EDI Update - a State by State Summary

Saturday, June 17, 2006 | 0

The following is a summary of recent changes to EDI requirements changes state by state. State Mandates
Colorado - Mandated EDI filing effective July, 1 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.

Maine - All Notices of Controversy (Denials) must be reported via EDI starting July 1, 2006. Maine will accept the FROI Denial and SROI Denial and Partial Denial. They also require the SROI CO-Correction if they return a TE-Transaction Accepted with Errors.

New Hampshire - Effective July 1, 2006, all First Reports of Injury shall be filed by the insurance carrier or self-insured employer electronically in a manner prescribed by the department. New Hampshire will be implementing Release 3, MTCs 00-Original, 01-Cancel, 02-Change, and CO-Correction Reports. ROES is currently testing with NH and will be ready for production when they are. For more information visit: http://www.labor.state.nh.us/edi_letter.asp. Your trading partner paperwork should be filled out and returned to the state 30 days before you plan on sending data.

Medical Bill Updates
Texas - Texas mandated on June 5, 2006, Medical Bill trading partners, should begin sending historical medical bill data to TX DWC. We are currently sending this historical data to the state on the behalf of many ROES clients. All TP's have 8 weeks to complete submission of all historic medical bill data based on requirements outlined in the May 2, 2006 Medical EDI Implementation Plan. If you would like a copy of this information or have technical questions, please contact Cheryl Keyes at (434)374-0893.

California - The electronic reporting of medical billing data is required in California for any medical service that occurs on or after September 22, 2006. Both California and Texas are using the same electronic format to obtain the data (IAIABC ASC X12 837). ROES is assisting the California with their system testing of the 837 so that any problems can be detected and corrected prior to implementation. ROES clients can use the same flat file format that is used in Texas and Florida to import claims into WorkComp.NET or on-line data entry for filing California medical bills.

Currently, the state of California is offering extensive online training sessions to help Carriers, Administrators and Bill Review Vendors better understand the state's requirements. Download more information and schedule of these training sessions at http://www.dir.ca.gov/dwc/WCIS/WebExMedicTraining.pdf.

IAIABC changes and discussions - in brief
A new data element for Adjusting Location Zip code was approved for Release 3. Technical details as to placement will be forthcoming.

A task force was formed to analyze current 02 changes requirements with the possibility of major changes concerning method and data content.

The IAIABC EDI council approved a Medical EDI committee recommendation that the IAIABC create standards for communicating medical data from providers to payers. This recommendation is a result of recent legislation in TX and CA for provider to payer EDI.

The IAIABC Implementation Guide for Release 3 is available at http://www.iaiabc.org/edi/implementation.htm. An updated edition of the Claims EDI Release 3 Implementation Guide will be available in June 2006, which will include clerical changes and amendments approved by recent IRR's. The IAIABC's website also contains a "Migration" document that compares the Release 1 standard to the new Release 3 standard, and other important code tables required in Release 3. It is recommended that claims-handling entities/claim administrators download this Guide and begin reviewing it with management and IT staff. If you choose to print the Guide, please be advised that it is set up to print double-sided and is 782 pages long.

More information on these topics can be found at www.iaiabc.org.

IAIABC 92nd Annual Convention
The IAIABC and Arkansas Workers' Compensation Commission invite you to attend the IAIABC 92nd Annual Convention in Little Rock, Arkansas, September 24 - 29, 2006. The 2006 program will examine the changes and challenges workers' compensation is currently facing. Agenda topics will include changing workforce demographics, new safety and disability management initiatives, standards for Proof of Coverage laws, and disaster preparedness and EDI committee meetings. More information can be downloaded at: http://www.iaiabc.org/events/convention2006/default.htm#Agenda*.

State Filing Updates
Alabama - Working on their voluntary EDI implementation in 2006.

Alaska - Alaska is planning to implement R3 EDI voluntary in 2006 or 2007.

California - Medical Bill Mandate: On and after September 22, 2006, claims administrators handling one hundred and fifty (150) or more total claims per year shall submit to the WCIS on each claim with a date of service on or after September 22, 2006, data for all medical services for which the claims administrator has received a billing or other report of provided medical services. The California EDI Implementation Guide for Medical Bill Payment Records sets forth the specific California reporting requirements. The claims administrator shall submit the data within ninety (90) calendar days of the medical bill payment.

The Medical Implementation Guide can be found at: http://www.dir.ca.gov/dwc/wcis.htm.

Florida - Planned Release 3 Mandate in 2007. Insurers will have at least 9 months after the effective date of the rule to start testing with the state and another 3 months to go into production.

If you are currently sending claims voluntary to Florida using Release 1 you will be required to convert to Release 3 in the first quarter of the mandate.

A draft of Florida's Release 3 Event Table, Element Requirement Matrix and Edit Matrix can be found here: http://www.fldfs.com/WC/.

Georgia - ICMS will incorporate Electronic Data Interchange (EDI) in Phase 4 implementation. Plan to begin the EDI implementation Summer 2006 with a pilot deployment, followed by a period of voluntary implementations, concluding with mandatory implementation for organizations of a certain claim volume . The details of the mandated implementation have not been determined. They are working on the EDI requirements such as event reporting triggers, MTC's, rules and data elements.

Kansas - Annuals are due within 10 days of June 1st. KS expects Annuals on all Medical Only Claims closed the previous calendar year and all Indemnity Claims that were closed the previous calendar year that had payments after the closing. Denials do not require an Annual to be filed if payments haven't been made after the time of the Denial.

Iowa - Annuals are due starting August. The reporting schedule is as follows - you have two weeks from the first date listed to get your reports into the state:

Company names beginning with A-C----August 1
D-G----August 15
H-Q----September 1
R-Z----September 15
Nebraska - The Employer FEIN will become a mandatory data element for FROI filings. Also, the court has identified a problem where SROI paid-to-date codes 430 and 440 are being used interchangeably for indemnity and medical benefits that are not acquired.

Whenever possible, advance notice of at least 90 days will be given for trading partners to implement EDI data element changes. Effective September 9, 2006, the edits described above will be in place to make the Employer FEIN a mandatory data element for FROI filings and to reject unacquired SROI SAs and FNs with paid-to-date codes of 430 and 440.

Tennessee - Annuals must be filed between July 1st and September 1st. Annuals are due on all files open more than 12 months as of June 30th. All the SROI ANs must be filed by September 1, 2005.

File an AN-Annual on all claims that are open and have been open more than a year as of 6/30/2005. (Do NOT file on claims that have a date of injury prior to 1992). Open means that a FN, SD1 or Court Order has not been filed with the Division.
1) Report all Benefits paid for the life of the claim
2) File for both Indemnity and Medical Only claims
3) "Lump" your Benefits together so that you only have one "line" to TTD, TPD, or each type of "Medical" that you paid out.

Texas - FROI/SROI Processing: Texas is still working on backlogs and reconciling all FROIs then will start processing backlogged SROI. We are working with the state to clear up back filings as soon as possible. Currently, we do not have a target date that TDI DWC will be caught up. All trading partners are asked to continue to submit their transactions in accordance with the jurisdictions statute and rule requirements.

Feature State - Arkansas
Arkansas is a voluntary EDI state. They take Release 1 00-Original reports only.

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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