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Periodic filings, SROI SA, FN report the total cumulative amounts paid in indemnity (Benefits segment) and certain medical costs (Other Benefits segment.)
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8. 8 Recap: For Periodic MTC’s SA, FN, “Benefit Period Start Date” is:
Earliest date for a BTC;
Even if multiple benefit periods have been paid for the BTC. “Benefit Period Start Date”
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34. 34 SROI SA, FN Electronic Claim Cost
In addition to indemnity benefits, the following Other Benefit Type Codes/Amounts are required on Electronic Claim Cost Reports MTC SA and FN:
OBT 300 (Funeral),
OBT 310/311 (Penalties),
OBT 320/321 (Interest),
OBT 370 (Other/Misc. medical)...
35. 35 SROI SA, FN Electronic Claim Cost
…
OBT 380 (Voc Rehab Eval)
OBT 390 (Voc Rehab Education – includes post-secondary education to dependent)
OBT 400 (Other Voc Rehab),
OBT 430 (Unallocated Indemnity) and
OBT 475 (Mileage/Travel Expenses.
36. 36 SROI SA, FN Electronic Claim Cost
Miscellaneous Medical includes costs not otherwise classified or required to be reported to DWC pursuant to Rule 69L-7.602, F.A.C., including,
Custom handicapped equipped housing, incl. ramps, wide doorways, etc.,
Custom vans,
Therapeutic hot tubs,
Home attendant care,
On-site field case management services…
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37. 37 …Telephonic nurse case management services (except where Claim Admin. uses the services of a case manager for a face-to-face meeting with the physician to conduct a telephone call with the treating physician or participate in a team conference, in which case the claim administrator should report under medical EDI codes 99361 through 99373),
Hospice, etc.
38. 38 SROI SA, FN Electronic Claim Cost
Expense items should not be reported under Other Medical/OBT 370, e.g.:,
Cost for bill review services, or
Determining correct medical reimbursement relating to PPO discounts,
Drug screen expenses, etc.
Note: Payments to the EE for EE-paid Rx are reported as an ‘employee reimbursement’ via the medical EDI format (vs. Other medical).
39. 39 SROI SA, FN Electronic Claim Cost
FL no longer requires the inclusion of the following costs on the SROI SA or FN, since the following are reported via the medical EDI format:
OBT Code 350 (Physician),
OBT Code 360 (Hospital),
OBT Code 450 (Pharmacy)
OBT Code 455 (Durable medical),
OBT Code 460 (Physical therapy) and
OBT Code 465 (Chiropractic).
40. 40 SROI SA, FN Electronic Claim Cost
SROI SA/FN is not required for the following types of claims (and therefore not on Missing SA Report): , unless one or more BTC’s or required OBT’s have been paid:
FROI 04 (Total Denial)
00/PD (Indemnity Only Denied)
00/CD (Compensable Death, No Depndts)
00/VE (Compensable Volunteer)
S8 (Claim transferred to another juris)
PY with RBAC S or N (Settlement with $0)
FROI 01 (Claim cancelled)
41. 41 Caveats and Tips for Successfully Filing SROI SA, FN
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43. 43 If a suspension is not yet ‘on file’ and you need to report a BTC paid in the past that was improperly left off the previous accepted filing, our program will allow you to ‘introduce’ the new Benefit type via MTC CB.
(Even though you are not actually changing the current BTC to the new BTC.)
44. 44 However, if you need to report a BTC that was paid in the past but left off the previously accepted transaction but a suspension has already been filed, it is difficult to fix the ‘benefit picture’ with another transaction / MTC.
45. 45 In this case, you would not send a SROI RB if indemnity benefits have truly not been reinstated. If you filed an RB, you would be precluded from sending another Sx with the same (true) Susp. Effective Date.
Therefore, you would need to send a request to the Claims EDI Team for special handling.
46. 46 As a result of seeing this situation occur for legacy as well as new claims, FL has proposed a new Lump Sum Payment/Settlement Code (ND – Non Disputed) to enable the reporting of a one time payment of back benefits without having to “change” or “reinstate” benefits (pending IRR discussion/vote.)
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