annual workers’ compensation information system advisory committee · pdf...
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ANNUAL WORKERS’ COMPENSATION INFORMATION
SYSTEM
ADVISORY COMMITTEE MEETING
2016 First Reports of Injury and Subsequent Reports of Injury Update
Oakland, CA
October 24, 2016
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Discussion Outline
FROI Reporting Update
SROI Reporting Update
Proposed Version 3.1 Regulations
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System Basics As of October 2016:
12 Million Claims
Completeness (2015)*
FROI: 91-92%
SROI: 64%
Denials: 88%
Data Quality (2015)
FROI: 74% Transactions Accepted (TA) without error
SROI: 86% Transactions Accepted (TA) without error
Timeliness of FROI (2013-2015) : 76% to 84%
*Estimated against DWC-Audit Report of Inventory (ARI)
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FROI Completeness (92% for 2015)
2015 ARI-WCIS Comparison
701,343
636,197
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
ARI* WCIS
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Changing requirements and uses of FROIs Foundational Documents will effect completeness
1. Employers First Report (EFR)
2. Doctors First Report (DFR)
3. Application for Adjudication (WCAB case)
4. Any information that the injury requires medical care. (Bill, etc.)
* SB 1160 requires to be collected electronically.
** Matching FROI-WCAB integral part of measuring lien claimant impact.
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FROI Data Quality 2015
Accept (TA) 75%
Accept with
errors (TE) 21%
Reject (TR) 4%
Industry Code (NAICS, SIC)*
Wage Period Code (6,1,2,4 only)
Class Code (WCIRB Only)
Postal Code Injury Site (USPS)
2015 Total FROI Records: 2.2 Million
Top Rejection (TR) Reason
Duplicate FROI
Top Error (TE) Reasons
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Discussion on FROI Quality How do we improve employer information reporting and coding? Including the reporting of FEINs, Names, Industry Codes and Class codes
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Timeliness: 2015 Statewide FROI Timeliness of Reporting
FROIs Reported %
On-Time 84%
Late ( > 10 business days) 16%
Median Days for All Statewide Reported FROIs = 3 Days Mean (Average) Days for All Statewide Reported FROIs = 10
Aggregate Reports for Timeliness of Reporting and Data on other
Items can be found on the WCIS Reports page:
http://www.dir.ca.gov/dwc/wcis/WCIS_Reports.html
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SROI Completeness (64% for 2015)
2015 ARI-WCIS Comparison
536,922
344,501
0
100,000
200,000
300,000
400,000
500,000
600,000
ARI* WCIS
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SROI Completeness not the same for all Carriers Levels of Reporting
1. Reporting All SROI
2. Reporting Most/Some SROI A. Missing a component of SROI (AN reporting, Medical Only
Reporting, Settlements)
B. Missing an element: Date Disability Began, Permanent Impairment Rating )
3. Reporting No SROI
4. Reporting No FROI or SROI
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SROI completeness issues not the same across employer types Self-insured and self-administered employers (Public and Private) struggle to report when compared to large multistate carriers.
60.9
69.7
50.1
33.3
0
10
20
30
40
50
60
70
80
All EMPLOYERS INSUREDEMPLOYER
SELF-INSUREDEMPLOYER
PUBLICEMPLOYER
SROI percentage of FROI (not excluding Denials)
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Discussion on SROI Completeness
How can we get reporters of FROI to start reporting SROI?
How can we help increase the reporting of public employers and self-insured employers?
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SROI Data Quality 2015
Top Rejected (TRs) Reasons
Invalid Payment/Adjustment Code
Invalid Sequencing
Event Criteria not Met
2015 Total SROI Records: 2.2 Million
Accept (TA) 86%
Accept with
errors (TE) 4%
Reject (TR) 10%
Top Error (TE) Reason
Reporting number of Permanent Impairments
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Discussion on SROI Complexity and Reporting Burden
How can we reduce the SROI reporting burden and make it easier to send data while maintaining the structure of the IAIABC system?
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Proposed FROI/SROI Guide 2nd 15 day comment period coming soon.
Sign-up for E-News
See Rule Making website
37 Proposed changes (for complete listing see appendices A and B of the proposed)
12 Month implementation schedule
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Highlights of the Current Proposal
Changes in how to transmit data (FTP, File Naming Convention)
Control over JCN assignments with new Matching Criteria
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Changes to how FROI/SROI Receives Data
SFTP Transmission and Account
Will no longer allow FTPS, or FTP over SSL. Will only allow SFTP known as SSH (Secure Shell).
More direct account management by WCIS
New File Naming Convention.
FROI/SROI Naming Convention will match medical billing naming convention
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New File Naming Convention FROI/SROI Naming Convention will match medical billing naming convention
FILE TYPE (148,A49, AK1) , followed by Underscore
Sender 9 Digit FEIN, followed by Underscore
Sender 9 digit Zip Code, followed by Underscore
8 Digit Date Stamp- Formatted as (CCYYMMDD) , followed by Underscore
6 Digit Time Stamp- Formatted As (HHMMSS), followed by Underscore
T or P for Testing or Production, followed by Underscore
Unique 3 digit (148 or A49) or 9 digit counter for (AK1) files , followed by Underscore
Followed by .txt
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Control over JCN For better management of JCNs and avoidance of duplicate claims, WCIS proposes:
Make JCN Mandatory on all FROI non-original transactions and all SROI
Establish new match criteria. Current Criteria uses the same secondary match attempt on
all FROI transactions.
This criteria relies on easily inconsistent data elements like part of body and nature of injury for all different types of transactions
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Proposed New Matching
Uses a set of common more static elements: Data elements (JCN, Insurer FEIN, Claim Admin FEIN, Claim
Admin Claim Number, DOI, DOB, Employee First Name, Employer FEIN, TOI).
Tailored specifically to each transmission type:
The 00, the 01, the 04, and CO/02 have their own matching criteria
All SROIs have the same matching criteria
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Other Proposed Changes of Note:
Proposed Changes
Time of Injury now conditionally required on non-CT claims
All Industry Codes must be NAICS
Claim Administrator FEIN now required on all transactions.
TPA FEIN and Name changed to Claim Admin FEIN and Claim Admin Name
Corrections must be sent in 60 days.
Reduction in sequencing requirements for Date of Maximum Medical Improvement
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Sign-up for Aggregate and Detail WCIS FROI Reports at [email protected]
• Download from http://www.dir.ca.gov/dwc/WCIS.htm
• FROI and SROI Valid Values Table (Release 1, Version 3.0)
• 2013 - 2015 WCIRB Class Codes (DN 59)
Read the Guides, and FAQs
Check your Mapping, Event and Validation Tables
Contact Your Trading Partner EDI Contact or [email protected]
Contact Us for Consultations
Sign up for E-news and Training Bulletins
Where to get informed…
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Current Reports Available Timeliness of FROI Reporting-Sent Semi-Annually
Data Quality Report to Claim Administrator-Sent Monthly
ARI-WCIS Comparison Report-Sent Annually.
Completeness and Timeliness of TD reporting on the IP-Sent Semi-Annually
All available by signing-up at [email protected]
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* This Workflow Diagram covers a majority of Scenarios, but due to space limitations does not cover 100% of the scenarios in FROI/SROI 28
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Acknowledgments before we begin DIR Staff
EDI Staff
Programmers
Reporting Team
Trading Partners
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EDI Contacts Johnny Lee
email: [email protected] Trading partner letters A, C, G, I-L, S-V, Z
Elisema Cantu email: [email protected] Trading partner letters B, D-F, H, M-R, W-Y
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Questions?
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