EDI State Filing Update

Saturday, January 14, 2006 | 0

The following is an EDI state filing update prepared by Red Oak E-Commerce Solutions, Inc.:

California Medical -

CA is mandating Medical Bill submission for 2006. CA proposed rules for Medical EDI and updated Implementation Guides are available at the following web site: http://www.dir.ca.gov/dwc/DWCPropRegs/WCIS_Regulations/WCIS_regulations.htm.


California - Annuals

Yes, it's that time already! It may seem like summer just ended, but January is here which means CA Annuals are due once again.

What you need to know on filing CA Annuals:

1) All files that had activity in the previous calendar year (January 1 through December 31) that have NOT had an FN-Final reported (note, if there were payments made after the FN-Final those must appear on the Annual). This includes both Indemnity and Medical Only claims.
2) Be sure to include all payments made for the life of the claim.
3) Like payments should be added together and "lumped" on one line.
4) If reporting Medical Only and the claim is closed, you can send the Claim Status code as "Closed" and not have to report a Final. Alternatively, you can report a Final instead of the Annual for Medical Only claims.
5) You can NOT close an Indemnity claim on an Annual. Be sure your Claim status is NOT "Closed" for Indemnity claims.
6) Make sure all back filings are caught up before you file your Annuals. If you report a Payment/Adjustment on an Annual that was not previously reported on another filing, CA will Reject your Annual.

Colorado

Don't forget Colorado MANDATED EDI filing for July 2006! All First Reports and Notices of Contests (Denials) must be filed by EDI starting in July. All Denials in Colorado must be filed as a Subsequent report. FN-Final reports can also be filed by EDI.

Florida

Plans to adopt the IAIABC Claims Release 3.0 national standard by a future rule that will require (mandate) insurers to electronically report certain claims information to the Division (initially the DWC-1 First Report of Injury and the DWC-13 Claim Cost Report). A draft of the rule is expected to be workshopped later this year, but the compliance/implementation date for electronically filing the DWC-1 and DWC-13 is anticipated to occur in mid to late 2006 -- Insurers will be allowed at least 9 months after the effective date of the rule to commence testing with the Division, plus another 3 months to be in production status. A draft version of the FL R3 manual will be posted to the Division's web site, http://www.fldfs.com/WC/edi_clms.html, later.

Iowa

Chris Godfrey is the new commissioner of the Iowa Workers' Compensation Division. Godfrey will assume his new position on Monday, taking over the division that Mike Trier ran from 2002 until his retirement on Dec. 30.

Also, Iowa's email addresses are changing; new emails are:
Janna Polite, EDI Compliance Mgr, (515) 281-4177, Janna.Polite@iwd.iowa.gov
Larry Lancaster, (515) 281-8336, Larry.Lancaster@iwd.iowa.gov

Maine

The mandate for FROI has been completed and a Committee was formed to review the strategy and time frame for Denials and Payments. The Committee has decided to implement Denials in a phased fashion beginning in April 06 with the goal of having all Trading Partners in production by July 1, 2006. The Event, Element Requirement, and Edit Matrix tables have been uploaded to Maine web site, http://www.maine.gov/wcb/Electronic%20Claims%20Reporting/IAIABC/IA%20Format%20Docs.htm.

Nebraska

Filing changes - Nebraska has added some new edits to their system to help guarantee the quality of the data on their side. These include:

1) An Initial Payment (IP) or Semi-Annual (SA) will no longer be accepted following an Acquired/Unallocated (AU).
2) An Acquired Payment (AP) will no longer be accepted after an Original (00).
3) Indemnity Benefits will no longer be accepted on a First Non-Indemnity Payment (PY), as this interferes with transaction sequencing and it is not an R1 standard.
4) A Final (FN) will not be accepted without a prior IP, AP or PY being received and accepted.

Also, Nebraska will take the new, more specific, Body Part Codes for Permanency on SROI filings. These include more exact impairment definitions for Ear, Eye, Finger, Thumb, Toes, and Great Toe.

New contact information - If you haven't done so already, please update your Nebraska Contact information. Bruce Mayfield's email address has changed to: bruce.mayfield@wcc.ne.gov. Also, if you previously used Sandy White as a contact, she is no longer at the division. Please call on Beth Garbers or James Lillis instead:
Beth Garbers: 402-471-8992, beth.garbers@wcc.ne.gov
Jamie Lillis: 402-471-6457, james.lillis@wcc.ne.gov
Main toll free line: 800-599-5155

New Hampshire

Enactment of recent legislation affecting RSA 281-A:SB58 - requires first reports of injury to be filed electronically as of July 1, 2006 unless it causes a carrier or self-insured employer undue hardship.

Texas

House Bill 7 transfers the functions of the Texas Workers' Compensation Commission (TWCC) to the newly created Division of Workers' Compensation at the Texas Department of Insurance (TDI), effective September 1, 2005. All addresses and telephone numbers for the DWC Central Office and Field Offices will remain the same as the TWCC numbers.

The DWC Central Office is at: 7551 Metro Center Drive, Ste. 100, Austin, TX 78744-1609. The main phone number for the Central Office is 512-804-4000.

The WC Division Web site changed to http://www.tdi.state.tx.us/wc/indexwc.html EDI Information can be found at http://www.tdi.state.tx.us/wc/information/ediguide/edi-guides.html.

TX DWC Medical EDI Test Environment (ref DWC memo 1/10/06): Technical issues that prevented testing of Medical EDI files in the test environment have been resolved and the test process is online. Automated scripts are picking up inbound test files and processing those files during four test cycles scheduled at 8:00 a.m., 10:00 a.m., 1:00 p.m., and 4:00 p.m. Outbound test acknowledgment files are placed in the outbound directories the on the same schedule.

Inbound 837 test files submitted between Monday, December 19, 2005 and Monday, January 9, 2006 are being processed. Duplicate files do not have to be submitted by trading partners for files submitted during this period of time.

If 837 test files pass structural edits and trading partner validation, acknowledgement files are placed in the outbound test directories the next test cycle.

An updated Medical EDI 837 Defects document will be published to the Division website Wednesday, January 11, 2006. Please report defects that are not identified in the updated Defects document, or that reflect a closed status, to the Division in writing. Include the file name of the associated test file, a detailed description of the potential defect, and contact information in the report.

Please submit questions and defects in writing via email to Joseph Montoya, joseph.montoya@tdi.state.tx.us through Friday, January 20, 2006 and copy Sandy Guidry, sandy.guidry@tdi.state.tx.us. Questions after January 20, 2006 may be submitted directly to Sandy Guidry.

West Virginia

The following change should not impact EDI reporting to WV. On January 1, 2006, the West Virginia Workers' Compensation Commission will cease to exist and be replaced by BrickStreet Mutual Insurance. From Jan. 1, 2006 to July 1, 2008, BrickStreet Insurance will be the sole source of legally required workers' compensation coverage for all employers doing business in West Virginia. On July 1, 2008, West Virginia's insurance market will open to all private carriers licensed to do business in West Virginia. BrickStreet will continue to be the sole source of workers' compensation coverage for all state agencies, boards, commissions, and higher education through 2012. Go to http://www.wvwcc.org/ for more info.

Article by the staff at Red Oak E-Commerce Solutions, Inc. (ROES). ROES offers a full range of products and services to meet the Electronic Data Interchange (EDI) and state reporting compliance of the workers' compensation industry. ROES' products and services are available to claim administrators, insurance companies, self-insured / self-administered employers, and state agencies. For more information, please contact Pat Cannon at 512-363-4297, email prcannon@roesinc.com or visit www.roesinc.com.

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