Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 Florida Division of Workers Compensation Claims EDI Release 3 Training 2008 (Continued)

Similar presentations


Presentation on theme: "1 Florida Division of Workers Compensation Claims EDI Release 3 Training 2008 (Continued)"— Presentation transcript:

1 1 Florida Division of Workers Compensation Claims EDI Release 3 Training 2008 (Continued)

2 MTC 02 Change Processing Rules

3 3 Change Processing Rules Transaction Usage MTC 02 (Change) transaction is intended to: Allow Claim Administrators to correct data previously reported erroneously and/or, Allow Claim Administrators to correct data previously reported erroneously and/or, Allow Claim Administrators to update previously reported data. Allow Claim Administrators to update previously reported data.

4 4 02 Change Processing Rules Transaction Usage MTC 02 should not be used to report a change in data where other transactions are intended to serve that purpose. CACB ABRB P7

5 5 Change Processing Rules Transaction Usage If a data element designated as FY, fy, Y, Y 1, Y 2, Y 3, Y 4 or YC in the MTC 02 column of the Element Requirement table is changed, the Claim Administrator must trigger an 02 (Change) transaction, unless another MTC applies.

6 6 Change Processing Rules Transaction Usage If a data element designated as N 1 in the MTC 02 column of the Element Requirement table is changed, the Claim Administrator can send an 02 (Change) transaction, unless another MTC applies; however, an 02 is not required every time the value in this field changes.

7 7 Change Processing Rules Transaction Usage An example of a data element designated as N 1 is Benefit Type Amount Paid. If you have reported this incorrectly, then an MTC 02 should be sent; however, if the Benefit Type Amount Paid changes because you have paid another bi-weekly check, we do not need or want an MTC 02.

8 8 Change Processing Rules Florida has expanded on the ERT standard Requirement Codes for MTC 02. See bottom of SROI Element Requirements.

9 9 Change Processing Rules R3 Limitations Known to Date

10 10 Change Processing Rules R3 Limitations Known to Date The current R3 MTC 02 has several known limitations, e.g., a transaction must not include changes to more than one Match data element at a time. The current R3 MTC 02 has several known limitations, e.g., a transaction must not include changes to more than one Match data element at a time. A full listing of these limitations can be found in Section 4 of the Release 3 Implementation Guide (02 Change Processing Rules). A full listing of these limitations can be found in Section 4 of the Release 3 Implementation Guide (02 Change Processing Rules). The IAIABC is currently working on resolving these limitations. The IAIABC is currently working on resolving these limitations.

11 11 Change Processing Rules Claim Administrator Considerations

12 12 Change Processing Rules Claim Administrator Considerations Claim administrators must send MTC 02 (Change) transactions at the appropriate time to avoid transactions rejecting. Claim administrators must send MTC 02 (Change) transactions at the appropriate time to avoid transactions rejecting. (e.g., must send SSN change via MTC 02 before sending next the transaction containing the new SSN). (e.g., must send SSN change via MTC 02 before sending next the transaction containing the new SSN).

13 13 Change Processing Rules Claim Administrator Considerations Claim administrators should analyze Floridas Element Requirement Table and Edit Matrix to learn how data element(s) will be processed on MTC 02 Change transactions.

14 14 Electronic Notice of Change MTC 02 (Required by Primary Implementation Schedule) See Rule 69L , F.A.C.

15 15 An Electronic Notice of Change, MTC 02 is due if: A DN designated as Y, YC, Y 1, Y 2, Y 3, Y 4, fy or FY in the FROI/SROI 02 columns of the FL Element Requirement Table changes, unless specifically indicated in the Rule as not required until the Secondary Implementation Schedule. MTC 02 Changes (Primary)

16 16 MTC 02 Changes (Primary) If any of the following DN(s) change, an MTC 02 is required during the Primary Implementation (DWC-4): 1. Insurer FEIN (not due to change in claims administration) 2. Claim Admin. FEIN (not due to change in claims administration) 3. Claim Admin. Postal Code (not due to change in claims administration) …

17 17 (contd) … Claim Administrator Claim Number 4. Claim Administrator Claim Number 5. Employee SSN or Division-Assigned # 6. Employee Name (First, Middle, Last, Suffix) … 7. Date of Injury … MTC 02 Changes (Primary)

18 18 (contd) … 8. Employee Date of Death 9. Manual (Risk) Class Code (FROI 02 Only) Industry Code (NAICS) (FROI O2 Only) 10 Industry Code (NAICS) (FROI O2 Only) MTC 02 Changes (Primary)

19 19 Electronic Notice of Change MTC 02 (Required by Secondary Implementation Schedule) See Rule 69L , F.A.C.

20 20 If any of the following DN(s) change, an MTC 02 is required during the Secondary Implementation (DWC-4): 1. MMI 2. PI 3. Initial RTW (and RTW Type Code, Physical Restrictions Indicator) 4. Current RTW (and RTW Type Code, Physical Restrictions Indicator) … MTC 02 Changes (Secondary)

21 21 (contd) … 5. PI Minimum Payment Indicator 6. RTW with Same Employer Indicator 7. Suspension Effective Date 8. Suspension Narrative (not required, but used to report a change if previously sent inaccurately). MTC 02 Changes (Secondary)

22 22 9. Average Wage 10. Wage Effective Date 11. Calculated Weekly Comp. Amnt. 12. Gross Weekly Amount 13. Gross Weekly Amount Eff. Date 14. Net Weekly Amount Eff. Date … MTC 02 Changes (Secondary) No Change to Net to require CA

23 23 (contd) … 15. Benefit Adjustment Code 16. Benefit Adjustment Start Date 17. Benefit Adjustment End Date 18. Benefit Credit Code 19. Benefit Credit Start Date 20. Benefit Credit End Date MTC 02 Changes (Secondary) No Change to Net to require CA

24 24 An MTC 02 must be sent when there is NO CHANGE TO THE NET WEEKLY AMNT because: The indemnity benefit being paid will continue to be paid at the same statutory maximum weekly rate, OR The indemnity benefit being paid will continue to be paid at the same statutory maximum weekly rate, OR A code, date, or amount previously reported is being corrected AND the Net Weekly Amount is unchanged: A code, date, or amount previously reported is being corrected AND the Net Weekly Amount is unchanged:

25 Benefit Redistribution Amount 22. Benefit Redistribution Start Date 23. Benefit Redistribution End Date Benefit Redistribution Code is not listed because FL only accepts one valid Redistribution Code; therefore, it will reject if invalid and can not be changed via MTC 02. MTC 02 Changes (Secondary)

26 26 Note: If reporting the End Date for a Benefit Redistribution in conjunction with the suspension of indemnity, the Benefit Redistribution End Date may be reported on the MTC Sx in lieu of sending MTC 02. MTC 02 Changes

27 27 Important: The JCN sent on the SROI MTC 02 must match the JCN on file for the existing SSN/DOI. Important: The JCN sent on the SROI MTC 02 must match the JCN on file for the existing SSN/DOI. MTC 02 Changes

28 28 Important: If you are trying to change the date the initial payment was mailed, you must send an 02 change reflecting a new Benefit Payment Issue Date AND Payment Issue Date. DWCs system will be updated from the corresponding Payment Issue Date in the Payment segment. Important: If you are trying to change the date the initial payment was mailed, you must send an 02 change reflecting a new Benefit Payment Issue Date AND Payment Issue Date. DWCs system will be updated from the corresponding Payment Issue Date in the Payment segment. MTC 02 Changes

29 29 Important: If you are trying to change certain data related to the initial payment, and subsequent MTCs have been accepted since the FROI/SROI, the 02 will not update certain fields. You will need to contact your EDI Liaison to make the change manually. Important: If you are trying to change certain data related to the initial payment, and subsequent MTCs have been accepted since the FROI/SROI, the 02 will not update certain fields. You will need to contact your EDI Liaison to make the change manually. MTC 02 Changes

30 30 Change Processing Rules If the Element Requirement Table for MTC 02 indicates that a data element can be changed on both the FROI and SROI, an 02 can be sent on either the FROI or SROI.

31 31 A single MTC 02 transaction can not be sent to change multiple match data elements, such as SSN, Claim Admin. Claim Number, etc. A single MTC 02 transaction can not be sent to change multiple match data elements, such as SSN, Claim Admin. Claim Number, etc. If two match data elements need to be changed, a second MTC 02 transaction will need to be sent after the first MTC 02 is accepted. If two match data elements need to be changed, a second MTC 02 transaction will need to be sent after the first MTC 02 is accepted. Change Processing Rules

32 32 Exceptions: Exceptions: Employee Name fields will be treated as one match data field if more than one aspect of the name is changed; Employee Name fields will be treated as one match data field if more than one aspect of the name is changed; Employee ID & Employee ID Type Qualifier can both change on a single MTC 02; Employee ID & Employee ID Type Qualifier can both change on a single MTC 02; The same is true for Claim Administrator FEIN and Claim Administrator Postal Code The same is true for Claim Administrator FEIN and Claim Administrator Postal Code Change Processing Rules

33 33 If multiple MTC 02s to change match data elements are sent in the same batch (i.e., same transmission, same day), the Claim Administrator will have to incorporate the prior change(s) in each subsequent MTC 02 transaction(s) and risk that each prior MTC 02 was accepted, so that the match data elements will match down the line. Change Processing Rules

34 34 Changes to data elements designated as N, NA or X on FLs Element Requirement Table, that are sent on an MTC 02 transaction, will not be processed/loaded to the Divisions database. Change Processing Rules

35 35 Also, invalid data sent on an MTC 02 transaction will not overlay existing data on the Divisions database. Change Processing Rules

36 36 Data previously required or reported on another transaction will be expected to be included on the MTC 02 transaction. Change Processing Rules

37 37 Change Previously Sent Data to Spaces Data

38 38 Change Previously Sent Data to Spaces Florida will not be setting data to spaces based on MTC 02. Florida will not be setting data to spaces based on MTC 02. If a data element was reported in error and needs to be removed (vs. changed), the Claim Administrator should contact the Division for special handling. If a data element was reported in error and needs to be removed (vs. changed), the Claim Administrator should contact the Division for special handling.

39 39 SROI MTC 02 Reporting a Benefit Redistribution for Child Support (after Initial Payment)

40 40 Benefit Redistribution for Child Support If a portion of the Net Weekly Amount is being directed to another party due to a court ordered lien for child support, an Electronic Notice of Action or Change is represented by sending: MTC 02 MTC 02

41 41 Note: MTC CA does not apply as the Net Weekly Amount is unchanged. Benefit Redistribution for Child Support

42 42 SCENARIO: SROI MTC 02 Reporting a Benefit Redistribution for Child Support (after Initial Payment)

43 43 Reporting a Benefit Redistribution for Child Support Court-ordered child support in the amount of $50/week has been assessed against the employees WC benefits. Amount is to be paid directly to employees ex-wife. Court-ordered child support in the amount of $50/week has been assessed against the employees WC benefits. Amount is to be paid directly to employees ex-wife.

44 44 Reporting a Benefit Redistribution for Child Support We are going to fill out the Benefit and ACR segment live (time permitting). The following slide is the IP transaction that immediately preceded the Benefit Redistribution.

45 45 Reporting a Benefit Redistribution for Child Support The Benefit Redistribution is now to be reported at the time the next bi-weekly is sent. Please complete the Benefit and ACR segment to report this event.

46 46 Benefit Segment last reported to DWC for IP: IP , $1, June 29, 2007

47 47 Now lets build the Benefit and ACR Segments for a Redistribution of Benefits

48 48 Variable Segment Counters 0288Number of Benefits Number of Payments Number of Other Benefits Number of Benefit ACR Number of Recoveries Number of Reduced Earnings00

49 Number of Concurrent Employers Number of Full Denial Reason Code Number of Denial Reason Narratives Number of Suspension Narratives00

50 50 Benefits 1 Occ 0085Benefit Type Code050Temporary Total 0002 Maintenance Type Code02Change 0174Gross Weekly Amount $ Gross Weekly Amount Effective Date June 15, Net Weekly Amount $ Net Weekly Amount Effective Date June 15, Benefit Period Start Date June 16, 2007

51 Benefit Period Through Date July 27, Benefit Type Claim Weeks Benefit Type Claim Days Benefit Type Amount Paid $2, Benefit Payment Issue Date N/A

52 52 Benefit ACR 1 Occurrence 0130 Benefit Redistribution CodeH050 Court Ordered Lien 0131 Benefit Redistribution Start Date July 20, Benefit Redistribution End Date Blank because redistribution is continuing 0133 Benefit Redistribution Weekly Amount $50.00

53 53 Reporting Benefit Redistribution for Child Support (after initial payment): If the lien for Child Support ends and indemnity is ongoing, MTC 02 should be sent with a Benefit Redistribution segment reflecting an End Date. If the lien for Child Support ends and indemnity is ongoing, MTC 02 should be sent with a Benefit Redistribution segment reflecting an End Date. If all indemnity is being suspended, the Benefit Redistribution segment reflecting an End Date can be sent on the Sx. If all indemnity is being suspended, the Benefit Redistribution segment reflecting an End Date can be sent on the Sx.

54 54 Questions?

55 55 Suspensions(Full)

56 56 Pop Quiz: Are Suspensions an Event Benefit Segment, or Sweep Benefit Segment?

57 57 Answer: Event Benefit Segment

58 58 Suspensions (Full) If ALL payments of indemnity benefits have stopped (not just one class of benefits), an Electronic Notice of Suspension is represented by sending: SROI S1-S8. SROI S1-S8. See Rule 69L (5), F.A.C.

59 59 Suspensions (Full) Please be aware that if you previously sent a paper DWC-4 to report a suspension of one type of benefit, or return to work; however, ALL benefits were really NOT suspended, you will have to reinstate benefits (MTC RB) prior to sending the next event.

60 60 Suspensions Hint: If you file an incorrect Suspension Code MTC via R3, you can correct the Suspension MTC by sending in a subsequent Suspension MTC, as long as the Suspension Effective Date is the same as the previous one.

61 61 Full Suspension MTC Codes Full Suspension MTC Codes

62 62 S1 Suspension, RTW, or Medically Determined to RTW S1 Suspension, RTW, or Medically Determined to RTW S2 Suspension, Medical Non-Compliance S2 Suspension, Medical Non-Compliance S3 Suspension, Administrative Non- Compliance S3 Suspension, Administrative Non- Compliance S4 Suspension, Claimant Death S4 Suspension, Claimant Death Full Suspension MTCs

63 63 S5 Suspension, Incarceration S5 Suspension, Incarceration S6 Suspension, Whereabouts Unknown S6 Suspension, Whereabouts Unknown S7 Suspension, Benefits Exhausted S7 Suspension, Benefits Exhausted S8 Suspension, Jurisdiction Change S8 Suspension, Jurisdiction Change Full Suspension MTCs

64 64 SCENARIO: SROI MTC S1 Suspension, RTW

65 65 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW TT Benefits commenced effective 6/16/07. TT Benefits commenced effective 6/16/07. On 8/27/07, the Clm. Admin. receives notification the EE RTWd with the same employer on 8/25/07, with no restrictions, and mails the EEs last TT check. On 8/27/07, the Clm. Admin. receives notification the EE RTWd with the same employer on 8/25/07, with no restrictions, and mails the EEs last TT check.

66 66 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW On 8/27/07, the Clm. Admin. sends a SROI S1 to DWC to report the suspension of all indemnity benefits. Partial Display of SROI Record Layout – (only pertinent DNs displayed)

67 67 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW EE RTW 8/25/07 w/same employer, no restrictions. TT was suspended effective 8/24/07. Partial Display of SROI Record Layout – (only pertinent DNs displayed)

68 68 SUSPENSION EFFECTIVE DATE For MTCs S1-S8 (Suspension): The last date through which all indemnity benefits are due. The last date through which all indemnity benefits are due. Note: This date is not always the last day through which benefits were paid if there was an overpayment.

69 69 SROI MTC S1 Scenario Since Suspension MTCs are considered Events, the MTC is required in the Benefits segment. All required benefit information is also sent. 0

70 70 SUSPENSION NARRATIVE SEGMENT Per IAIABC Variable Segment Rules: Maximum of 3 Suspension Narrative segments may be sent, and Maximum of 3 Suspension Narrative segments may be sent, and Must equal theNumber of Suspension Narratives sent. Must equal theNumber of Suspension Narratives sent. Note: This is an If Available/Applicable field for FL, but not required.

71 71 Only 1 Benefit Type was paid, and Suspension Narrative was sent with < 50 characters, so corresponding Number (segment counters) = 1. SROI MTC S1 Scenario

72 72 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW The Suspension Narrative segment: Partial Display of SROI Record Layout – (only pertinent DNs displayed)

73 73 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW This scenario does not reflect any Other Benefits segments because the majority of medical-type expenses (e.g., physician, hospital, etc.), are not required to be reported to the Division via the Claims EDI R3 format.

74 74 SROI MTC S1 Scenario Suspension, RTW or Medically Released to RTW See FLs Element Requirement Table (and rule) for Other Benefit Types required to be reported for Claims EDI R3 filings. (e.g., Funeral, Total Other Medical, Voc Rehab).

75 75 Issues with S1 transactions: 1.If EE released to return to work with restrictions, but is not returning to work, an IRTW date must still be reported, with a RTW Type Code R for Released. 2.If EE returned to work light duty, and TP benefits might be paid when earnings are obtained, an S1 should not be filed. The return to work information should be reported via MTC If TP is subsequently paid, it would be reported via MTC CB. 4.Do not send an Sx unless ALL indemnity is suspended.

76 76 SROI MTC S8 Suspension, Jurisdiction Change

77 SROI MTC S8 Suspension, Jurisdiction Change Another states workers comp Act, Another states workers comp Act, Or, U.S. Longshoremens and Harbor Workers Compensation Act, U.S. Longshoremens and Harbor Workers Compensation Act, Or, MTC S8 is used to report the suspension of all indemnity benefits when a claim is transferred to another jurisdiction after indemnity benefits have been initiated, i.e.,

78 SROI MTC S8 Suspension, Jurisdiction Change Federal Employers Liability Act, Federal Employers Liability Act,Or, Federal Employees Compensation Act, Federal Employees Compensation Act,Or, Jones Act. Jones Act.

79 79 No further EDI filings No further EDI filings (e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC S8. (e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC S8. SROI MTC S8 Suspension, Jurisdiction Change

80 80 Reminder: Jurisdiction Transfer Claim administrator then sends the following to the appropriate state (if applicable): FROI MTC 00 FROI MTC 00 SROI MTC IP SROI MTC IP (or other applicable SROI)

81 81 If a claim is transferred TO FL from another jurisdiction (i.e., a different state, or compensation act, etc.)… Reminder: Jurisdiction Transfer

82 82 The claim administrator should send FROI 00 and SROI IP (or other FROI/SROI filing equivalent), and The claim administrator should send FROI 00 and SROI IP (or other FROI/SROI filing equivalent), and Report Late Reason Code L4 – Late Notification, Jurisdiction Transfer. Report Late Reason Code L4 – Late Notification, Jurisdiction Transfer. Reminder: Jurisdiction Transfer

83 83 If no indemnity was paid (e.g., 04, 00/PD, 00/CD, or 00/VE on file), or indemnity was paid but check(s) was returned/voided/cancelled prior to the change in jurisdiction, the Claim Admin. should send: If no indemnity was paid (e.g., 04, 00/PD, 00/CD, or 00/VE on file), or indemnity was paid but check(s) was returned/voided/cancelled prior to the change in jurisdiction, the Claim Admin. should send: MTC 01 to Cancel the claim with the Division (since indemnity is not being suspended) and not an S8. MTC 01 to Cancel the claim with the Division (since indemnity is not being suspended) and not an S8.

84 84 Questions?

85 85 Partial Suspension

86 86 Partial Suspension A Partial Suspension occurs when 1 of the 2 concurrent benefits is suspended, but the other Benefit Type continues. A Partial Suspension occurs when 1 of the 2 concurrent benefits is suspended, but the other Benefit Type continues. For Concurrent Benefit Types Only

87 87 SROI MTC P7: Partial Suspension, Benefits Exhausted SROI MTC P7: Partial Suspension, Benefits Exhausted Partial Suspension For Concurrent Benefit Types Only

88 88 For FL – SROI MTC P7 is used when Permanent Total Supplemental (021) benefits are suspended, but Permanent Total (020) benefits are continuing. For FL – SROI MTC P7 is used when Permanent Total Supplemental (021) benefits are suspended, but Permanent Total (020) benefits are continuing. See Rule 69L (5)(j), F.A.C. For Concurrent Benefit Types Only Partial Suspension

89 89 EXISTING CLAIM: Suspension of PT Supp Only (Partial Suspension) If PT Supplemental Benefits (021) are being suspended, but PT Benefits (020) are continuing to be paid, an Electronic Notice of Action or Change is due Electronic Notice of Action or Change is due

90 90 SCENARIO: SROI MTC P7 Partial Suspension of a Concurrent Benefit Type

91 91 SROI MTC P7 Scenario Previously Submitted Reports: 1.FROI MTC 00 (Original) sent with SROI MTC IP (Initial Payment) 2.SROI MTC CB (Change in Benefit) -TTD to IB and…

92 92 Previously Submitted Reports: (contd) … 3.SROI MTC CB (Change in Benefit) - IB to PT 4.SROI MTC AB (Add Concurrent Benefit) - PT Supp after PT SROI MTC P7 Scenario

93 93 Because the employee will reach age 62 on 2/10/09, the claim administrator by law is not required to continue payment of PT Supp Benefits after that date. Because the employee will reach age 62 on 2/10/09, the claim administrator by law is not required to continue payment of PT Supp Benefits after that date. SROI MTC P7 Scenario

94 94 On 2/16/09, the claim administrator suspends Benefit Type 021 (PT Supp), and sends SROI P7 to DWC to report the partial suspension of indemnity benefits, specifically, PT Supp Benefits, effective 2/10/09, along with corresponding payment On 2/16/09, the claim administrator suspends Benefit Type 021 (PT Supp), and sends SROI P7 to DWC to report the partial suspension of indemnity benefits, specifically, PT Supp Benefits, effective 2/10/09, along with corresponding paymentinformation. SROI MTC P7 Scenario

95 95 PT Supplemental Benefits are suspended effective 2/10/09. SROI MTC P7 Scenario

96 96 SROI P7 (Partial Suspension of a Concurrent Benefits) is sent to DWC on 02/16/2009. SROI MTC P7 Scenario

97 97 Three different Benefit Types have been paid on this claim. SROI MTC P7 Scenario

98 98 MTC P7 is reported in the Benefits segment for the concurrent benefit type that is being stopped. Partial Suspensions Because a Partial Suspension is considered an Event,

99 99 MTC P7 is placed in the Benefits segment for BTC 021 (PT Supp). SROI MTC P7 Scenario

100 100 Required Benefit information is provided. SROI MTC P7 Scenario

101 101 The two remaining Benefit Type Codes are sent as Sweep Benefits segments. SROI MTC P7 Scenario

102 102 Questions?

103 103 Reinstatement of Benefits By Claim Administrator SROI MTC RB

104 104 If Indemnity payments previously paid by the Claim Administrator are being resumed by the Claim Administrator, an Electronic Notice of Reinstatement is represented by sending: SROI RB SROI RB MTC RB Reinstatement of Benefits By Claim Administrator

105 105 Note: The reinstated Benefit Type may or may not have been previously paid. MTC RB Reinstatement of Benefits By Claim Administrator See Rule 69L (6)(a), F.A.C.

106 SROI MTC S1-S8 SROI MTC S1-S8 (Full Suspension), Or, A previous Subsequent Report (SROI) must have been filed terminating all indemnity benefits via either: A previous Subsequent Report (SROI) must have been filed terminating all indemnity benefits via either: MTC RB Reinstatement of Benefits By Claim Administrator

107 Where the SROI 04 or PD is acting like a suspension because all indemnity benefits are being terminated at the time of denial. SROI MTC 04 (Full Denial) or SROI MTC 04 (Full Denial) or SROI MTC PD with Partial Denial Codes A or E. SROI MTC PD with Partial Denial Codes A or E. MTC RB Reinstatement of Benefits By Claim Administrator

108 108 For all MTCs that initiate or reinstate a Benefit Type Code (AB, IP, RB, EP, ER, CB): The Benefit Period Start Date is the first date of the uninterrupted period of benefit payments that corresponds to the Benefit Type Code being paid. The Benefit Period Start Date is the first date of the uninterrupted period of benefit payments that corresponds to the Benefit Type Code being paid. Benefit Period Start Date MTC RB Reinstatement of Benefits By Claim Administrator

109 109 SCENARIO: SROI MTC RB Reinstatement of Benefits by Claim Administrator After Prior Suspension

110 110 SROI MTC RB Scenario Reinstatement of Benefits by Claim Admin. after Prior Suspension The Claim Administrator initiated payment of TT Benefits effective 6/16/07 (MTC 00/IP). The Claim Administrator initiated payment of TT Benefits effective 6/16/07 (MTC 00/IP). The Claim Admin. subsequently suspended all indemnity benefits because the employee RTWd full duty, no restrictions (SROI MTC S1). The Claim Admin. subsequently suspended all indemnity benefits because the employee RTWd full duty, no restrictions (SROI MTC S1).

111 111 SROI MTC RB Scenario Reinstatement by Claim Administrator Employees doctor determined EE reached MMI on 10/8/07, with a PI rating of 25% to the whole body. Employees doctor determined EE reached MMI on 10/8/07, with a PI rating of 25% to the whole body. On 10/21/07, Clm. Admin. mails a check to the employee for the initial installment of IB benefits. EE is due IBs at weekly rate of 50% of On 10/21/07, Clm. Admin. mails a check to the employee for the initial installment of IB benefits. EE is due IBs at weekly rate of 50% of the comp rate. the comp rate.

112 112 The Date of MMI is also reported. SROI MTC RB Scenario Reinstatement by Claim Administrator On 10/21/07, the Claim Admin. notifies DWC re: the re-instatement indemnity benefits. Partial Display of SROI Record Layout – (only pertinent DNs displayed)

113 113 SROI MTC RB Scenario One Permanent Impairment segment reports 25% Whole Body impairment

114 114 Two Benefit Types have been paid. SROI MTC RB Scenario Reinstatement by Claim Administrator

115 115 Event Benefits segment for the reinstated Benefit Type has complete details. SROI MTC RB Scenario Reinstatement by Claim Administrator

116 116 Sweep Benefits segment (for the previously reported benefit type) SROI MTC RB Scenario

117 117 Electronic Notice of Reinstatement of Employer Paid Benefits Rule 69L (6)(b), F.A.C.

118 118 If the employer is resuming payment of salary in lieu of compensation following the suspension of all prior employer paid indemnity benefits, an Electronic Notice of Action or Change is represented by sending: SROI ER SROI ER Reinstatement of Employer Paid Benefits

119 119 Questions?


Download ppt "1 Florida Division of Workers Compensation Claims EDI Release 3 Training 2008 (Continued)"

Similar presentations


Ads by Google