EDI News From Around The Nation

Saturday, May 5, 2007 | 0

ROES Updates

Automated Triggers is coming to WorkComp.NET! Are you tired of remembering when a report needs to go to the state? If so, contact Pat Cannon at (512) 363-4297, e-mail: prcannon@roeisinc.com to learn how we can automatically trigger your reports so you don't have to!

The Annual ROES User's Conference was held in October 2006 at The Best Western on the Lake in Clarksville, Va.

Nineteen ROES clients and partners attended two and one half days of training tailored to their needs. The User's Conference consisted of state specific training for FROI, SROI and Medical Bills and WorkComp.NET specific training. In addition, Paul Fortier of Maine was present to address Maine specific questions and concerns. Ideas were exchanged and valuable information learned by all.

This year's Annual ROES User's Conference will be scheduled for the third quarter of 2007, dates yet to be determined. The 2007 conference is sure to bring together clients and partners from all over the country so that ideas can be heard and Workers' Compensation EDI skills mastered. Don't delay, put in for your travel request early and contact Shelby Puryear at (434) 374-0893, e-mail: srp@roesinc.com to put your name on the "conference interest" list.

State Filing Updates

Medical Bill EDI Updates

California Medical Bill Reporting -- All Medical Bills with a service date on or after Sept. 22, 2006 must be filed by EDI. If you missed CA's training sessions, you can review their presentations at:

http://www.dir.ca.gov/dwc/WCIS/WCIS_TrainingPresentations/WCISPresentations.htm

ROES is Certified for Production for California, Florida and Texas Medical Bill Reporting: Congratulations to all of our Medical Bill Clients that have completed the test process and are now in production. If you would like information on ROES Medical Bill Solutions, please contact Pat Cannon at (512) 363-4297 or prcannon@roesinc.com.

First & Subsequent Report of Injury Updates Alabama Mandating EDI with Release 3 effective 8-1-07: Alabama is requiring EDI for First Reports (FROI). ROES is beta testing with AL and will let our clients know when they can start reporting via EDI. We plan to move to production in the near future when AL completes development of acknowledgements. AL suggested clients submit their profiles ASAP. Please contact Shelby Puryear, Customer Support, (434) 374-0893, e-mail: srp@roesinc.com for AL TP profiles. More information can be found at:

http://dir.alabama.gov/wc/EDI/edipg1.aspx.

Connecticut is processing FROIs and is looking to implement EDI with new trading partners.

Florida Mandating EDI with Release 3 (R3) includes reporting of FROI and SROI, which correspond to the DWC-1, 12 & 13. More information and Implementation Schedule can be found at:

http://www.fldfs.com/WC/edi_clms.html

Georgia Implementing EDI with Release 3 -- Georgia's Integrated Claims Management System (ICMS) will incorporate Electronic Data Interchange (EDI) in Phase 4 with plans to begin the EDI implementation spring 2007. There will be 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 and need to complete the specifics for electronic reporting, such as event reporting triggers, MTC's, rules and data elements. Updated requirements will be published on their Web site at:

www.sbwc.ga.gov.

If your company is interested in submitting and/or testing with AL, FL or GA, please contact Shelby Puryear, Customer Support, (434) 374-0893, e-mail: srp@roesinc.com or Pat Cannon at (512) 363-4297, e-mail: prcannon@roesinc.com.

New Jersey Clarification on Denials -- If a claim administrator knows they are denying a claim at the outset, no 04-Denial is due in New Jersey. A FROI Denial is only due if an Original FROI was already reported and then the claim was denied with no monies paid. A SROI Denial is due on claims denied but had payments.

West Virginia Reminders and Clarification -- Periodic reports must be filed on any indemnity claim that was open on or after July 1, 2004 until an FN has been submitted. Periodic reporting must resume if the claim is ever reopened for indemnity benefits until a subsequent FN is submitted.

Note: quarterly reporting is not required on medical only claims. Proper quarterly reporting is vital to maintain the integrity of the claims liability calculations. MIRA, the reserving system utilized by W. Va., reads data for a specific period of time in order to calculate claims liabilities. If MIRA does not see either a quarterly (showing the indemnity paid) or an FN (showing that no further indemnity or medical is anticipated), incorrect assumptions are made which result in inaccurate liability calculations.

Also, W. Va. is aware of situations where assigned numbers for claims could be changed for some reason (for example: the first claim is incorrectly cancelled or there is an EDI problem). The Offices of the Insurance Commissioner (OIC) and the Office of Judges (OOJ) needs to be kept informed about these changes so everyone is aware of it and our records reflect accurate information. Should a claim number need to be changed for any reason, please send notice to both Gwen Stone gwen.stone@wvinsurance.gov in Self Insurance and Patricia Fink Patricia.Fink@wvinsurance.gov at the Office of Judges.

EDI/Workers' Compensation Events

IAIABC All Committee Conference: The IAIABC will be hosting the 2007 All Committee Conference at the Galt House Hotel & Suites in downtown Louisville, Ky. on March 26-31, 2007. EDI Training is March 26-27, please see EDI Training Agenda & Registration Form, at www.iaiabc.org/events/acc2007 or contact Julie Krautkramer, (608) 663-6355; e-mail jkrautkramer@iaiabc.org.

93rd Annual IAIABC Convention: The IAIABC and Arizona Workers' Compensation Commission invite you to attend the 93rd Annual IAIABC Convention in Phoenix, Ariz. on Sept. 18-22, 2007.

For more information please see http://iaiabc.org/events/convention2007/

The full series of EDI Training will also be held at the Annual Convention, with special attention to medical billing standards and use of Release 3 for claims.

Feature State -- New Hampshire

New Hampshire mandated FROI EDI filing in July 2006. New Hampshire's implementation was very smooth and there is no test period for ROES clients. If you have NH claims and haven't started doing EDI, please contact Shelby Puryear at (434) 374-0893, e-mail: srp@roesinc.com.

New Hampshire Fun Facts

Of the thirteen original colonies, New Hampshire was the first to declare its independence from England -- a full six months before the Declaration of Independence was signed.

Shrouded in mystery, America's Stonehenge in Salem, N.H., is a popular tourist destination. Was it built by Native Americans, or is it an ancient Celtic calendar, or just the former home of 18th and 19th Century farmers making soap? No one knows for sure, but everyone can agree that it does have some really big rocks.

The Old Man of the Mountain, nicknamed the Great Stone Face or Profile, was located in Franconia Notch State Park. When viewed from the correct angle, it appeared to be the jagged profile of a face. First discovered in 1805, the outcrop was 1,200 feet above Profile Lake, and measured 40 feet tall and 25 feet wide. It collapsed on May 3, 2003. If you didn't get a chance to see it, you can sort of make it out on the back of the N.H. state quarter released in 2000.

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, e-mail prcannon@roesinc.com or visit www.roesinc.com .

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