Oklahoma Workers Compensation Commission

Transcription

1 Oklahoma Workers Compensation Commission

2 EDI = Electronic Data Interchange o EDI format is governed by the International Association of Industrial Accident Boards and Commissions (IAIABC) IAIABC is an association of workers compensation jurisdictional regulators and industry professionals who find solutions to reduce harm and aid recovery from occupational injuries and illnesses. Formats for EDI o OVERVIEW OF EDI The most current release of the IAIABC format is Release 3.0, which the Commission has adopted for mandatory implementation beginning January 1, 2018.

3 Group 1 Voluntary Phase o Registration should be complete by August 25, 2017 o Testing from September 5, 2017 through October 13, 2017 o o Friday October 13, 2017: the last reportable paper report must be received by OKWCC Production Date is Monday, October 16, 2017 if successful completion of testing and approval by OKWCC. Group 2 Mandatory Phase o Suggested to complete registration by October 15, 2017 o Testing from October 16, 2017 through December 15, 2017 o Paper reporting on Friday, December 29, o TIMELINE Production date January 1, OKWCC will no longer accept paper reports starting on this day. Final paper reports must be received by the last business day of 2017 to be processed.

4 TRADING PARTNER REGISTRATION o Registration should be completed at o All Trading Partners are encouraged to submit the OKWCC Trading Partner Profile registration as soon as possible with consideration of the deadlines previously discussed.

5 The various tables, along with the Implementation Guide, define the requirements of EDI reporting in Oklahoma. Event Table o o o Specifies which EDI reports should be filed under what circumstances, and under what deadlines. Includes a Form to MTC Crosswalk MTC= Maintenance Type Code. Example of an MTC is a FROI 00 (First Report of Injury Original) FROI Event Table EVENT TABLE FROI Trigger value indicates when a FROI must be submitted.

6 EVENT TABLE o o FROI 00 due within 10 business days from the date of employer s notice or knowledge of the injury or illness. Rule change requires the FROI submission on all claims resulting in lost time beyond the shift or medical attention away from the work site.

7 EVENT TABLE o SROI Event Table SROI = Subsequent Report of Injury SROI IP (Initial Payment) report is due 15 calendar days from the employer notification

8 EVENT TABLE o Note: calendar and business day distinctions in the Event Table are due to Commission rule requiring that when the time prescribed is less than eleven (11) days, intermediate legal holidays and any other days when the Commission clerk s office is not open, shall be excluded from the computation

9 SROI Periodic Event Table o MTC SA Sub- Annual EVENT TABLE First SA is due 6 months from date of injury and every 6 months thereafter until the SROI FN is filed, indicating closure of the claim. If the claim is closed prior to the initial 6 months when the SA is due, a SROI FN should be filed instead.

10 ELEMENT REQUIREMENT TABLE Element Requirement Table (ERT) defines what data elements are needed for any given report (MTC) ERT contains 6 worksheets: FROI Element Requirements FROI Conditions SROI Element Requirements SROI Conditions Benefit Segments Requirements Benefit Conditions

11 ELEMENT REQUIREMENT TABLE What data is required on EDI reports? o Each MTC and Data Element has a Requirement Code assigned. Requirement Codes express OKWCC s requirement severity by data element and report type (FROI or SROI MTCs).

12 ELEMENT REQUIREMENT TABLE Each MTC and Data Element has a Requirement Code assigned. This example shows F: Fatal and M: Mandatory on specific MTCs. Both will cause the transaction to be rejected if the data elements are missing or invalid

13 ELEMENT REQUIREMENT TABLE This example shows Requirement Codes AR if Applicable/Available Transaction Rejected for DN0021 Employer Physical City for MTC AQ Acquired Unallocated. If the data is sent for a DN defined as AR and fails the edits, the acknowledgment will include an error and the report will be rejected.

14 ELEMENT REQUIREMENT TABLE Data elements that have conditions that make them mandatory if the condition exists are indicated with the MC requirement code such as DN0016 Employer FEIN for MTC 04 Denial, shown here:

15 ELEMENT REQUIREMENT TABLE Conditions are defined on a separate table These are the conditions that define when a DN is mandatory. In the example below, Employer FEIN is required on MTC 04 Denial if Full Denial Reason Code indicates no coverage in effect on the DOI or no coverage due to no jurisdiction.

16 EDIT MATRIX The Edit Matrix defines the edits that will be applied to the EDI data. It conveys each specific edit that will be applied ot each data element and provides the standard error messages associated with these edits. DN Error Message contains standard editing developed for Release 3 data elements Value Table expresses acceptable code values Match Data Describes data elements that will be used to determine if the report will create a new claim or find an existing claim or transaction in the jurisdiction s database Population Restrictions contains any restrictions applied to the data elements Sequencing Table Contains MTC types with the order/sequence that they can be sent, e.g., the sequence in which business events (MTCs) typically occur during the life of a claim

17 EDIT MATRIX- DN ERROR MESSAGE These edits determine what errors would result in rejection. Example: Number of Days Worked Per Week must be 0-7 An L present in a non-grayed field indicates that the edit applies to the data elements based on the requirements indicated on the Element Requirement Tab. On the element requirement table, Number of Days worked per week is AE on all MTC s.

18 EDIT MATRIX- VALUE TABLE The Edit Matrix defines the edits that will be applied to the EDI data. It conveys each specific edit that will be applied ot each data element and provides the standard error messages associated with these edits. For data elements offering multiple different responses, edits are applied to specify which responses are accepted. Here, codes that are accepted for Benefit Type Code are not grayed out. Code 050 for example indicates TTD paid.

19 EDIT MATRIX- MATCH DATA Match Data are data elements that will be used to determine if the report will create a new claim or find and existing claim or transaction in the jurisdiction s database. P indicates the data element is a primary match data element. When there is no match on one of the primary elements, a secondary element is used to match a claim.

20 EDIT MATRIX- MATCH DATA OKWCC also has an indication on the Match Data Table to communicate the match data that is used to match to Legacy Claims-claims received on paper prior to EDI (aka OKWCC Internal MTC JH-Jurisdiction History). For Legacy Claims, OKWCC will allow a FROI or SROI MTC UR to follow.

21 EDIT MATRIX- MATCH DATA Additional Confirmation: When a match is found on the primary or secondary match" data elements, these data elements can be used as additional confirmation that the claim is a duplicate for situations where there may be multiple injuries for the same Date of Injury.

22 EDIT MATRIX- POPULATION RESTRICTIONS Where P exists in the Restrictions Indicator column of the DN-Error Message table, there will be a corresponding entry in the Populations Restrictions table.

23 EDIT MATRIX- POPULATION RESTRICTIONS Each population restriction contains: o Population restriction o Element error number o Error message text o Element error text

24 EDIT MATRIX- POPULATION RESTRICTIONS Example: The population restriction for Industry Code must be 6 characters and a valid NAICS code. Employee ID assigned by jurisdiction must be 4 or 5 digits with last 5 digits of employee SSN, employment visa, green card, or passport number

25 EDIT MATRIX- SEQUENCING TABLE The sequencing table indicates the order in which MTC types can be sent. NA indicates that the MTC is not accepted Minimum sequencing requirements specifies which MTC s must have been accepted before the specified MTC can be accepted. Here, we see that the SA is accepted when a FROI 00, 04, AQ/AU, UI, UR, or previous SROI has been accepted.

26 EDIT MATRIX- SEQUENCING TABLE Simpler version of the sequencing table Fields not filled in gray can follow the subject MTC. Example, FROI 01, 02, 04, CO, AQ, AU, can follow 00 Original.