Proof of Coverage State-Specific Reporting · Proof of Coverage State-Specific Reporting NCCI’S...
Transcript of Proof of Coverage State-Specific Reporting · Proof of Coverage State-Specific Reporting NCCI’S...
Proof of Coverage State-Specific Reporting
NCCI’S 2016 DATA EDUCATIONAL PROGRAM
January 26–29, 2016
Palm Beach County Convention CenterWest Palm Beach, FL
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
Proof of Coverage State-Specific Reporting
Presented By:
Amy Royce and Jorge Acevedo
© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Objective
To provide you with state-specific Proof of Coverage (POC) requirements and exceptions to ensure POC reporting success.
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Agenda
POC State Overview
POC Data Element Requirements
State POC Processing
POC and Professional Employment Organizations
POC State Exceptions and State Programs
Policy and POC Resources
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
NCCI DAILY POC: AL, AZ, KS, MD, MO, OK, VA, WV
NCCI POC States
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POC INQUIRY ONLY: AR, DC, GA, IA, IL, LA, NV, SD, TX, VT
IAIABC: AK, CO, HI, ID, IN, KY, ME, MS, MT, NE, NH, NM, NY, OR, RI, SC, TN, UTCT, FL,
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
POC Data Element Requirements
© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
POC Data Elements
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Amy’s Beach Club#123456789
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2016 DATA EDUCATIONAL PROGRAM
Federal Employer Identification Number
Required by NCCI and all POC states
NCCI returns Data Grade 7 edit for missing or invalid Invalid edit is limited Enhanced edit in November 2015 Employer records held Coming soon in Q4: Hold condition
removed
IAIABC Reject
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
POC Data Elements
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2016 DATA EDUCATIONAL PROGRAM
State Unemployment Identification Number
UI, UIAN, DOL#
Required and will reject (TR) Maine Utah—if UI unknown, report seven zeros
Required and will accept with errors (TE) Rhode Island
Required and will send Criticism letter Hawaii
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2016 DATA EDUCATIONAL PROGRAM
POC Data Elements
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Manufacturing Contracting Office & Clerical Goods & ServicesMiscellaneous
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2016 DATA EDUCATIONAL PROGRAM
Industry Code
NAICS vs SIC
Data Grade 7—Missing or Invalid FL, KS, KY, ME, MT, NM, OR*, WV
*NCCI edits on Oregon for Policy Effective Date 7/1/15 and later only
IAIABC Transaction Reject FL, KY, ME, MT, NM, OR*
*Oregon will reject on Policy Effective Date 7/1/2015 and later only
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
POC Data Elements
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2016 DATA EDUCATIONAL PROGRAM
Prior Policy Number
Renewal Rejected for Prior Policy Number No match on database because state was not on prior term Maine and Kentucky Contact NCCI NCCI will manually resend as an Add
Jurisdiction transaction
IAIABC 3.0 provides Reason State Was Added to Policy Code
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
POC Data Elements
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2016 DATA EDUCATIONAL PROGRAM
Insurer FEIN
New writers (affiliated and licensed) in states need to have their FEIN added to states trading partner table before sending first policy
Following states will reject POC AK, CO, FL, ME, NE, NM, OR, RI, SC, TN
State special forms KY and NY
All instructions provided through POC State Guide
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
State POC Processing
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Hold Conditions
NCCI currently holds Employer Records from POC data file for: Missing or invalid FEIN (All states) Missing or invalid UI (ME) All names and addresses linked together
(All states) Unlinked names and addresses (All states)
Policy data receives Data Grade 7 Uncorrected data viewable in Monthly
Data Grade 7 Report
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Hold Condition Changes
NCCI will no longer hold Employer Records in 4Q 2016 Missing or invalid FEIN Missing or invalid UI All names and addresses linked together
NCCI will continue to alert through Data Grade 7 on NCCI reports
POC state may reject and alert on IAIABC reports
Note: Unlinked names and unlinked addresses will continue to be held
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2016 DATA EDUCATIONAL PROGRAM
Address Reporting for POC
When employer does not have physical location in jurisdiction:
Report Address Type 6
Report Address Type 2—Out of State Address
Note: Not all states accept both types of addresses
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2016 DATA EDUCATIONAL PROGRAM
Address Reporting for POC
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Data Grade 8 Address Record rejects implemented January 7, 2016
Circular and State Applicability Chart published October 2015 (in Supplement)
POC State Guide updated to reflect requirements
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2016 DATA EDUCATIONAL PROGRAM
Address Reporting for POC
States that do not accept Address Type 6 Employer Records: AZ, IA, IN, KY, MT, OK, TX
States that do not accept Address Type 2—Out-of-State type Employer Records: AK, CO, FL, ID, MD, NM, OR, UT
All other POC states will accept either type of address
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2016 DATA EDUCATIONAL PROGRAM
Received Dates
The following states DO NOT recognize NCCI Received Date as their Received Date: HI, KY, ME, NH, NY, OR
State considers Received Date as the date the transaction is accepted
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2016 DATA EDUCATIONAL PROGRAM
Continuous Coverage
Nonrenewals are required to expire coverage at Policy Expiration Date
The following POC states are considered Continuous Coverage states: AK, DC, FL, ID, IL, KY, MD, MS, MT, NE,
NH, NY, RI, SC, TX, UT, VT
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2016 DATA EDUCATIONAL PROGRAM
Continuous Coverage
Other states that require Nonrenewals, however, do not call themselves Continuous Coverage: AZ, MO, NV, NM, VA
If Nonrenewals are reported, they are not sent to the following states: CO, ME, OK
Check POC State Guide for requirements
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2016 DATA EDUCATIONAL PROGRAM
POC Coverage Notice/Binders
State Filing Requirements
Not allowed in Idaho and Maine
Be Careful When Entering Florida does not extend filing requirement New Hampshire employers
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2016 DATA EDUCATIONAL PROGRAM
So What If?
2015 Policy term covered five states
2016 Renewal only covers four states
State not covered on Renewal is New York (Continuous Coverage state)
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How would you end coverage for New York?
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2016 DATA EDUCATIONAL PROGRAM
State-level NonRenewals
State-level Nonrenewal to be accepted in Q4 2016 for multistate policies
Change to WCIO WCPOLS State Code applicability scheduled for Spring 2016
State-level Nonrenewal—looking at State Code when reported
State-level Reinstatement only accepted for State-level Nonrenewal
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2016 DATA EDUCATIONAL PROGRAM
State-level Nonrenewals
Full Reporting rules provided in circular Must reinstate each state prior to
accepting a Cancellation Must reinstate each state prior to
accepting a Policy Level Nonrenewal If State-level Reinstatement and Policy
Level NonRenewal are submitted the same day, original Received Date will be retained
Cannot nonrenew a state on a Cancelled policy
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2016 DATA EDUCATIONAL PROGRAM
State-level Nonrenewals
Scenario #1 Policy Effective 01/01/2016—1/01/2017 Multistate policy covering NY, OK, and OR NY will not be on 2017 Renewal Filing Requirement—30 days prior to effective
date of nonrenewal Report Transaction 05
Cancellation/Reinstatement ID Code 3 State Code 31 Effective Date 01/01/2017
Report 01/01/2017 Renewal with OK and OR
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2016 DATA EDUCATIONAL PROGRAM
State Level Non-Renewals
Scenario #2 Policy Effective 01/01/2016—01/01/2017 Multistate policy covering FL, NY, OK, and OR
FL and NY have been Nonrenewed
Now need to Nonrenew full policy
Report 2 Transaction Code 05 Cancellation/Reinstatement ID Code 2 State Code 31 and 09 Effective Date 01/01/2017
Report 1 Policy Level Nonrenewal
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2016 DATA EDUCATIONAL PROGRAM
State Level Non-Renewals
Scenario #2 Continued
If State-level Reinstatements and Policy Level Nonrenewal reported in same day:
NY and FL will not receive transactions Original State-level Nonrenewal still in effect
OR will receive Nonrenewal
OK will not receive NonrenewalAnyone know why?
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2016 DATA EDUCATIONAL PROGRAM
IAIABC Update
States evaluating 3.0 format: Florida Montana New York
IAIABC developing POC training webinar for release in 2016
POC “Community” section on iaiabc.org
Request in pipeline for Employer Email Address reporting
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2016 DATA EDUCATIONAL PROGRAM
Proof of Coverage and Professional Employer
Organizations
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2016 DATA EDUCATIONAL PROGRAM
POC and PEO Reporting
Oregon
Master Policies = PEO Policy Type 2 All employees (leased and nonleased) are
covered All clients should be reported on PEO Policy
Types 4 or 5, which are used for Experience Rating purposes only State requires PEO to report client information
directly to state
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2016 DATA EDUCATIONAL PROGRAM
POC and PEO Reporting
Florida State database used to check validity of PEO
status Will reject for PEO Policy Type 8
Virginia Only one licensed PEO reported per policy
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2016 DATA EDUCATIONAL PROGRAM
POC State Exceptions and State Programs
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2016 DATA EDUCATIONAL PROGRAM
Hawaii
IAIABC POC 3.0 implemented October 2013
State still unable to process change transactions
Manually updating state system with NCCI POC or data received on WC36 forms
State Email Communication process
Potential future fining program based on timeliness of corrections only
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2016 DATA EDUCATIONAL PROGRAM
Idaho
Record Type 43 required to capture Losses Subject to Deductible Code
Compare process with Idaho Fiscal Department
NCCI will perform carrier outreach if necessary
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2016 DATA EDUCATIONAL PROGRAM
Maine
Matches POC to existing Department of Labor database
Matching criteria is FEIN, UIAN, and Address (not Name)
Provides separate error code in state comment section of IAIABC Error/Reject report Link to list of error messages in POC
State Guide
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Maine
If Name Standardization splits names, Maine considers second part a duplicate and will reject* Ex: Jorge Acevedo dba Jorge’s BBQ
Maine will provide correct UIAN if necessary—email contacts available
Fines for timeliness
Appeal process in place
*Name Standardization changes coming!
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2016 DATA EDUCATIONAL PROGRAM
New Hampshire
If you report a NH State Premium Record, you must report at least one NH employer Address Type 2 or 6 linked to State Code Link 28
Matches POC to existing DOL database
Matching criteria is Name, FEIN, and Address
NH employers reported on POC Notices
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2016 DATA EDUCATIONAL PROGRAM
New Hampshire
Fines for timeliness Fines are per employer, not policy Looking at making changes due to Assigned
Risk policy assignment date, insured originating changes, and changes due to audits Appeal process in place
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2016 DATA EDUCATIONAL PROGRAM
New York
Same prior policy number cannot be reported on multiple renewals If you split coverage at time of renewal, you
need to report one as New and one as Renewal
Opt-In POC state Form in POC State Guide NYWCB website allows for changes but consult
with NCCI first
Fines for timeliness of establishing coverage and midterm cancellations
Appeal process in place
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2016 DATA EDUCATIONAL PROGRAM
Oregon
Performs additional editing on FEINS and will reject
PEO reporting
Fines for timeliness of establishing coverage and midterm cancellations
Appeal process in place
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Utah
Requires UI number
Utah will provide correct UI number through online look-up tool or via email
Penalty process in place Changes in process announced in FYI
December 2015. No longer penalizing: Add/Delete Employers Add/Delete Jurisdictions Insured/Employer FEIN changes Changes to Policy Effective Date
Performance threshold still 99%
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Virginia
If you report a VA State Premium Record, you must report at least one VA employer Address Type 2 or 6 linked to State Code Link 45
Matches POC to existing DOL database
Matching criteria is Name, FEIN, and Address
Fines for timeliness Fines are per policy Made changes to look at assignment date on
Assigned Risk policies Appeal process in place
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Policy and POC Resources
© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Policy Resources for POC
Policy and Proof of Coverage Reporting Guidebook POC data element requirements by state
POC State Guide State contacts Filing requirements Exceptions
Data Manager Dashboard Monitor POC state timeliness
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2016 DATA EDUCATIONAL PROGRAM
Other POC Services
Coverage Verification Service (CVS) 32 of 38 POC states have link on their websites Public access Search by Employer Name or FEIN Coverage date driven
Workers Compensation Coverage Verification (WCCV) Mobile application through Apple, Google, or
Windows stores All 32 states available
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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.
2016 DATA EDUCATIONAL PROGRAM
Questions
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Supplemental Information
Presenter Biographies
Amy Royce joined NCCI 20 years ago and is currently a consultant in the Data Services Department of Data Resources. Her primary responsibilities include Proof of Coverage management and industry communication. She also represents NCCI on the International Association of Industrial Boards and Commissions POC Committee.
Amy earned a bachelor’s degree in human resource management from Palm Beach Atlantic University in Florida as well as Associate of Commercial Underwriting (AU) and Associate in General Insurance (AINS) designations.
Jorge Acevedo has been with NCCI since 2005. He is the Proof of Coverage lead data analyst on the Policy/Proof of Coverage Team in the Data Collection Department. Prior to joining Data Collection in 2007, he worked in the Experience Rating Department as an analyst.
Jorge’s professional background includes technical support for a major computer company and fraud detection for an Internet hosting company.