Florida Division of Workers’ CompensationClaims EDI MTC’s, Codes, FROI 00, SROI IP Overview 2013 WELCOME
Presenter: Tonya Granger Administrator, Claims & POC EDI Team Bureau of Data Quality and Collection FL Division of Workers’ Compensation
In R3 EDI, all WC data is sent electronically via a FROI or SROI transaction.
What Is A ? FROI
Release 3 FROI Transaction Originally, the EDI First Report of Injury Record was identified by a single record with a Transaction Set ID of '148'. In Release 3, the 148 record must be paired with a companion record - R21, FROI Companion Record to complete the First Report of Injury transaction.
Release 3 FROI Transaction This means the Release 3 FROI transaction requires 2 records to communicate the First Report event, the “148” & “R21” records.
First Report of Injury FROI =148 + R21
FROI Flat File Record Layout is found in Section 2 of the Implementation Guide
FROI Flat File (148) Record Layout Data Elements Filler
Data Elements Filler FROI Companion Flat File (R21) Record Layout
What Is A ? SROI
Subsequent Report of Injury (SROI)
Release 3 SROI Transaction Originally, the EDI Subsequent Report of Injury Record was identified by a single record Transaction Set ID of ‘A49’. In Release 3, the A49 must be paired with a companion record - R22, SROI Companion Record, to complete the SROI transaction.
Release 3 SROI Transaction This means the Release 3 SROI transaction requires 2 records to communicate the Subsequent Report event, the “A49” & “R22” records.
Subsequent Report of Injury SROI = A49+R22
SROI Flat File Record Layout is found in Section 2 of the Implementation Guide
SROI Flat File (A49) Record Layout Data Elements Filler
SROI Companion Flat File (R22) Record Layout Data Elements Filler
SROI R22 Variable Segment Counters
SROI R22 Recoveries/Reduced Earnings/Segments **Reduced Earnings are not reported in FL.
Important Codes • R3 Quick Code Reference Guide (see FL Claims EDI webpage) • Maintenance Type Codes • Benefit Type Codes • Other Benefit Type Codes
R3 Quick Code Reference Found on FL Claims EDI webpage One Stop Shopping for most codes
What Is An ? MTC MTC
Maintenance Type Code
Maintenance Type Code A code that defines the specific purpose of each transaction being transmitted.
Maintenance Type Code DWC Forms required to be filed with the Division are replaced by EDI filings identified by MTC codes.
Maintenance Type Code Most MTC codes equate to a DWC Form that will no longer be required to be filed with DWC. However the DWC Form may still be required to be sent to other parties(e.g., DWC-1, 4, 12).
Maintenance Type Code When an MTC is required to be sent at the ‘Benefits level’ on the SROI (i.e., in the benefits segment itself), the same MTC must be sent at the ‘Claim level’ on the SROI.
FL FROI MTC’s Include : 00 – Original 04 – Total Denial 01 – Cancel (Claim Filed in Error) AQ – Acquired Claim AU – Acquired First Report
FL FROI MTC’s: Changes 02– Change
FL SROI MTC’s: Initial Payment Equivalents: IP- Initial Payment PY– Payment EP– Employer Paid Salary in Lieu of Comp AP- Acquired First Payment
FL SROI MTC’s: Initial Payment Equivalents (cont’d): CD– Compensable Death-No Known Dependents/Payees VE- Volunteer
FL SROI Report MTC’s: Denials: 04– Full Denial PD– Partial Denial (Indemnity Only & other required partial denials).
FL SROI MTC’s: Additions/Changes AB– Add Concurrent Benefit CA– Change in Benefit Amount CB– Change in Benefit Type
FL SROI MTC’s: Reinstatements RB– Reinstatement of Benefits ER– Employer Reinstatement
FL SROI MTC’s: Full Suspensions (of all Indemnity) S1– RTW or Released to RTW S2 - Medical Non-Compliance S3– Administrative Non-Compliance