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1© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Unit Editing and Data Validation Concepts
Presented by:Bruce Hallman and Hal Dooley
2© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Objectives
Become familiar with the types of Unit Edits/Validation Tests and how
to research and resolve them
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Agenda
Unit Data Editing
• Unit Edit Process• Examples
Unit Data Validation
• Unit Validation Process• Examples
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Unit Data Editing
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Unit Data Editing Topics
• Resources for reporting requirements
• Data grades
• Types of Edits—Field, Logical, Relational, and Net
• Editing path in Data Collection
• Edit matrices
• Edit creation process
6© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Resources for Reporting Requirements
• Statistical Plan• Filed rules
• Unit Statistical Reporting Guidebook• Reporting examples• Edit and Validation Test Matrices
• WCIO Data Specifications Manual• WCSTAT
• Online Tools• DCA Access® Online• Unit Pre-Edit Service/Tool• Data Transfer via the Internet
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Editing Path in Data Collection
Corrections/ReplacementsUpdate source system if using DCA Access® Online
Submission Results/Reports
Net Edits
Data Accepts/Rejects
Front-End Edits
Submit Data for Processing
Pre-Edit
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Pre-Edit Options
Unit Pre‐Edit Service
•Submit electronic files to see errors before submitting to production
Unit Pre‐Edit Tool
•Allows you to update your units online and submit
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Unit Edit Data Grades
Error Class(Data Grade Description)
Data Grade(Level of Severity)
Error-Free 0
Informational 1
Suspect 2
Default 3
Priority Error 4
Priority/Critical Error 5
Reject 9
10© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Edit Types
Field:Checks field values, e.g., numeric, alphanumeric, and valid codesLogical:Checks that the data reported in a field is valid in relation to:– One or more fields on the record or– Within other records on the unit report
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Edit Types
Relational:Compares data reported in a field:– With other data in the same submission– With data on the databaseNet (Logical and Relational): Uses the current header and latest exposure and loss information at each report level to:– Identify error conditions– Clear errors on corresponding unit reports
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Unit Submission Results Report
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Unit Edit Matrix
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Unit Edit Matrix
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Unit Edit Matrix
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Future Enhancement Unit Edit Matrix
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Edit Creation Process
New Edit Idea (data quality concern or rule requirement)
Internal Review
External Edit Task Group
Future Edit Enhancement Matrix
Production Edit Matrix
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Unit Data Editing Match Game
Questions
Identifies the Severity of an Error
Checks for Numeric/Alpha Values
First Step in Editing Path
Error Free Data
Location of Edit Matrix
Answers
Pre‐Edit
Unit Statistical Reporting Guidebook
Data Grades
Field Edit
Data Grade 0
10
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Unit Data Edits—Examples
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Before We Begin, a Few Notes …
• The focus should be on reporting accurate data rather than clearing errors
• There can be multiple ways to clear an error depending on what data is in error
• Update source system if using DCA Access®
Online
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21© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Unit Data Edits
Edit Number
Description
0282-14 LOSSES WITHOUT EXPOSURE (Front-End)
0282-18 LOSSES WITHOUT EXPOSURE (Net)
0075-03 EXPERIENCE MODIFICATION FACTOR INCONSISTENT
0282-17 INCONSISTENT CLASS CODE ACROSS REPORT LEVELS
9901-07 OPEN LOSSES NOT UPDATED ON SUBSEQUENT
0286-05 LOSS MATCHING
0286-06 LOSS MATCHING
22© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Losses Without Exposure
Relational Edit Number: 0282-14Data Grade: 5 (9 for MN and NC)Element: Classification Code (on Loss Record)
Edit Description: The loss class code on the incoming unit must have a corresponding exposure class code with a nonzero exposure amount.
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23© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Losses Without Exposure
Concept: We don’t expect a loss to be paid for a worker that wasn’t covered under the policy.
Example: A loss is reported for a roofing injury under Classification Code 5551, but no roofers are covered on the policy—i.e., there is no exposure record for Code 5551.
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Losses Without Exposure—Set Up
2-1 R–Claim2 5551 $500 5
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810 $1,000 R–Claim1 8810 $250 0
2-0 P–Claim1R–Claim1
88108810
$250$300 0
0282-14
Losses Without Exposure Data Issue
Matching exposure class code is missing
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Losses Without Exposure Correcting—Method 1
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810 $1,000 R–Claim1 8810 $250 0
2-0 P–Claim1R–Claim1
88108810
$250$300 0
2-1 R–Claim2 5551 $500 5
2-2 P–Claim2R–Claim2
55518810
$500$500 0
Based on research, it is determined that the class code on the loss is incorrect.
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Losses Without Exposure Correcting—Method 1
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The current data grade for this claim is 5.
For additional priority errors, you can check here.
Losses Without Exposure Correcting—Method 1
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Losses Without Exposure Correcting—Method 1
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The report level data grade is now zero.
Losses without Exposure Correcting—Method 1
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The report level data grade is now zero. The current data
grade for this
claim is now zero.
For further confirmation,you can check here.
Losses without Exposure Correcting—Method 1
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Losses Without Exposure Correcting—Method 2
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810 $1,000 R–Claim1 8810 $250 0
2-0 P–Claim1R–Claim1
88108810
$250$300 0
2-1 R–Claim2 5551 $500 5
Based on research, it is determined that the class code on the loss is correct.
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Losses Without Exposure Correcting—Method 2
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810 $1,000 R–Claim1 8810 $250 0
2-0 P–Claim1R–Claim1
88108810
$250$300 0
2-1 R–Claim2 5551 $500 5
1-1 R–5551 $1,500 0
0
Based on research, it is determined that the class code on the loss is correct.
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Net Edits
• Compare reported values on incoming units with data on NCCI’s database
• Apply to the newly reported or previously submitted data
• Corrections must be submitted in sequential report level order, starting with the earliest report level that the error occurred
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Front-End vs. Net
Aspect Front-End Net
Field Yes No
Logical Yes Yes
Relational Yes Yes
Aspect Front-End Net
Field Yes No
Logical Yes Yes
Relational Yes Yes
Unit Pre-Edit Tool/Service
Yes No
Aspect Front-End Net
Field Yes No
Logical Yes Yes
Relational Yes Yes
Unit Pre-Edit Tool/Service
Yes No
Rejected Units Yes No
Aspect Front-End Net
Field Yes No
Logical Yes Yes
Relational Yes Yes
Unit Pre-Edit Tool/Service
Yes No
Rejected Units Yes No
Edit Operation Edits operate on submitted records
All edits operate when any unit is received
Applying Edits Incoming Unit Incoming Unit and unit(s) on database
Clearing Errors Yes, by replacing the record
Yes, even to records previously submitted
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Losses Without Exposure Net
Net Edit Number: 0282-18Data Grade: 5Element: Classification Code (on Loss Record)
Edit Description: The loss class code on a previously reported unit must have a corresponding exposure class code with a non-zero exposure amount.
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1-1 P–8810 $1,000 0
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810R–8742
$1,000$750
R–Claim3 8810 $250 0
2-0 P–Claim3R–Claim3
88108810
$250$300 0
Losses Without Exposure Net—Set Up
5
5
Net 0282-18
Losses Without Exposure Net—Data Issue
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Losses Without Exposure NetCorrecting—Method 1
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810R–8742
$1,000$750
R–Claim3 8810 $250 5
2-0 P–Claim3R–Claim3
88108810
$250$300 5
1-1 P–8810 $1,000 0
Based on research, it is determined that the class code on Claim3 is correct and the removal of exposure Class Code 8810 was incorrect.
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Losses Without Exposure NetCorrecting—Method 1
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810R–8742
$1,000$750
R–Claim3 8810 $250 5
2-0 P–Claim3R–Claim3
88108810
$250$300 50
1-1 P–8810 $1,000 0
1-2 R–8810 $1,500 0
0
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Based on research, it is determined that the class code on the claims is incorrect and the removal of exposure Class Code 8810 was correct.
Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810R–8742
$1,000$750
R–Claim3 8810 $250 5
2-0 P–Claim3R–Claim3
88108810
$250$300 5
1-1 P–8810 $1,000 0
Losses Without Exposure NetCorrecting—Method 2
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Report # and Seq. #
Exposure Class Code Exposure
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R–8810R–8742
$1,000$750
R–Claim3 8810 $250 5
2-0 P–Claim3R–Claim3
88108810
$250$300 5
1-1 P–8810 $1,000 0
1-2 P–Claim3R–Claim3
88108742
$250$250 0
2-1 P–Claim3R–Claim3
88108742
$300$300 0
Losses Without Exposure NetCorrecting—Method 2
0
0
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Match Game
Questions
Two Types of Errors
Highest “Current” Data Grade
Pre‐Edit Applies To
View Data Grade 4 and 5 Errors
Possible Corrective Actions
Answers
Front‐End Edit
Update Exposure or Loss Classification
Front‐End and Net
Report Level
Outstanding Priority Errors
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Experience Modification FactorInconsistent
Relational Edit Number: 0075-03Net Edit Number: 0075-07Relational Edit Data Grade: 4 (9 for MN and NC)Net Edit Data Grade: 4Element: Experience Modification Factor
Edit Description: The Experience Modification Factor on the incoming unit must be the same for all class codes with the same Experience Modification Effective Date.
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Experience Modification FactorInconsistent
Concept: We expect the Experience Modification Factor to be the same for all class codes subject to experience rating that share the same Experience Modification Effective Date.
Example: Class Code 8742 with a 1/1/09 Experience Modification Effective Date has an Experience Modification Factor of 0.79. Class Code 8810 has 0.82 for the same Experience Modification Effective Date.
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1-1 P – 8742R – 8742R – 8810
1/1/091/1/091/1/09
$250,000$275,000$475,000
0.790.820.79
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Experience Modification Factor Inconsistent
Report # and Seq. #
Exposure Class Code
Exp Mod Eff Date Exposure
Experience Mod
Data Grade
1-0 R - 8742 1/1/09 $250,000 0.79 0
0075-03Inconsistent Modification Factors
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1-1 P – 8742R – 8742R – 8810
1/1/091/1/091/1/09
$250,000$275,000$475,000
0.790.820.79
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Experience Modification Factor Inconsistent
Report # and Seq. #
Exposure Class Code
Exp Mod Eff Date Exposure
Experience Mod
Data Grade
1-0 R - 8742 1/1/09 $250,000 0.79 0
0075-03 Errors are cleared
1-2 P – 8742R – 8742
1/1/091/1/09
$275,000$275,000
0.820.79 0
Based on research, it is determined that the Experience Mod should not have changed.
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Experience Modification FactorInconsistent
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Experience Modification FactorInconsistent
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Experience Modification FactorInconsistent
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Experience Modification FactorInconsistent
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Inconsistent Class Code AcrossReport Levels
Relational Edit Number: 0282-17Net Edit Number: 0282-20Data Grade: 9 (Relational)/5 (Net)Element: Classification Code (on Loss Record)
Edit Description: The class code must be reported consistently across all report levels for this loss.
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Inconsistent Class Code AcrossReport Levels
Concept: The reported class code of the injured worker is not expected to change over the life of the loss.
Example: A claim is reported under Classification Code 8810 (office and clerical) on the first report. Then on the second report, the class is reported as Code 8742 (Salesperson).
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3-0 P – Claim4R – Claim4
88108742
$300$350 9
Inconsistent Class Code Across Report Levels—Data Issue
Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
UnitRejected
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Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
3-0 P – Claim4R – Claim4
88108742
$300$350 9
Inconsistent Class Code Across Report Levels Correcting—Method 1
Unit Rejected
Based on research, it is determined that the class code on the 3-0 is incorrect.
54© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
3-0 P – Claim4R – Claim4
88108742
$300$350 9
Inconsistent Class Code Across Report Levels Correcting—Method 1
Unit Rejected
3-0 P – Claim4R – Claim4
88108810
$300$350 0
Correct Data and Resubmit Unit
Based on research, it is determined that the class code on the 3-0 is incorrect.
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Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
3-0 P – Claim4R – Claim4
88108742
$300$350 9
UnitRejected
Based on research, it is determined that the class code on the 3-0 is correct.
Inconsistent Class Code Across Report Levels Correcting—Method 2
56© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
3-0 P – Claim4R – Claim4
88108742
$300$350 9
1-1 P – Claim4R – Claim4
88108742
$250$250 05
5
UnitRejected
Based on research, it is determined that the class code on the 3-0 is correct.
Inconsistent Class Code Across Report Levels Correcting—Method 2
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Report # and Seq. #
Claim Number
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim4 8810 $250 0
2-0 P – Claim4R – Claim4
88108810
$250$300 0
3-0 P – Claim4R – Claim4
88108742
$300$350 9
1-1 P – Claim4R – Claim4
88108742
$250$250 0
2-1 P – Claim4R – Claim4
88108742
$300$300 0
UnitRejected
3-0 P – Claim4R – Claim4
87428742
$300$350 0
Resubmit Rejected 3-0 Unit
Based on research, it is determined that the class code on the 3-0 is correct.
Inconsistent Class Code Across Report Levels Correcting—Method 2
58© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Open Losses Not Updatedon Subsequent
Relational Edit Number: 9901-07Data Grade: 5 (NC and WI are not included)Element: Miscellaneous edit (on Header Record)
Edit Description: The incoming unit does not contain updates for all open claims that exist at the previous report level.
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Open Losses Not Updatedon Subsequent
Concept: All open losses must be reported on subsequent units.
Example: If a loss is open at the 1st report, the loss must be updated and reported on the 2nd report.
60© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR – Claim6R - Claim7
O – OpenO – Open
88108810
$250$125
00
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
00
Open Claims Not Updated on a Subsequent Report Level—Data Issue
Since Claim6 was open at the 1st report level and not updated at the 2nd report, the header record for the 2-0 receives a 9901-07 DG 5 error.
Then the header record of the 1-0 receives a 9901-26 Net DG 5 error.
500
Edit 9901-07
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
00
500
Edit 9901-26Writes the Error
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After carrier research, it is determined that Claim6 was still open at the 1st report and requires an update.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
Open Losses Not Updated on a Subsequent Report Level—Correction Method 1
62© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR – Claim6R - Claim7
O - OpenO - Open
88108810
$250$125
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
2-1 HeaderP - Claim6R - Claim6
O - OpenC - Closed
88108810
$125$175
000
No Error
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
000
9901-26Clears the Error
Open Losses Not Updated on a Subsequent Report Level—Correction Method 1
These edits write to the header record. When the 2-1 arrived, it became the latest header at the 2nd report and it has no errors. The DG 5 on the 2-0 is just historical.
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Open Claims Not Updated on a Subsequent Report Level—Correction Method 2
After carrier research, it is determined that Claim6 should have been closed at the 1st report.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
64© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$250$125
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
1-1 HeaderP - Claim6R - Claim6
O - OpenC - Closed
88108810
$125$125
000
Open Claims Not Updated on a Subsequent Report Level—Correction Method 2
Submitting a 1-1 loss correction that closes Claim6 will clear the 1st report error by replacing the current header.
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
33
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Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$250$125
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
1-1 HeaderP - Claim6R - Claim6
O - OpenC - Closed
88108810
$125$125
000
Open Claims Not Updated on a Subsequent Report Level—Correction Method 2
Report # and Seq. #
Claim Number
ClaimStatus
Loss Class Code
Loss Amount
Data Grade
1-0 HeaderR - Claim6R - Claim7
O - OpenO - Open
88108810
$125$250
500
2-0 HeaderP - Claim7R - Claim7
O - OpenC - Closed
88108810
$250$300
500
Next, Net edit 9901-26 will operate to physically clear the error on the 2-0.
000
9901-26 Clears the Error
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Loss Matching
Relational Edit Number: 0286-05Data Grade: 9Element: Update Type Code
Edit Description: If the reported Update Type is P, C, or D, a previously reported R, A, or C Update Type must be found on the database for that claim.
Matching fields used to identify previously reported loss records are: Claim Number and Accident Date.
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Loss Matching
Relational Edit Number: 0286-06Data Grade: 9Element: Update Type Code
Edit Description: If the reported Update Type is A or R without a corresponding D or P on the same unit, the claim must not already exist on the database.
Matching fields used to identify previously reported loss records are: Claim Number and Accident Date.
68© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Loss Matching
Concept: If a loss is being updated, it must have the same claim number and accident date as the loss on our database. If a new loss is being added, it must not match a claim that already exists on our database.
Maintaining the Claim Number and Accident Date for the life of the loss is very important because these fields uniquely identify the claim.
35
69© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Loss Matching FieldsStates Loss Fields
All States Except MD and VAClaim NumberAccident DateTX—Policies Effective 01/01/15
and Subsequent
TX—Policies Effective 10/01/08 Through12/31/14
Claim NumberAccident DateLoss Condition Code: ActLoss Condition Code: Type of Claim
MD and VA Only—Policies Effective10/01/08 and Subsequent
Claim NumberAccident DateLoss Condition Code: Type of Claim
MD, TX, and VA—Policies Effective Priorto 10/01/08
Claim NumberAccident DateLoss Condition Code: ActLoss Condition Code: Type of LossLoss Condition Code: Type of RecoveryLoss Condition Code: Type of ClaimVocational Rehabilitation IndicatorJurisdiction State Code
Part 5—Unit Statistical Reporting Guidebook
70© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Report # and Seq. #
Claim Number
Accident Date
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim8 4/1/06 8810 $250 0
Loss Matching—Data Issue
• Previous (P) record rejected for 0286-05 (matching)• Revised (R) record rejected for 0286-06 (duplicate)
Report # and Seq. #
Claim Number
Accident Date
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim8 4/1/06 8810 $250 0
2-0 P – Claim8R – Claim8
4/2/064/1/06
88108810
$250$300
99
Unit Rejected
36
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Report # and Seq. #
Claim Number
Accident Date
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim8 4/1/06 8810 $250 0
2-0 P – Claim8R – Claim8
4/2/064/1/06
88108810
$250$300
99
Loss Matching—Correcting
Based on research, it is determined that the date on the previous record of the 2-0 should have been 4/1/06.
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Report # and Seq. #
Claim Number
Accident Date
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim8 4/1/06 8810 $250 0
2-0 P – Claim8R – Claim8
4/2/064/1/06
88108810
$250$300
99
Loss Matching—Correcting
Now the previous (P) record for the loss on the 2-0 correctly matches the revised (R) record for the loss on the 1-0 and the unit loads to the database.
Report # and Seq. #
Claim Number
Accident Date
Loss Class Code
Loss Amount
Data Grade
1-0 R – Claim8 4/1/06 8810 $250 0
2-0 P – Claim8R – Claim8
4/1/064/1/06
88108810
$250$300
99
Correct Data and Resubmit Unit
00
37
73© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
New Unit Edits
Edit Number Description
0055‐130055‐14
Ensure that the correct Deductible Reimbursement Amount is being applied based on date. (Colorado only)
0095‐02 Ensures that the Incurred Claimant Attorney Fee Amount does not exceed the incurred amount of the claim. (Florida only)
0116‐050116‐06
Identifies lump‐sum or closed claims that have an increase in Paid Indemnity that isn’t identified as having a settlement.
9905‐12 Identifies suspect claims that have not been deleted at every report level.
74© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Match Game
Questions
Loss Classification Code
Experience Modification Factor Must Be Consistent
Open Claims
Loss Matching Fields
Proper Reporting of Deleted Claims
Answers
Must Be Reported at Next Report Level
New Unit Edits
Should Never Change
Same Experience Modification Effective Date
Claim Number and Accident Date
38
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Unit Data Validation
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Unit Data Validation Tests
Quality checks after the data is loaded
Verify the completeness, validity, accuracy, and reasonability of the data
Identify patterns and data anomalies over a specified time
Check for reasonability against countrywide or state norms
39
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Unit Data Validation Tests
Apply to data effective 2000 and subsequent
Performed prior to the state rate filings
Responses are required within a predetermined time frame
Results and responses via Notifications in DCA Access® Online
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Countrywide Tests
Countrywide Tests
Identify suspect patterns across states
Impact ratemaking and experience rating
Identify aggregate data issues
Review of historical data before implementation of an edit
40
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State-Based Tests
Note: Similar issues may occur in numerous states.
State Tests
Identify suspect patterns within a state
Detect unusual year-to-year changes
Have shorter validation periods
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Unit Validation Process
Data Provider Research
Outbound Results via DCA Access® Online
Run Validation Tests
NCCI Database
Take Appropriate Action Correction
DetailedExplanation
41
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Unit Validation Tests Matrix
• Details on All Validation Tests• Assists with working notifications
• Unit Statistical Validation Matrices:• All Validation Tests in production • Future Validation Test Enhancements
Part 12—Unit Statistical Reporting Guidebook
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Unit Statistical Validation Test Matrix
42
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Unit Statistical Validation Test Matrix
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Unit Statistical Validation Test Matrix
43
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Unit ValidationMatch Game
Questions
Identifies Data Anomalies
Countrywide and State Validation Tests
View and Respond to Validation Tests
Identifies State Reporting Patterns
Resource for Working Notifications
Answers
Notifications via DCA Access® Online
Validation Test Matrix
Validation Tests
The Two Types of Validation Tests
State‐Based Tests
86© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Validation Tests
Validation Type Code Validation Description
C821 Suspect Exposure/Claims Distribution
E133 Duplicate Exposure for Uneven Split Periods
44
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Validation Tests
Validation Type Code Validation Description
L246 Claims With No Recovery
L501 Deleted Claims on Subsequent Report Level
L303 Suspect Permanent Total Claims
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Validation Tests
Validation Type Code Validation Description
L256 (New) Catastrophe Number Greater Than 10
L741 (New) Increased Paid Indemnity With Lump Sum and No Settlement
L742 (New)Increased Paid Indemnity With Closed Claim and No Settlement
45
89© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Suspect Exposure/Claims Distribution
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
C821
SUSPECT EXPOSURE/ CLAIMS DISTRIBUTION
CLAIM DISTRIBUTION
SUSPECT COMPARED
TO EXPOSURE
Unusually low claim counts compared to high exposure/premium or unusually high claim counts compared to low exposure/premium in a given class.
The inaccurate distribution of exposure and claims across states or within a state may result in overstated and/or understated loss costs/rates.
90© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Unit Notifications via DCA Access® Online
46
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Unit Notifications via DCA Access® Online
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Unit Notifications via DCA Access® Online
47
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Unit Notifications via DCA Access® Online
94© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Claim counts are high or low for policy period
Payroll increases with decrease in claim count
Payroll decreases with increase in claim count
Suspect Exposure/Claims Distribution
48
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Suspect Exposure/Claims Distribution—Example
StatePolicy Number
Class Code Exposure
Indemnity Claims
Medical‐Only Claims
01 WC1111 9015 575,675 22 0
01 WC1111 9061 8,975,464 1 1
01 WC1111 8810 45,964 0 1
96© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Verify Class Code (Exposure and Loss)
Confirm Exposure Amount
Submit Correction or Detailed Explanation
Suspect Exposure/Claims Distribution
49
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Duplicate Exposure—Uneven SplitValidation
Type Code
ValidationType
ValidationDescription
ValidationSummary
E133
SUSPECT DUPLICATES RECON-CILIATION
DUPLICATE EXPOSURE IS REPORTED IN UNEVEN EXPERIENCE MODIFICATION AND/OR RATE EFFECTIVE PERIODS
The attached grid displays exposure records on the same policy containing identical class code and payroll amount in unevenly divided experience modification and/or rate effective periods.
Please verify the exposure amounts or submit corrections to reconcile the exposure with the duration of the split experience periods by the due date.
98© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Duplicate Exposure—Uneven Split
Identifies exposure records on same policy with the same class code and payroll but
uneven split periods
50
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Duplicate Exposure—Uneven Split—Example
State
Policy Eff. Date
Policy Number
Class Code Exposure Rate Premium
Mod Eff. Date
Rate Eff. Date
Split Period
02 1/1/10 WC1111 8742 825,205 1.25 10,315 1/1/10 1/1/10 0
02 1/1/10 WC1111 8742 825,205 1.25 10,315 9/1/10 9/1/10 1
100© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Duplicate Exposure—Uneven Split
Confirm Exposure Amounts
Confirm Split Dates Are Correct
Submit Correction or Detailed Explanation
51
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Claims With No Recovery
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L246CLAIMS WITH NO
RECOVERY
DECREASING PAID
LOSSES REPORTED
ON CLAIMS WITH NO
RECOVERY
The attached grid displays claims with a total paid amount less than the total paid amount at the prior report level in absence of a recovery.
Please verify the recovery type code and paid amounts at all applicable report levels by the due date.
102© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Claims total paid amount is less than the total paid amount at the prior report level
No Recovery Code
Claims With No Recovery
52
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Claims With No Recovery—Example
Rpt.#
Policy Eff. Date
Policy Number
Claim Number
Inj.Type
Paid Indemnity Paid Med
Type of Recovery
1 1/1/10 WC1111 WC1234 09 13,553 25,834 01
2 1/1/10 WC1111 WC1234 09 15,648 28,685 01
3 1/1/10 WC1111 WC1234 09 38,159 30,521 01
4 1/1/10 WC1111 WC1234 09 12,526 30,521 01
104© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Verify Paid Loss Amounts
Confirm if a Recovery Was Received
Submit Correction or Detailed Explanation
Claims With No Recovery
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105© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Match Game
Questions
Researching DistributionTest
Paid Loss Decreases With No Recovery
Alternative to Working Grid in DCA Access® Online
Confirm Split Dates
Always Do This
Answers
Downloadable Spreadsheet
Submit Corrections or Provide Explanations
Verify Both Exposure and Claim Values
Verify Paid Amounts and if There Was a Recovery
Uneven Splits Identified With Duplicate Exposure
106© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L501
DELETED CLAIMS ON SUBSEQUENT REPORTS
CLAIMS HAVE BEEN DELETED IN ERROR ON SUBSEQUENT UNIT REPORTS LEVELS
The attached grid displays claims that have been deleted or reduced to zero at one or more subsequent report levels.
If claims were deleted or reduced to zero in error, please submit corrections to add the necessary claim data at all applicable report levels by the due date. If the removal of a claim is justified at a subsequent report level, submit corrections to remove the claim at prior report levels and/or add the appropriate loss condition coding.
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107© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports
Claim was deleted or had zero‐filled Loss Amounts on a subsequent report level
108© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports—Example
Upt. Type
Policy Eff. Date
Policy Number
Rpt. #
Class Code
Claim Number
Inj.Type
Inc. Indem.
Inc. Med
R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258
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109© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports—Example
Upt. Type
Policy Eff. Date
Policy Number
Rpt. #
Class Code
Claim Number
Inj.Type
Inc. Indem.
Inc. Med
R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258
110© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports—Example
Upt. Type
Policy Eff. Date
Policy Number
Rpt. #
Class Code
Claim Number
Inj.Type
Inc. Indem.
Inc. Med
R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258
P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258
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111© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Deleted Claims on Subsequent Reports
Review claim to determine if reported in error on subsequent report
Determine appropriate corrective action
Submit Correction Report
112© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Suspect Permanent Total Claims
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L303
SUSPECTPERMANENTTOTAL CLAIMS
CLAIMS REPORTED WITH A PERMANENT TOTAL INJURY TYPE BUT HAVE SUSPECT INCURRED INDEMNITY AND/OR MEDICALAMOUNTS
The attached grid identifies claims with a Permanent Total injury type that appear inconsistent with the incurred indemnity and/or medical amount reported.
Please verify the claim information or submit corrections to reflect the appropriate injury type and incurred amounts at all report levels by the due date.
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Permanent Total injury type inconsistent with incurred indemnity and/or medical amount
Injury usually likely to develop and require more medical expenses and lost time
Suspect Permanent Total Claims
114© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Suspect Permanent Total Claims—Example
Policy Eff. Date
Policy Number Rpt. #
Claim Number
Inj.Type
Inc. Indem
Inc. Med Part Nature Cause
1/1/10 WC1111 1 WC1234 09 58,200 61,258 35 10 65
1/1/10 WC1111 2 WC1234 09 65,356 62,556 35 10 65
1/1/10 WC1111 3 WC1234 02 72,398 63,672 35 10 65
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115© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Verify the Injury Type Code
Confirm the Indemnity and Medical Amounts
Submit Correction or Detailed Explanation
Suspect Permanent Total Claims
116© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Catastrophe Number Greater Than 10
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L256
CATASTROPHENUMBER GREATERTHAN 10
CLAIMS AREREPORTED WITH A CATASTROPHENUMBER GREATERTHAN 10 AND ARENOT PART OF ANEXTRAORDINARYLOSS EVENT
The attached grid displays claims reported with a catastrophe number greater than 10, which do not appear to be extraordinary loss events.
Please submit corrections to reflect the appropriate catastrophe coding at all report levels by the due date.
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Catastrophe Number greater than 10 but not an Extraordinary Loss Event
Catastrophe Number Greater Than 10
118© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Catastrophe Number Greater Than 10—Example
Policy Eff. Date
Policy Number
Rpt. #
Claim Number
Acc.Date
Inc. Indem
Inc. Med Cat. #
1/1/12 WC1111 1 WC1234 10/21/12 58,200 61,258 11
1/1/12 WC1111 1 WC4321 10/21/12 65,356 62,556 11
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119© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Verify ELE Catastrophe Codes
ELE Codes and Descriptions on ncci.com
Submit Correction
Catastrophe Number Greater Than 10
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Increased Paid Indemnity WithLump Sum and No Settlement
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L741
LUMP SUM FLAG “Y” AND NO LOSS CONDITIONSETTLEMENTCODE (00) WITHINCREASED PAIDINDEMNITYAMOUNTS
CLAIMS REPORTEDWITH A LOSS CONDITION SETTLEMENT CODEOF 00, A LUMP SUMFLAG OF “Y,” ANDPAID INDEMNITYAMOUNTS THAT HAVE INCREASEDSIGNIFICANTLY
Claims reported with a Lump‐SumFlag of “Y” and a large increase in paid indemnity amount on a subsequent report or is reported for the first time with a large paid indemnity amount. These claims are reported with a Loss Condition Settlement Type Code of 00.
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Lump Sum Indicator = Yes
Loss Condition—Type of Settlement = 00
Significant Increase in Paid Indemnity
Increased Paid Indemnity WithLump Sum and No Settlement
122© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Increased Paid Indemnity WithLump Sum and No Settlement—
Example
Policy Eff. Date Policy Number
Rpt. #
Claim Number
Paid Indem.
Lump Sum
Loss Cond. –Settlement
1/1/10 WC1111 1 WC1234 58,200 N 00
1/1/10 WC1111 2 WC1234 165,356 Y 00
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123© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Verify Paid Indemnity Amount
Check Lump Sum Indicator
Submit Correction or Detailed Explanation
Increased Paid Indemnity WithLump Sum and No Settlement
124© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Increased Paid Indemnity WithClosed Claim and No Settlement
Validation Type Code
ValidationType
ValidationDescription
ValidationSummary
L742
CLOSED CLAIMSINDICATE NO LOSS CONDITIONSETTLEMENTCODE (00) WITH AN INCREASE OR HIGH PAIDINDEMNITYAMOUNT
CLAIMS REPORTEDWITH A LOSS CONDITION SETTLEMENT CODEOF (00), CLOSEDCLAIM STATUS, ANDPAID INDEMNITYAMOUNTS THAT HAVE INCREASEDSIGNIFICANTLY
The attached grid displays closed claims reported with a large increase in paid indemnity amount on a subsequent report or is reported for the first time with a large paid indemnity. These claims are reported with a Loss Condition Settlement Type Code of 00.
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Claim Status = Closed
Loss Condition—Type of Settlement = 00
Significant Increase in Paid Indemnity
Increased Paid Indemnity WithClosed Claim and No Settlement
126© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Increased Paid Indemnity WithClosed Claim and No Settlement—
Example
Policy Eff. Date Policy Number
Rpt. #
Claim Number
Paid Indem.
Claim Status
Loss Cond. –Settlement
1/1/10 WC1111 1 WC1234 68,200 0 00
1/1/10 WC1111 2 WC1234 175,258 1 00
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Verify Paid Indemnity Amount
Check Claim Status
Submit Correction or Detailed Explanation
Increased Paid Indemnity WithClosed Claim and No Settlement
128© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Editing Process Recap
Data provider submits data to
NCCI
NCCI edits applied
Submission Results report
issued
Updated/corrected data is submitted
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Validation Process Recap
Data is subject to NCCI validation tests
Verification or correction requested
via DCA Access®
Online Unit Notifications
Data provider submits corrections or provides detailed
explanation
NCCI validates response—closes notification or requests more information
130© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.
Unit Notifications
Losses Without Exposure
Identifies Suspect Patterns Across States
Clears Errors on NCCI’s Database
Data Grade 9
Nonextraodinary Loss Event
USRG
Hal’s Beverage Choice
66
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Thank You!
Supplemental Information
Presenter Biographies
Bruce Hallman, AIDM, has worked in NCCI’s Data Services Department for 18 years. He is a product support manager, subject matter expert, and the data liaison between NCCI and the independent bureaus. Bruce participates in many projects, including enhancements to Unit and Policy edits. He is actively involved in various industry groups, including the Workers Compensation Insurance Organization, Policy Advisory Task Group, and Advisory Statistical Work Group Committees.
Bruce earned the Associate Insurance Data Manager designation from the Insurance Data Management Association (IDMA). Before joining NCCI, he was employed by the Pennsylvania Compensation Rating Bureau.
Hal Dooley, AIDM, works in NCCI’s Data Quality Department as a lead analyst and unit data subject matter expert. He is involved in all aspects of unit data editing and leads unit data projects. During his 23 years at NCCI, Hal has held positions in Customer Service, Experience Rating, and Data Resources.
Hal earned the Associate Insurance Data Manager designation from the Insurance Data Management Association (IDMA). He holds a bachelor of science degree in business management from Nichols College in Massachusetts.
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