submitting the First Report of Injury (DFS-F2-DWC-1) via EDI,
will be required to submit an “Electronic Supplement to the First Report of Injury” for
each claim reported as a Medical Only which became a Lost Time Case.
(EDI Claim Type L)
Overview of proposed changes to 69L-56
Electronic Supplement to the First Report of Injury For Claims EDI
This requirement will remain in place from the compliance date of the 69L-3 rules, through the
date the insurer begins submitting the FROI electronically in the new IAIABC Release 1.2 format. After the insurer is submitting data in the R1.2 format, the Supplement to the FROI
format will no longer be required.
EDI Claims Filing Requirement for ALL Insurers
The requirement to implement Claims EDI will begin with the
electronic form equivalent for the DFS-F2-DWC-1, First Report of
Injury or Illness
Claims EDI Filing Requirement
The requirement to implement Claims EDI is anticipated to also
include the electronic form equivalent for the DFS-F2-DWC-13,
Claim Cost Report
Claims EDI
Proposed EDI Claims Implementation Requirement:
The Division proposes to divide insurers/self-insurers into three
implementation groups, based on insurer code number.
- Lowest one third in the series will implement first.
- Middle one third in the series will implement next.
- Highest one third in the series will implement last.
The first group is to begin testing 6 months after the effective date of the rule
and be in production no later than 1 quarter after that.
Sample Claims EDI Implementation Schedule
Example: If Effective Date of Rule: 1-1-2005
First Group Must Begin Testing: 7-1-2005
First Group Must Be In Production: 10-1-2005
The second group is to begin testing no later than nine months after the effective date of the rule, and be in
production no later than one quarter after that date.
Proposed Claims EDI Implementation Schedule
The third group is to begin testing no later than 12 months after the
effective date of the rule, and be in production no later than one
quarter after that date.
Proposed Claims EDI Implementation Schedule
Paper forms will be accepted after the insurer’s EDI
FROI/SROI implementation date for unique and exceptional filing situations only, that can not be
handled electronically.
Claims EDI transactions must be filed with the
Division using the national IAIABC Claims EDI Release 1.2 format.
The Release 1.2 Claims Implementation Guide can be
downloaded from the IAIABC’s website in the near future. This guide contains the transaction record layouts, data dictionary,
scenarios, trading partner requirements, etc.
www.iaiabc.org
Then click on “Implementation Guides”
Florida’s Workers’ Compensation EDI Implementation Manuals are
available under the Electronic Data (EDI) link on the Division’s website.
They provide all the FL specific requirements, including required fields, edits and error messages.
The FL Claims EDI manual is currently under revision to match
the requirements of new Claims rule 69L-3.
It will be available on the web upon completion, which will be prior to the
filing of the rule requiring the electronic reporting of EDI First/Sub
Reports.
www.fldfs.com/WC/
Ensuring Data Quality
Since EDI is a computer-to-computer exchange of information, the data is less likely to have errors;
however, the data is only as good as it is initially input into the
database. All EDI programs at the Division have standard edits that are applied
to ensure data quality.
The Division will acknowledge every EDI transaction sent by the Insurer, on the
standard EDI Acknowledgement Transaction.
This report tells the Insurer how many records passed edits and how many failed edits, and what the errors were
that caused the record to reject.
The Division identifies all edits utilized in any EDI program in the FL
EDI Implementation Manuals.
It is recommended that Insurers also edit their data before it is sent to the Division, so that the data will pass
edits and the transaction will be accepted as timely filed.
Once an Insurer is submitting reports electronically, it is recommended to pay close
attention to the Acknowledgement report
received daily, so Insurers can identify which records rejected,
and quickly correct and resubmit them. ACK
Repor
t
EDI Acknowledgement Report
Recent additions to the Acknowledgement Report now provide EDI Insurers with the
following information:
If a DWC-1 record is accepted and there is a “Coverage Exemption” on file for that injured worker (same SSN), the words
“EXEMPT” will be sent back in a text field of the Acknowledgement Report for that
record, indicating an exemption is on file.
EDI Acknowledgement Report
The Claims Handler should then further research this exemption information in the
Division’s POC online database to see if the exemption on file is for the same employer as
the injury being reported.
It is possible to have more than one job, but to only have an exemption for one of those
jobs.
EDI Acknowledgement Report
Another recent addition to the Acknowledgement Report is the addition of the code “NODWC1” in the
free form text field.
If a DWC-13 (Claim Cost Report) is electronically filed and accepted; however, there is no DWC-1 on
file for that record, this code will let the claims-handling entity know that a DWC-1 (First Report of
Injury) needs to be filed.
In addition to the daily Acknowledgement report, the Division issues two monthly reports for Claims transactions to help an Insurer know where it stands with errors.
“Rejected Cases Not Resubmitted Successfully” Report
Report Card of Error Percentages and top 5 recurring errors
EDI Contacts at DWCLinda Yon
EDI Coordinator 850-413-1702 [email protected]
Karen Kubie
Claims EDI 850-413-1703 [email protected]
Tonya Granger
POC EDI 850-413-1709 [email protected]