Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved. Detailed Claim Information Submission, Editing, and Data Reports
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1 Detailed Claim Information Submission, Editing, and Data Reports
2 Agenda Resources Submitting Your DCI Data Overview of Editing Process Editing Flow Reports Recap
3 DCI Resources Reporting Requirements Instructions Record Layouts Edit Matrices General Rules for claim reporting Requirements for preparing and submitting test and production files
4 DCI Resources Access this page by clicking on Data Reporting in the top banner and selecting Detailed Claim Information on the left
5 Submission Methods Data Transfer via the Internet (DTVI) DCI Data Collection File submissions Individual claim entry
6 Data Transfer via the Internet Data Transfer via the Internet (DTVI) Secure Browser Mailbox Web based application Submission and retrieval of data files and return reports/data files are sent electronically through online mailbox Secure FTP Software Software based Submission and retrieval of data files and return reports/data files are automated and based off customer s scheduler File level submissions PGP encryption
7 Data Transfer via the Internet Requires Proper Set Up Data Provider Profile Form Service Provider Agreement (If applicable) Service Provider Data Tool Access Addendum (If applicable) Files must be submitted using the correct naming convention
8 Data Transfer via the Internet Requires Proper Set Up Files must be submitted using the correct naming convention Example: File Prefix *Additional Characters File Extension Identifies data type Identifies DCI files in your system Identifies production file Identifies test file V2DCI. January.TXT.TST * Optional Up to additional 30 characters File Name: V2DCI.January.txt
9 Data Transfer via the Internet Certification Ensures that all connections are functioning, data files are received successfully, and systems are processing correctly. Simulates production processing Required for your vendors and Third Party Administrators (TPA s) Recommended when system changes are made Refer to Electronic Transmission User s Guide on ncci.com for certification requirements
10 Data Transfer via the Internet Pre-Editing Service (Optional) Allows you to submit a file through NCCI s edits without loading to production database. Provides you with Pre Edit Submission Results Report to correct your source system Uses a different naming convention V2DCIPR.February.txt
11 Submission and Editing Flow NCCI Submission Edits Submission Rejects Correct the issue and resubmit Error Free Exhaustive Editing Default NCCI database Reports Rejects Staging
12 DCI Editing Process Receiving DCI Checks for: Validity Accuracy Completeness Accepting DCI Ensure data is: Consistent with Reporting Requirements Meets quality standards Rejecting DCI Allows data provider to: Identify data that may be in error Take corrective action
13 Edit Types Submission Field Logical Relational
14 Submission Edits Submission Field Logical Relational
15 Field Edits Submission Field Logical Relational Is the policy effective date a valid date?
16 Logical Edits Submission Field Logical Relational Is the birth year greater than the accident date?
17 Relational Edits Submission Field Logical Relational Exception: A claim that becomes death or permanent total disability after original reports have been submitted #1234 Open TTD RTI: 9/2014 Original (018): 3/2016 #1234 1/2017 Subsequent (030): 3/2017 include PTD claim in 030 submission
18 Miscellaneous Link Edits Relational edits tied to existing reports on NCCI s database or within the submission For Reporting Replacement Reports: A replacement (with key field changes) must not match an existing claim with the same key fields Original Claim: Policy # P1234 Replacement Report: P12345 Existing Database: P12345
19 Miscellaneous Link Edits Relational edits tied to existing reports on NCCI s database or within the submission For Reporting Replacement Reports: A replacement (with key field changes) must not match an existing claim with the same key fields In order to replace a claim, there must be a matching claim for the same valuation level Original Claim: Policy # P1234 Replacement Report: P12345 Existing Database: P12345
20 Miscellaneous Link Edits Relational edits tied to existing reports on NCCI s database or within the submission For Reporting Subsequent Valuations: Claim must exist prior to reporting a subsequent valuation Be sure to submit in proper sequence Latest Valuation: 030 Next Valuation:
21 Error Classes and Data Grades Error Classes determine how data is processed Data Grades describe the level of severity Error Class Error Free Data Grade Description 0 The DCI report is free of errors. (This error class and data grade are applicable and viewable only when using the DCI tool.) Default 3 A data element was reported incorrectly and NCCI substituted an assumed correct default value for this data element. Reject 9 A critical data element or condition needed for loading and mapping the data was reported incorrectly and is invalid. The DCI report was rejected, is not captured on the production database, and is not used in NCCI s products and services. Corrective Action Required None. None unless default value is incorrect. A resubmission of the report is required.
22 Edit Matrix Available in the DCI Reporting Guidebook Resource for details on all edits performed Available in two versions: DCI Edit Matrix All Edits in Production DCI Edit Matrix Future Edit Enhancements Provides information to assist with working the Submission Results Report and Reject reports
23 DCI Edit Matrix Record Type: Valid record types are: 1 DCI Record Layout 9 Submission Control Record
24 DCI Edit Matrix Data Grade: 0: Error Free 3: Default Edit number: 9: Reject First 4 digits = Data Element Number Last 2 digits = Edit Sequence Number
25 DCI Edit Matrix Data Field: Data element the edit is performed on
26 DCI Edit Matrix Edit Message: Details of the edit performed
27 DCI Edit Matrix Report Type: Original Subsequent Replacement
28 DCI Edit Matrix Edit Type: F= Field L= Logical S = Submission R = Relational
29 DCI Edit Matrix Applicable States: All = All states Otherwise, specific state as listed Excluded States: States that are not subject to edit
30 DCI Edit Matrix Effective Date: The date the edit became effective Edit Change: Provides information on
31 Data Reports Guide
32 Data Reports Guide
33 Data Reports Guide
34 NCCI Generated Produced based on: Submission or Schedule Accessed from: Data Reports Feature within DCI Data Collection Or DCI Data Reporting Page
35 NCCI Generated Submission Results Reports sent to submitter Monthly Reports sent to DCI Data Contact
36 Submission Results Report Details of claims submitted, including rejects (Data Grade 9) and default errors (Data Grade 3) Details of claims submitted, including rejects (Data Grade 9) and default errors (Data Grade 3) notification: Each file submitter Each online data submitter Generated with each electronic submission Generated with each electronic submission Viewable online with option to print Viewable or download online with option to print or download
37 Submission Results Report
38 Submission Results Report
39 DCI Reject Follow-Up Report Details of claims with one or more Details of claims submitted, including rejects rejects (Data (Data Grade Grade 9) and default 9) errors (Data Grade 3) Remains on the report until corrected or is removed from staging and returned to the data provider notification: Each file submitter Each online data submitter Generated with each electronic submission Produced monthly Viewable online with option to print or download
40 DCI Reject Follow-Up Report
41 DCI Reject Follow-Up Report
42 DCI Expected Subsequents Report Details subsequent valuation claims expected in the next 60 days Details of claims submitted, including rejects (Data Grade 9) and default errors (Data Grade 3) Generated two months prior to its valuation month (six months prior to due date) notification: Each file submitter Each online data submitter Generated with each electronic submission Produced monthly Viewable online with option to print or download
43 DCI Expected Subsequent Report Example Claim is valued March 2016 and due June 2016 Will first appear on: January 2016 report (60 days prior to valuation) Will continue to appear on: February 2016 report March 2016 report April 2016 report May 2016 report June 2016 report Claim can now be reported Claim will display on these reports until June unless submitted earlier
44 DCI Expected Subsequents Report
45 DCI Expected Subsequents Report
46 DCI Overdue Subsequents Report Details subsequent valuation not Details of claims submitted, including rejects received (Data three Grade months 9) and after default valuation errors month (Data Grade 3) Overdue notification: 1 12 months, summary and detail Each file submitter Each online data submitter Overdue 13 or more months, counts Generated only with each electronic submission Produced monthly Viewable online with option to print or download
47 DCI Overdue Subsequents Report
48 DCI Overdue Subsequents Report
49 DCI Overdue Subsequents Report
50 Customer-Generated Reports Available upon customer request Based on user criteria Customized version of NCCI production reports DCI Reject Report DCI Expected Subsequents Report DCI Overdue Subsequents Report
51 Customer-Generated Reports
52 Customer-Generated Reports Customized version of NCCI production reports
53 Customer Generated Reports
54 Recap Submission Methods Editing Process DCI Edit Types and Data Grades Data Reports
55 Recommendation
56 Thank you for viewing the Detailed Claim Information Submission, Editing and Data Reports Presentation For questions or additional information, please contact our Customer Service Center at: 800-NCCI-123 ( ) ncci.com, click Contact Us
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