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Claims EDI R3 Data Warehouse Featured Functionality

Claims EDI R3 Data Warehouse Featured Functionality. The DWC Claims EDI Data Warehouse reflects the raw data exactly as sent by the claim administrator, with a few formatting exceptions (e.g. dates displayed in readable format).

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Claims EDI R3 Data Warehouse Featured Functionality

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  1. Claims EDI R3 Data Warehouse Featured Functionality

  2. The DWC Claims EDI Data Warehouse reflects the raw data exactly as sent by the claim administrator, with a few formatting exceptions (e.g. dates displayed in readable format). It does not imply that the EDI filing was accepted and loaded to DWC’s accident database.

  3. Maintaining Trading Partner Accounts The EDI Team establishes the initial data warehouse administrator account for each Trading Partner. Afterwards, this designated“Account Administrator” isbe responsible for the maintenance of their company’s account.

  4. Maintaining Trading Partner Accounts Access to a Trading Partner’s warehouse account should be removed when an employee no longer works for your company. Please do not delete the user from the warehouse … Do Not Delete

  5. Maintaining Trading Partner Accounts … An account should only be deleted if it was established in error. Deleting the user will also delete the user’s name as the ‘last note author’ in the warehouse. Instead, follow the instructions on the following slides…

  6. From the Main Menu click on Maintain My Company’s Log In Accounts.

  7. Find the user you wish to revoke and click on their user id.

  8. Place a check mark in the revoked box and a date and time revoked will be automatically added.

  9. Click Save and Close. The user will no longer have access; however, their notes will remain as the last note author.

  10. POP QUIZ: If a transaction receives a TR, and I don’t understand why, what do I do next?...

  11. ANSWER: … Login to the Data Warehouse and look up the filing.

  12. Claims EDI Data Warehouse Search for an individual claim or query by date ranges.

  13. Let’s look at a “Rejected Record” Click on EE name hyperlink to see details of filing. Note: You can sort on any column header (defaults to Div Rec’d + Date/Time Processed.)

  14. Caution: There may be more than one page of transactions per query. Be sure to hit the ‘Next’ key to scroll to the next page, or enter the page number you want to see.

  15. This is a test case.

  16. There are 3 Tabs of Data This is a test case. Click on Errors and Problems

  17. Errors are noted on the Errors Tab FROI has 1 error; SROI rejected because FROI was not accepted.

  18. Fatal Errors are inRed

  19. What do you do if you do not understand the error? Note the Element # (0185) and Error # (064)

  20. Go to your copy of theEdit Matrix. Most recent version is posted on DWC’s Claims EDI webpage athttp://www.myfloridacfo.com/wc/edi_clms.html

  21. Click on the ‘Population Restrictions’ tab in the spreadsheet.

  22. Find the DN # and Error # from the Error tab in the warehouse, in the 3rd column of the Population Rest.

  23. Read the details of the error in the 5th column.

  24. This error indicates that although Insurer Type Code ‘S’ was sent to indicate a self-insured employer, DWC can not match the Insurer FEIN sent to the FEIN of an authorized self insurer.

  25. In this example, since the rejection was for an EDI DWC-1, the Claim Admin. must quickly determine the correct self insured FEIN number (or Insurer Type Code) and resubmit both the FROI 00 and SROI IP to achieve a “TA” within the timeframes required by rule.

  26. New Feature: Search by Element/Error Code

  27. The new ‘Search by Element/Error Code’ feature was added in response to a suggestion from a Trading Partner.

  28. Search by Element/Error Code • This feature allows you to research how many claims have rejected (or received TA-FL) for a particular DN/Error combination. • We recommend your query include a reasonable date range to avoid locking up the system.

  29. Search by Element/Error Code

  30. Search by Element/Error Code Drop Down Box with all DN/Error Combinations

  31. Search by Element/Error Code As with all Search Results, you can import the results into Excel.

  32. Let’s Look At Another Error Example Filing in the Warehouse…

  33. The error, “BOTH FROI & SROI MUST PASS EDITS TO ACCEPT FILING” means: • When submitting an original First Report (MTC 00), you are required to submit a corresponding SROI initial payment or equivalent, so • If either transactions fails edits, both transactions will automatically fail for this reason.

  34. In this example the SROI failed, so the FROI was not accepted. All 001 Error requirements/conditions are documented in the Element Requirement Table. Note DN 0196.

  35. Go to your copy of theElement Requirement Table. Most recent version is posted on the Claims EDI webpage at http://www.myfloridacfo.com/wc/edi_clms.html

  36. Click on SROI Elements Tab…and find DN 0196. The requirement code = MC, which means you must look at the SROI Conditions Tab

  37. Click on SROI Conditions Tab…and find DN 0196.

  38. Reminder: How to research errors? Error 001 – Element Requirement Table (including Conditions Tab) Error 057 – Edit Matrix: Pop Rest and Duplicate Tab Error 063 – Edit Matrix: Pop Rest, Sequencing and Duplicate Tab Error 117 - Edit Matrix: Pop Rest and Match Data, and Duplicate Tabs All Other Error #’s: Pop Restrictions Tab

  39. Some Errors for Error # 063 are found in the Sequencing Tab of the Edit Matrix.

  40. Most Errors for Error # 057, and some for #063 and 117 are found in the Duplicate Processing Tab of the Edit Matrix.

  41. Recap: • ‘TR’ Acknowledgement Code means your “transaction rejected” and must be resent. • A TR can not be fixed with an 02 Change. • At this time, please do not write notes or ask questions related to TRrecords via the warehouse; instead email claims.edi@myfloridacfo.com

  42. Reminder: • Do not alter any factual data or Benefit/Payment information in an attempt to pass an edit. • Thoroughly research the problem and either correct the inaccurate data and re-send the transaction, or email the EDI team if you suspect our program/edit is at fault.

  43. Recap: • If inaccurate data results in a CPS penalty, the Claim Administrator must send MTC 02 (or other appropriate MTC) to correct the data. • After the MTC is accepted, notify the CPS specialist to re-evaluate the penalty.

  44. CLAIMS EDI If you already investigated an error and still do not understand it, please send an email to claims.edi@myfloridacfo.com, rather than individual EDI team members. This email copies all team members.

  45. When sending emails, please: • Create a subject line specific to the error; do not include SSN’s; • Provide the JCN or your Claim number; • Provide the MTC and Received Date; & • Clarify which error in which table you do not understand. • Note: We can not address questions relative to problems in your company’s or vendor’s software.

  46. The Claims EDI Team receives approximately 50+ emails per day; therefore, if you have not received an answer or some acknowledgement of your emailed question within 2 business days, please resubmit.

  47. Responding to Reconciliation (Non-Fatal) Errors TA-FL’s

  48. Reconciliation (Non-Fatal) Errors • FL’s program also contains edits that identify data considered to be “suspect”, but which does not warrant rejecting the filing. • These edits generate “Reconciliation Errors”.

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