1 florida division of workers’ compensation claims edi mtc’s, codes, froi 00, sroi ip overview...

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Florida Division of Workers’ Florida Division of Workers’ Compensation Compensation

Claims EDI Claims EDI MTC’s, Codes, MTC’s, Codes, FROI 00, SROI IP FROI 00, SROI IP Overview 2013Overview 2013

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Presenter:Presenter:

Tonya GrangerTonya Granger Administrator, Claims & POC Administrator, Claims & POC

EDI TeamEDI Team

Bureau of Data Quality and Bureau of Data Quality and CollectionCollection

FL Division of Workers’ FL Division of Workers’ CompensationCompensation

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In R3 EDI, all WC In R3 EDI, all WC data is sent data is sent

electronically electronically

via a via a

FROI or SROI FROI or SROI transaction.transaction.

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What Is AWhat Is A

??

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First First Report ofReport of

Injury Injury (FROI)(FROI)

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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 In Release 3, the 148 record must be paired with a must be paired with a companion record - companion record - R21R21, FROI , FROI Companion Record to complete Companion Record to complete the First Report of Injury the First Report of Injury transaction.transaction.

Release 3 FROI Release 3 FROI TransactionTransaction

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This means the Release This means the Release 3 FROI transaction 3 FROI transaction

requires requires 2 records2 records to to communicate the First communicate the First Report Report event, the event, the

“148” & “R21”“148” & “R21” records.records.

Release 3 FROI Release 3 FROI TransactionTransaction

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First Report First Report

of Injuryof Injury

FROI =148 + FROI =148 + R21R21

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The FROI The FROI Flat FileFlat File

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FROI Flat File Record FROI Flat File Record Layout is found in Layout is found in Section 2 of the Section 2 of the

Implementation GuideImplementation Guide

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FROI Flat File (148) Record LayoutFROI Flat File (148) Record Layout

Data ElementsData Elements

FillerFiller

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FROI Companion Flat File (R21) Record LayoutFROI Companion Flat File (R21) Record Layout


FillerFiller

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FROI R21 Variable SegmentsFROI R21 Variable Segments

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What Is AWhat Is A

??

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Subsequent Subsequent Report of Report of

InjuryInjury

(SROI)(SROI)

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Originally, the EDI Subsequent Originally, the EDI Subsequent Report of Injury Record was Report of Injury Record was identified by a single record identified by a single record Transaction Set ID of ‘Transaction Set ID of ‘A49A49’. ’.

In Release 3, the A49 must be In Release 3, the A49 must be pairedpairedwith a companion record - with a companion record - R22R22, , SROI Companion Record, to SROI Companion Record, to complete the SROI transaction.complete the SROI transaction.

Release 3 SROI Release 3 SROI TransactionTransaction

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This means the Release This means the Release 3 SROI transaction 3 SROI transaction

requires requires 2 records2 records to to communicate the communicate the

Subsequent Report Subsequent Report event, the event, the

“A49” & “A49” & “R22” “R22” records.records.

Release 3 SROI Release 3 SROI TransactionTransaction

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Subsequent Subsequent Report Report

of Injury of Injury

SROI = SROI = A49+R22A49+R22

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The SROI The SROI Flat FileFlat File

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

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SROI Flat File (A49) Record LayoutSROI Flat File (A49) Record Layout


FillerFiller

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SROI A49 Variable SROI A49 Variable SegmentsSegments

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SROI Companion Flat File (R22) Record LayoutSROI Companion Flat File (R22) Record Layout


FillerFiller

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SROI R22 Variable SROI R22 Variable SegmentSegmentCountersCounters

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SROI R22 Benefit (BEN) SROI R22 Benefit (BEN) SegmentSegment

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SROI R22 Payment/OBT SROI R22 Payment/OBT SegmentsSegments

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SROI R22 SROI R22 Adjustment/Credit/Redistribution Adjustment/Credit/Redistribution

SegmentsSegments

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SROI R22 SROI R22 Recoveries/Reduced Recoveries/Reduced Earnings/SegmentsEarnings/Segments

**Reduced Earnings are not reported in FL.

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SROI R22 Concurrent SROI R22 Concurrent Employer SegmentEmployer Segment

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SROI R22 Denial SROI R22 Denial Reasons/Suspension Reasons/Suspension Variable SegmentsVariable Segments

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EDIEDI TerminologyTerminology

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Let’s Review Let’s Review Important Codes Important Codes Common To EDI Common To EDI

TransactionsTransactions

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Important CodesImportant Codes R3 Quick Code Reference R3 Quick Code Reference

Guide (see FL Claims EDI Guide (see FL Claims EDI webpage)webpage)

Maintenance Type CodesMaintenance Type Codes

Benefit Type CodesBenefit Type Codes

Other Benefit Type CodesOther Benefit Type Codes

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R3 Quick Code R3 Quick Code ReferenceReference

One Stop

Shopping for most codes

Found on Found on FL Claims FL Claims EDI EDI webpagewebpage

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What Is AnWhat Is An

??MTCMTC

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A code that defines A code that defines the specific purpose the specific purpose of each transaction of each transaction being transmitted.being transmitted.

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

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Most MTC codes equate Most MTC codes equate to a DWC Form that will to a DWC Form that will no longer be required to no longer be required to be filed with DWC. be filed with DWC. However the DWC Form However the DWC Form may still be may still be required to required to be sent to other partiesbe sent to other parties (e.g., DWC-1, 4, 12).(e.g., DWC-1, 4, 12).

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When an MTC is required When an MTC is required to be sent at the ‘Benefits to be sent at the ‘Benefits level’ on the SROI (i.e., in level’ on the SROI (i.e., in the benefits segment the benefits segment itself), the same MTC itself), the same MTC must be sent at the ‘Claim must be sent at the ‘Claim level’ on the SROI.level’ on the SROI.

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First First Report ofReport of

Injury Injury MTC’sMTC’s

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FL FROI MTC’s Include FL FROI MTC’s Include ::0000 – Original – Original

0404 – Total Denial – Total Denial

AUAU – Acquired First Report – Acquired First Report

AQAQ – Acquired Claim – Acquired Claim

0101 – Cancel (Claim Filed in Error) – Cancel (Claim Filed in Error)

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FL FROI MTC’s:FL FROI MTC’s:

ChangesChanges

0202 – Change– Change

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SubsequeSubsequent Report nt Report

MTC’sMTC’s

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FL SROI MTC’s:FL SROI MTC’s:

Initial Payment Initial Payment Equivalents:Equivalents:IPIP - Initial Payment- Initial Payment

EPEP – Employer Paid Salary – Employer Paid Salary in Lieu of Compin Lieu of Comp

PYPY – Payment– Payment

APAP - Acquired First Payment- Acquired First Payment

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Initial Payment Initial Payment Equivalents (cont’d):Equivalents (cont’d):

CDCD – Compensable – Compensable Death-No Known Death-No Known Dependents/PayeesDependents/Payees

VEVE - Volunteer- Volunteer

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FL SROI Report MTC’s:FL SROI Report MTC’s:

Denials:Denials:

0404 – Full Denial– Full Denial

PDPD – Partial – Partial Denial Denial (Indemnity (Indemnity Only & other required Only & other required partial denials).partial denials).

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Additions/ChangesAdditions/Changes

CBCB – Change in Benefit – Change in Benefit TypeType

ABAB – Add Concurrent – Add Concurrent BenefitBenefit


CACA – Change in Benefit – Change in Benefit AmountAmount

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ReinstatementsReinstatements

ERER – Employer Reinstatement– Employer Reinstatement

RBRB – Reinstatement of Benefits– Reinstatement of Benefits


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Full Suspensions Full Suspensions (of all Indemnity)(of all Indemnity)

S1S1 – RTW or Released to – RTW or Released to RTWRTW

S2 S2 - Medical Non-- Medical Non-ComplianceCompliance

S3S3 – Administrative Non-– Administrative Non-ComplianceCompliance


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S4S4 – Claimant Death– Claimant Death

S5 S5 - Incarceration- Incarceration

S6S6 – – Claimant’s Claimant’s Whereabouts Whereabouts UnknownUnknown


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S7S7 – Benefits Exhausted– Benefits Exhausted

S8 S8 – Jurisdiction Change– Jurisdiction Change


You should recognize these from the You should recognize these from the DWC-4 FormDWC-4 Form

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Partial Suspension Partial Suspension (of a concurrent (of a concurrent

benefit)benefit) P7P7 – Benefits – Benefits ExhaustedExhaustedFL’s only concurrent benefit type is FL’s only concurrent benefit type is

PT and PT Supplemental Benefits. If PT and PT Supplemental Benefits. If one benefit is suspended but the one benefit is suspended but the other benefit continues, a Partial other benefit continues, a Partial Suspension is filed.Suspension is filed.


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Periodic ReportsPeriodic Reports

SASA – Sub – Sub AnnualAnnualFor EDI R3, the Annual Claim For EDI R3, the Annual Claim Cost Report has been replaced Cost Report has been replaced with a Sub Annual report, with a Sub Annual report, due every 6 months from the due every 6 months from the Date of Injury until the claim is Date of Injury until the claim is closed.closed.


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FNFN – Final– Final

Periodic ReportsPeriodic Reports (cont’d)…(cont’d)…


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Changes Changes

0202 – Changes– Changes

EDI EDIFL SROI MTC’s:FL SROI MTC’s:

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FL requires both the FL requires both the FROI and SROIFROI and SROI combination filing to combination filing to constitute the constitute the electronic form electronic form equivalent of a DWC-1equivalent of a DWC-1 reporting initial reporting initial payment or payment or ‘equivalent’ ‘equivalent’ information. information.

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SROI Maintenance Type SROI Maintenance Type Codes (MTC’s) required by FL Codes (MTC’s) required by FL to be filed with a FROI MTC to be filed with a FROI MTC (00 or AU) (00 or AU) to report the to report the initial payment or equivalent initial payment or equivalent areare: :

IP, EP, PY, PD, CD, VE, & IP, EP, PY, PD, CD, VE, & AP AP

Claims EDI R3 Required Claims EDI R3 Required MTC’sMTC’s

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What are What are

Benefit Type Benefit Type Codes (BTC) ?Codes (BTC) ?

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BTC’s are BTC’s are codes that identify the codes that identify the

type of type of indemnityindemnity benefits being paid. benefits being paid.

TT - TT -

050050TP - TP - 070070

IB - IB -

030030

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010010 – Fatal/Death – Fatal/Death

020020 – Permanent Total – Permanent Total

021021 – Permanent Total Supplemental – Permanent Total Supplemental

Benefit Type Benefit Type CodesCodes

030030 – Perm Partial Scheduled – Perm Partial Scheduled (Impairment (Impairment Income)Income)

040040 – Perm Partial Unscheduled – Perm Partial Unscheduled (Supplemental (Supplemental Income)Income)

050050 – Temporary Total – Temporary Total

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051051 – Temporary Total Catastrophic – Temporary Total Catastrophic

070070 – Temporary Partial – Temporary Partial


090090 – Permanent Partial – Permanent Partial DisfigurementDisfigurement

410410 – Voc Rehab Maintenance – Voc Rehab Maintenance

500500 – Unspecified Lump Sum – Unspecified Lump Sum Pmt/SettlementPmt/Settlement

5XX5XX – Specific Lump Sum – Specific Lump Sum Pmt/Settlement per Pmt/Settlement per Benefit Type Benefit Type Code (e.g., 510, 550, etc.)Code (e.g., 510, 550, etc.)

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210 – 210 – Employer Paid Fatal (Death)Employer Paid Fatal (Death)

230230 – Employer Paid Perm Partial – Employer Paid Perm Partial (IB’s)(IB’s)

240240 - Employer Paid Unspecified - Employer Paid Unspecified

242242 – Employer Paid Voc Rehab – Employer Paid Voc Rehab MaintenanceMaintenance

250250 – Employer Paid Temporary Total – Employer Paid Temporary Total

251251 – Employer Paid Temporary Total – Employer Paid Temporary Total CatastrophicCatastrophic

270270 – Employer Paid Temporary Partial – Employer Paid Temporary Partial


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What are What are “Other “Other

Benefit Type” Codes Benefit Type” Codes (OBT’s)?(OBT’s)?

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OBT’s are OBT’s are codes that represent the codes that represent the

type of type of non-indemnitynon-indemnity benefits being paid.benefits being paid.

311311 321321 370370

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300300 – Total Funeral Expenses – Total Funeral Expenses

310310 – Total Penalties – Total Penalties

311311 – Total – Total EmployeeEmployee Penalties Penalties

320320 – Total Interest – Total Interest

321321 – Total – Total EmployeeEmployee Interest Interest

Other Benefit Type Other Benefit Type Codes Codes (required by FL)(required by FL)

370370 – Total Other Medical – Total Other Medical

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380380 – Total Voc Rehab Evaluation – Total Voc Rehab Evaluation

390390 – Total Voc Rehab Education – Total Voc Rehab Education

400400 – Total Other Voc Rehab – Total Other Voc Rehab

430430 – Total Unallocated Prior Indemnity – Total Unallocated Prior Indemnity Benefits Benefits (acquired claims)(acquired claims)

475475 – Total Medical Travel Expenses – Total Medical Travel Expenses

Other Benefit Type Other Benefit Type Codes Codes (required by FL)(required by FL)

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FL has reduced the FL has reduced the amount of OBT Codes amount of OBT Codes

required to be reported required to be reported for R3, because the for R3, because the majority of medical majority of medical

information is already information is already being reported to the being reported to the Division via another Division via another electronic format.electronic format.

300300 400400 475475

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Hot Hot TopicTopic

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FL no longer requires the FL no longer requires the reporting of: reporting of:

Physician (Medical)Physician (Medical)Hospital, or Hospital, or Pharmacy/Durable Pharmacy/Durable Medical Medical Paid To Date Paid To Date

on the EDI Claim Cost on the EDI Claim Cost “Periodic” report.“Periodic” report.

Other Benefit Type Other Benefit Type Codes Codes (not required by (not required by

FL)FL)

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If you are currently reporting If you are currently reporting this information under OBT this information under OBT 370, it should be corrected 370, it should be corrected using one of the following:using one of the following:

SROI 02 SROI 02

SA (amended) SA (amended)

FN (amended)FN (amended)

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FL BUSINESS FL BUSINESS SCENARIOSSCENARIOS

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FL FL SCENARIO SCENARIO ASSUMPTIOASSUMPTIONSNS

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General scenario General scenario assumptions are assumptions are included in the included in the scenarios to assist in scenarios to assist in understanding the understanding the sample data that is sample data that is presented.presented.

FL SCENARIO ASSUMPTIONSFL SCENARIO ASSUMPTIONS

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The FL Scenarios were The FL Scenarios were enhanced from the IAIABC enhanced from the IAIABC scenarios in the R3 scenarios in the R3 Implementation Guide. Implementation Guide.

All the 2001 dates were moved All the 2001 dates were moved forward to 2007 (the next year forward to 2007 (the next year where all dates fell on the where all dates fell on the same day of the week). same day of the week).


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Calculated Weekly Calculated Weekly Compensation AmountCompensation Amount is is the Comp. Rate, and is 66 the Comp. Rate, and is 66 2/3% of the Average Wage2/3% of the Average Wage..

The statutory comp rate The statutory comp rate max is not accurate per FL max is not accurate per FL law.law.


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Scenarios are presented in Scenarios are presented in uppercase text. However, data uppercase text. However, data may be sent to FL in mixed case may be sent to FL in mixed case format format (except between FROI/SROI (except between FROI/SROI combos for match data.) combos for match data.)


The Industry Code must The Industry Code must be a 2002 or 2007 be a 2002 or 2007 NAICS codeNAICS code..

Payment of indemnity Payment of indemnity benefits benefits is based upon is based upon a 5 day work week.a 5 day work week.

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FL Scenarios contain FL Scenarios contain required sample data required sample data elements pertinent to the elements pertinent to the scenario. These data are scenario. These data are identified as identified as “M” “M” (Mandatory)(Mandatory) or or “MC” “MC” (Mandatory/Conditional)(Mandatory/Conditional) on on the FL Element Requirement the FL Element Requirement TableTable. .


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Additional data elements Additional data elements may be present in the may be present in the scenario if they are scenario if they are identified as identified as “IA” (If “IA” (If Applicable/Available)Applicable/Available) on on the Element Requirement the Element Requirement Table (e.g., Middle Initial Table (e.g., Middle Initial and Suffix)and Suffix). .


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Although Claim Although Claim Administrators may send Administrators may send additional data elements additional data elements marked marked “NA” (Not “NA” (Not Applicable),Applicable), such data will such data will not be edited or loaded by not be edited or loaded by FL, and therefore not FL, and therefore not presented in the scenarios. presented in the scenarios.


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Note:Note: Do Do notnot use the FL use the FL Business Scenarios to Business Scenarios to determine if a data determine if a data element is required for a element is required for a particular MTC.particular MTC.

The Element Requirement The Element Requirement Table is the official source Table is the official source of FL’s data element of FL’s data element requirements per MTC and requirements per MTC and the conditions under which the conditions under which the data must be present.the data must be present.

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FL SCENARIO FL SCENARIO PROFILESPROFILES

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Unless otherwise noted in Unless otherwise noted in the scenario narrative, the scenario narrative,

the basic scenario the basic scenario profile information for profile information for

all scenarios will be all scenarios will be as follows…. as follows….

FL Scenario FL Scenario ProfilesProfiles

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Injured EmployeeInjured Employee

DescriptionDescription DataData

Name:Name: John James John James Smith, Jr.Smith, Jr.

SSN:SSN: 324-55-6745324-55-6745

DOI:DOI: June 15, 2007June 15, 2007

DOB:DOB: May 1, 1953May 1, 1953

Empmnt Status: Empmnt Status: Full Time Full Time


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Injured EmployeeInjured Employee


Class Code:Class Code: 2802 2802 (Carpenter)(Carpenter)

Days Worked/Week:Days Worked/Week: 55

Wage:Wage: $15.00 $15.00 Wage Period:Wage Period: Hourly Hourly

(FROI)(FROI)


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Employer/InsuredEmployer/InsuredDescriptionDescription DataData

Employer:Employer: Acme Construction Acme Construction Inc.Inc.

FEIN:FEIN: 74-699423574-6994235

Physical Location:Physical Location: 32 32 Meadowbrook LaneMeadowbrook Lane

Anytown, FL 32399Anytown, FL 32399

Industry (NAICS): 236116Industry (NAICS): 236116


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FL Scenario FL Scenario ProfilesProfiles Insurer/Claim AdministratorInsurer/Claim Administrator


Insurer:Insurer: Old Reliable Old Reliable Ins. Co.Ins. Co.

FEIN:FEIN: 78-590237878-5902378

Average Wage:Average Wage: $600.00 $600.00 Wage Period:Wage Period: Weekly Weekly (SROI) (SROI)

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A FROI A FROI MUSTMUST be paired with be paired with the applicable SROI that is the applicable SROI that is reporting the initial payment reporting the initial payment or equivalent, unless the or equivalent, unless the FROI is reporting a Full FROI is reporting a Full Denial (MTC 04), Cancel Denial (MTC 04), Cancel (MTC 01), Change (MTC 02) (MTC 01), Change (MTC 02) or Acquired Claim (MTC AQ).or Acquired Claim (MTC AQ).

FL SCENARIOSFL SCENARIOS

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Complete Scenario Complete Scenario forfor FROI/SROI FROI/SROI

Combo Combo MTC “00” with MTC “00” with

“IP”“IP”Disability Disability

Immediate & Immediate & ContinuousContinuous

Rule 69L-Rule 69L-56.301(1)(a)1., 56.301(1)(a)1.,

F.A.C.F.A.C.

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NEW CLAIMNEW CLAIM: Lost Time Case: Lost Time CaseWhere Disability is Immediate and Where Disability is Immediate and ContinuousContinuous

If the Initial Payment of If the Initial Payment of Indemnity Benefits will be Indemnity Benefits will be made by the Claim made by the Claim Administrator, and Administrator, and

Indemnity Benefits Indemnity Benefits other other than TP or IB or settlementthan TP or IB or settlement will be paid, anwill be paid, an

Electronic First Report of Electronic First Report of Injury or Illness is due.Injury or Illness is due.

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NEW CLAIMNEW CLAIM: Lost Time Case: Lost Time CaseWhere Disability is Immediate and Where Disability is Immediate and ContinuousContinuous

Again, the specific Again, the specific timeframes for the timely timeframes for the timely submission of this and submission of this and other required electronic other required electronic filings are set out in Rule filings are set out in Rule 69L-56, F.A.C., the Event 69L-56, F.A.C., the Event Table, and the MTC Filing Table, and the MTC Filing Instructions document (all Instructions document (all available on the Claims EDI available on the Claims EDI web page.)web page.)

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To avoid late filing penalties To avoid late filing penalties for an Electronic First Report for an Electronic First Report of Injury or Illness, the EDI of Injury or Illness, the EDI DWC-1 should be triggered DWC-1 should be triggered immediately upon the CA’s immediately upon the CA’s disposition of the claim disposition of the claim (payment or denial), to allow (payment or denial), to allow time for correction of time for correction of potential errors and potential errors and resubmission and subsequent resubmission and subsequent receipt/acceptance by the receipt/acceptance by the Division within the filing due Division within the filing due dates specified in Rule 69L-56, dates specified in Rule 69L-56, F.A.C.F.A.C.

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FROI “00” Scenario FROI “00” Scenario NarrativeNarrative Employee fell from ladder at Employee fell from ladder at

employer’s warehouse employer’s warehouse on on 6/15/07. 6/15/07.

Employee broke his leg.Employee broke his leg. Foreman witnessed the Foreman witnessed the

accident.accident. Employee treated and released Employee treated and released

from the Emergency Room.from the Emergency Room.

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Employee earned Employee earned $15.00 an hour $15.00 an hour working 40 hours a working 40 hours a week.week.

Employer reported Employer reported injury to insurer on injury to insurer on 6/17/07.6/17/07.

FROI “00” Scenario FROI “00” Scenario NarrativeNarrative

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FROI MTC “00” FROI MTC “00” SCENARIOSCENARIO

Claim Administrator Claim Administrator reported the loss to DWC reported the loss to DWC on 6/29/07.on 6/29/07.

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Insurer is identified. Insurer is identified. Claim Administrator details Claim Administrator details are provided are provided (remainder are (remainder are on R21).on R21).


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Employer/Insured Employer/Insured information is reported.information is reported.

The Employer’s name is on the The Employer’s name is on the R21R21

The rest of the Employer’s address is on The rest of the Employer’s address is on the R21the R21

NAICS NAICS CodeCode


99

If applicable, Policy If applicable, Policy Number should be Number should be reported, but Effective reported, but Effective Date & Expiration Date are Date & Expiration Date are not required.not required.


100

Details of the accident are Details of the accident are included. included. Employee broke leg falling Employee broke leg falling fromfrom a ladder.a ladder.


101

Employer reported injury to Employer reported injury to Claim Administrator on Claim Administrator on 6/17/07.6/17/07.


102

The rest of The rest of the the Employee’s Employee’s name and name and address is address is on the R21 on the R21

Details about injured employee Details about injured employee are sent.are sent.


103

Date the initial disability began & Date the initial disability began & other FROI fields must be reported other FROI fields must be reported on the SROI.on the SROI.Manual “Risk” Class Code is only on Manual “Risk” Class Code is only on the FROI.the FROI.


104

Employee earned $15.00 an Employee earned $15.00 an hour and worked 5 days a hour and worked 5 days a week.week.Employee has not returned to Employee has not returned to work.work.


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FROI Companion Record - R21FROI Companion Record - R21


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Claim Administrator Claim Claim Administrator Claim Number is repeated in the Number is repeated in the R21. It links the R21 R21. It links the R21 companion to the related companion to the related 148.148.


107

Claim Administrator FEIN is Claim Administrator FEIN is sent.sent.Claim Administrator Name Claim Administrator Name is sent, is sent, & rest of the Claim Admin. & rest of the Claim Admin. Address.Address.


456 Main St

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ID qualifier = S.ID qualifier = S.Positions 232 to 246 Positions 232 to 246 contain a Social Security contain a Social Security Number.Number.


109

Remainder of Employee Remainder of Employee name, address fields and name, address fields and phone are here in the R21 phone are here in the R21 record. record.


110

Type of Loss Code is Type of Loss Code is reported on the SROI.reported on the SROI.Employee has not returned Employee has not returned to work.to work.


111

Insured FEIN and Insured Insured FEIN and Insured Name are reported.Name are reported.


112

Insurer Name and Insurer Type Insurer Name and Insurer Type Code are reported.Code are reported.


113

Details of accident site:Details of accident site:


114

Employer Name, Employer Name, PhysicalPhysical address and contact address and contact information.information.


115

Employer Employer MailingMailing Address Address information is not required.information is not required.


116

Claim Type Code and EP Salary Claim Type Code and EP Salary Indicator are to be reported on Indicator are to be reported on the SROI.the SROI.


117

Variable Segment Counters include:Variable Segment Counters include:Two Accident/Injury Narratives, andTwo Accident/Injury Narratives, andOne Witness segment.One Witness segment.


118

Accident description exceeds Accident description exceeds 50 characters; two segments 50 characters; two segments are needed to send entire are needed to send entire narrative description.narrative description.


119

Variable Segment Variable Segment Population Rules for Population Rules for

FROIFROI ACCIDENT/INJURY DESCRIPTION ACCIDENT/INJURY DESCRIPTION NARRATIVES NARRATIVES SEGMENT:SEGMENT:

No more than No more than 1010 (50 byte (50 byte narrative text) segments per narrative text) segments per claim, and the number of claim, and the number of segments sent must equal the segments sent must equal the ““Number” of Accident/Injury Number” of Accident/Injury Description Narratives segment Description Narratives segment counter.counter.

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Foreman Jones was the only Foreman Jones was the only witness.witness.


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Variable Segment Variable Segment Population Rules for Population Rules for

FROIFROI WITNESSES WITNESSES SEGMENT:SEGMENT:

No more than No more than 55 witnesses witnesses per claim, and the number per claim, and the number of segments sent must of segments sent must equal the “equal the “Number” of Number” of Witnesses segment Witnesses segment countercounter..

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CorrespondiCorrespondingng SROI SROI MTC “IP”MTC “IP”

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MTCMTC “IP” (Initial “IP” (Initial Payment)Payment)The Claim Administrator The Claim Administrator

has issued its first has issued its first payment of indemnity payment of indemnity benefits (not a lump sum benefits (not a lump sum payment/settlement.)payment/settlement.)The Initial Payment The Initial Payment transaction implies that transaction implies that indemnity benefits are indemnity benefits are ongoing until suspended.ongoing until suspended.

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SROI IP Scenario SROI IP Scenario NarrativeNarrative

On 6/29/07, the Claim On 6/29/07, the Claim Administrator issued the Administrator issued the first indemnity check. first indemnity check.

Check covered TTD Check covered TTD benefits from 6/23/07 benefits from 6/23/07 through 6/29/07 (through 6/29/07 (Day 8-Day 8-14).14).

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SROI MTC “IP” SROI MTC “IP” SCENARIOSCENARIOInitial Payment transaction Initial Payment transaction

is sent to the Division on is sent to the Division on 6/29/07.6/29/07.

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Initial Date Disability Began is Initial Date Disability Began is the day after DOI because the day after DOI because Employer paid for DOI.Employer paid for DOI.Employee was a 5 day per week Employee was a 5 day per week worker.worker.

SROI MTC “IP” SROI MTC “IP” SCENARIOSCENARIO

127

Claim Admin. Claim Number Claim Admin. Claim Number must be sent on every must be sent on every record.record.


128

No Jurisdiction Claim number No Jurisdiction Claim number required because IP SROI is required because IP SROI is filed with 00 FROI.filed with 00 FROI.


129

Claim Type indicates Lost Claim Type indicates Lost Time case.Time case.


130

No variable segments; A49 No variable segments; A49 ends at position 208.ends at position 208.


131

Claim Administrator Claim Claim Administrator Claim Number is repeated in R22. Number is repeated in R22. It links the R22 companion It links the R22 companion to the related A49.to the related A49.


132

Claim Administrator Claim Administrator information:information:


133

R22 includes additional R22 includes additional employee information.employee information.


134

These fields are either not These fields are either not required, or they are required, or they are reported on the FROI.reported on the FROI.


135

These fields are not These fields are not applicable to this claim, applicable to this claim, except the Initial Date Last except the Initial Date Last Day Worked.Day Worked.


136

Current Date Disability Began Current Date Disability Began should NOT be defaulted to the should NOT be defaulted to the same as the Initial Date Dis same as the Initial Date Dis Began. Only populated if there Began. Only populated if there is a 2is a 2ndnd period of disability. period of disability.


137

Weekly Compensation Rate is Weekly Compensation Rate is $400$400based on Average Wage of based on Average Wage of $600 effective the Date of $600 effective the Date of Injury.Injury.


138

Type of Loss Code and Type of Loss Code and Employment Status Code are Employment Status Code are reported on the SROI.reported on the SROI.


139

Additional wage Additional wage information:information:


140

One One BenefitsBenefits segment and one segment and one PaymentPayment segment are required segment are required on this claim.on this claim.


141

Temporary Total was the only Temporary Total was the only benefit paid. MTC is also in Ben benefit paid. MTC is also in Ben segment for IP.segment for IP.


142

Gross & Net Weekly Amount = Gross & Net Weekly Amount = $400/week (comp rate), effective $400/week (comp rate), effective on the DOI.on the DOI.


143

SROI MTC “IP” SROI MTC “IP” SCENARIOSCENARIOThe Gross Weekly Amount The Gross Weekly Amount

is the weekly payment rate is the weekly payment rate for the Benefit Type for the Benefit Type reported.reported.

144


145

Initial payment reflected benefits Initial payment reflected benefits paid from June 23 thru June 29, paid from June 23 thru June 29, 20072007 (Day 8-14) for 1 week in the (Day 8-14) for 1 week in the amount of $400.amount of $400.


146

Ben Payment Issue Date is the date Ben Payment Issue Date is the date payment left the CA’s control, e.g., payment left the CA’s control, e.g., mailed (6-28-07), not necessarily mailed (6-28-07), not necessarily the system check issue date.the system check issue date.


Benefit Payment Issue Date Benefit Payment Issue Date (DN 0192)(DN 0192)

& & Payment Issue Date Payment Issue Date

(DN 0195)(DN 0195)

Due to the advancement of Due to the advancement of technology, technology, Payment Issue DatePayment Issue Date & & Benefit Payment Issue Date Benefit Payment Issue Date werewere recently updated and recently updated and added to the current IAIABC added to the current IAIABC Supplement to include Supplement to include electronic fund transfer (EFT) electronic fund transfer (EFT) payments made by the claim payments made by the claim administrator to an injured administrator to an injured employee. employee.

Benefit Payment Issue Date (DN Benefit Payment Issue Date (DN 0192) and Payment Issue Date 0192) and Payment Issue Date

(DN 0195)(DN 0195)

The update to the The update to the definitions of definitions of Payment Payment Issue DateIssue Date and and Benefit Benefit Payment Issue DatePayment Issue Date will be will be in the 2014 IAIABC in the 2014 IAIABC Implementation Guide Implementation Guide (Data Dictionary). (Data Dictionary).


(DN 0195)(DN 0195)

For Maintenance Type For Maintenance Type Codes:Codes:

IPIP - Initial Payment,- Initial Payment,APAP - Acquired/Payment, - Acquired/Payment, PYPY - Payment Report, and- Payment Report, andRBRB - Reinstatement of - Reinstatement of Benefits,Benefits,

the Benefit Payment Issue the Benefit Payment Issue Date and Payment Issue Date and Payment Issue Date is…Date is…


(DN 0195)(DN 0195)

……the date when the check the date when the check that initiated the that initiated the Maintenance Type Maintenance Type Code is officially Code is officially surrendered during business surrendered during business hours to a letter delivery hours to a letter delivery organization, is available for organization, is available for pickup per agreement with pickup per agreement with the employee, or…the employee, or…


(DN 0195)(DN 0195)

… … the date the funds are the date the funds are available to the available to the employeeemployee, if the payment , if the payment is made by Electronic is made by Electronic Funds Transfer (EFT)Funds Transfer (EFT). .


(DN 0195)(DN 0195)

If a claim administrator If a claim administrator opts to pay an injured opts to pay an injured employee via EFT, it is the employee via EFT, it is the claim administrator’s claim administrator’s responsibility to be responsibility to be familiar with the bank’s familiar with the bank’s process to ensure Payment process to ensure Payment Issue Date is reported Issue Date is reported accurately. accurately.

Electronic Fund Transfer Electronic Fund Transfer (EFT) Payments(EFT) Payments

Florida Statute 440.20(1)(a) Florida Statute 440.20(1)(a) states:states:

““Compensation by direct Compensation by direct deposit or through the use of a deposit or through the use of a prepaid card is considered paid prepaid card is considered paid on the date the funds become on the date the funds become available for withdrawal by the available for withdrawal by the employeeemployee.”.”

Electronic Fund Transfer Electronic Fund Transfer (EFT) Payments(EFT) Payments

155

Back to the Back to the SROI MTC “IP” SROI MTC “IP”

SCENARIOSCENARIO

156

FL requires the reporting FL requires the reporting of the exact amount of of the exact amount of the Claim Administrator’s the Claim Administrator’s initial payment of initial payment of indemnity benefits on indemnity benefits on MTC IP; therefore, the MTC IP; therefore, the Payment Payment segment must segment must also be sent on the SROI, also be sent on the SROI, in accordance with the in accordance with the Element Requirement Element Requirement table.table.


157

If filing late, or re-sending If filing late, or re-sending an 00/IP that previously an 00/IP that previously rejected, rejected, ANDAND another another indemnity check has been indemnity check has been issued since the first issued since the first installment, the installment, the Benefit Benefit Type Amount Paid Type Amount Paid should should reflect the reflect the total amount and total amount and ALL benefits paid to dateALL benefits paid to date at at the time of filing, not just the time of filing, not just the amount of the initial the amount of the initial indemnity (IP) check. indemnity (IP) check.


158

However, theHowever, the PaymentPayment Segment should only Segment should only reflect the reflect the initial payment initial payment informationinformation, not , not subsequent payment subsequent payment information. information.

This is the segment from This is the segment from which DWC loads the ‘Date which DWC loads the ‘Date First Payment Mailed’, to First Payment Mailed’, to its claims system utilized its claims system utilized by CPS.by CPS.


159

MTC IP requires a Payments MTC IP requires a Payments segment.segment.Payment Reason Code = Payment Reason Code = Benefit Type Code.Benefit Type Code.


160

Payment information related Payment information related to the Initial Payment is to the Initial Payment is captured in the Payments captured in the Payments segment.segment.


161

Payment Issue Date = Benefit Payment Issue Date = Benefit Payment Issue Date in Benefits Payment Issue Date in Benefits Segment.Segment.


162

Hot Hot TopicTopic

Claim Claim Administrator Administrator Claim NumberClaim Number

(DN 0015)(DN 0015)

The current IAIABC Supplement The current IAIABC Supplement was recently updated to clarify was recently updated to clarify that a that a Claim Administrator Claim Administrator Claim NumberClaim Number should be unique should be unique for each claim in the claim for each claim in the claim administrator’s system. administrator’s system.

Claim Administrator Claim Claim Administrator Claim Number Number DN 0015 DN 0015

This means that a claim This means that a claim administrator should not report administrator should not report more than one claim with the more than one claim with the same claim number. same claim number.


Additionally, the Data Additionally, the Data Processing Rule for this Processing Rule for this definition was updated to definition was updated to ensure that the Employee SSN ensure that the Employee SSN is not reported as or embedded is not reported as or embedded in the claim number to prevent in the claim number to prevent confidentiality or redaction confidentiality or redaction issues for states that must issues for states that must produce public records.produce public records.


Due to Florida’s broad public Due to Florida’s broad public records law, which requires records law, which requires the release of a claim number the release of a claim number on a public records request, in on a public records request, in April 2013, the Division April 2013, the Division implemented edits to prevent implemented edits to prevent the reporting of Employee SSN the reporting of Employee SSN in the Claim Administrator in the Claim Administrator Claim Number field. Claim Number field.


These changes were necessary These changes were necessary to avoid the accidental release to avoid the accidental release of the employee’s SSN when a of the employee’s SSN when a claim number is provided as claim number is provided as part of a public records request. part of a public records request.


169

After you get back to the office,After you get back to the office, ALL Questions ALL Questions, either , either

Business or Technical, should Business or Technical, should be sent via email to be sent via email to

[email protected]

This email address is copied to This email address is copied to all members of the EDI team. It all members of the EDI team. It

is the quickest and most is the quickest and most efficient way for us to respond efficient way for us to respond

to your concerns. to your concerns.

170

Questions?Questions?

1 florida division of workers’ compensation claims edi mtc’s, codes, froi 00, sroi ip overview...

Documents

sroi transaction slide

r21 slide

froi transaction slide

mtc slide

sroi flat file slide

a49 r22 slide

froi flat file slide

report of injury froi