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WELCOME PowerPoint Presentation

WELCOME

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WELCOME

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  1. Florida Division of Workers’ CompensationClaims EDI MTC’s, Codes, FROI 00, SROI IP Overview 2013 WELCOME

  2. Presenter: Tonya Granger Administrator, Claims & POC EDI Team Bureau of Data Quality and Collection FL Division of Workers’ Compensation

  3. In R3 EDI, all WC data is sent electronically via a FROI or SROI transaction.

  4. What Is A ? FROI

  5. First Report ofInjury (FROI)

  6. 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.

  7. Release 3 FROI Transaction This means the Release 3 FROI transaction requires 2 records to communicate the First Report event, the “148” & “R21” records.

  8. First Report of Injury FROI =148 + R21

  9. The FROI Flat File

  10. FROI Flat File Record Layout is found in Section 2 of the Implementation Guide

  11. FROI Flat File (148) Record Layout Data Elements Filler

  12. Data Elements Filler FROI Companion Flat File (R21) Record Layout

  13. FROI R21 Variable Segments

  14. What Is A ? SROI

  15. Subsequent Report of Injury (SROI)

  16. 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.

  17. Release 3 SROI Transaction This means the Release 3 SROI transaction requires 2 records to communicate the Subsequent Report event, the “A49” & “R22” records.

  18. Subsequent Report of Injury SROI = A49+R22

  19. The SROI Flat File

  20. SROI Flat File Record Layout is found in Section 2 of the Implementation Guide

  21. SROI Flat File (A49) Record Layout Data Elements Filler

  22. SROI A49 Variable Segments

  23. SROI Companion Flat File (R22) Record Layout Data Elements Filler

  24. SROI R22 Variable Segment Counters

  25. SROI R22 Benefit (BEN) Segment

  26. SROI R22 Payment/OBT Segments

  27. SROI R22 Adjustment/Credit/Redistribution Segments

  28. SROI R22 Recoveries/Reduced Earnings/Segments **Reduced Earnings are not reported in FL.

  29. SROI R22 Concurrent Employer Segment

  30. SROI R22 Denial Reasons/Suspension Variable Segments

  31. EDITerminology

  32. Let’s Review Important Codes Common To EDI Transactions

  33. Important Codes • R3 Quick Code Reference Guide (see FL Claims EDI webpage) • Maintenance Type Codes • Benefit Type Codes • Other Benefit Type Codes

  34. R3 Quick Code Reference Found on FL Claims EDI webpage One Stop Shopping for most codes

  35. What Is An ? MTC MTC

  36. Maintenance Type Code

  37. Maintenance Type Code A code that defines the specific purpose of each transaction being transmitted.

  38. Maintenance Type Code DWC Forms required to be filed with the Division are replaced by EDI filings identified by MTC codes.

  39. 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).

  40. 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.

  41. First Report ofInjury MTC’s

  42. FL FROI MTC’s Include : 00 – Original 04 – Total Denial 01 – Cancel (Claim Filed in Error) AQ – Acquired Claim AU – Acquired First Report

  43. FL FROI MTC’s: Changes 02– Change

  44. Subsequent Report MTC’s

  45. FL SROI MTC’s: Initial Payment Equivalents: IP- Initial Payment PY– Payment EP– Employer Paid Salary in Lieu of Comp AP- Acquired First Payment

  46. FL SROI MTC’s: Initial Payment Equivalents (cont’d): CD– Compensable Death-No Known Dependents/Payees VE- Volunteer

  47. FL SROI Report MTC’s: Denials: 04– Full Denial PD– Partial Denial (Indemnity Only & other required partial denials).

  48. FL SROI MTC’s: Additions/Changes AB– Add Concurrent Benefit CA– Change in Benefit Amount CB– Change in Benefit Type

  49. FL SROI MTC’s: Reinstatements RB– Reinstatement of Benefits ER– Employer Reinstatement

  50. FL SROI MTC’s: Full Suspensions (of all Indemnity) S1– RTW or Released to RTW S2 - Medical Non-Compliance S3– Administrative Non-Compliance