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1 Electronic First Reports of Injury or Illness (EDI DWC-1 Equivalent)

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1 1 Electronic First Reports of Injury or Illness (EDI DWC-1 Equivalent)

2 2 Electronic First Report of Injury or Illness (EDI DWC-1 Equivalent) The most typical EDI DWC-1 filing is: FROI 00 + SROI IP FROI 00 + SROI IP Required to be filed with DWC per Rule 69L , F.A.C.

3 3 A SROI IP sent in combination with a FROI 00 reports the Claim Administrators initial payment on a lost time claim. A SROI IP sent in combination with a FROI 00 reports the Claim Administrators initial payment on a lost time claim. Electronic First Report of Injury or Illness

4 4 Electronic First Reports of Injury or Illness are also represented by the following other EDI DWC-1 equivalent MTCs to report lost time claims and are also required to be filed with DWC: Electronic First Reports of Injury or Illness are also represented by the following other EDI DWC-1 equivalent MTCs to report lost time claims and are also required to be filed with DWC:

5 5 Electronic First Report of Injury or Illness Other SROIs Sent with FROI 00: CD – Compensable Death with no Known Dependents/Payees CD – Compensable Death with no Known Dependents/Payees EP – Employer Paid EP – Employer Paid PD – Partial Denial PD – Partial Denial PY – Lump Sum Payment/Settlement PY – Lump Sum Payment/Settlement VE – Volunteer (covered under FL law) VE – Volunteer (covered under FL law) FROI Only 04 – Full (Total Denial) 04 – Full (Total Denial)

6 6 Please note that we will be deferring discussion on AU/AP EDI DWC-1 equivalents and other Acquired Claims issues until tomorrow. Please note that we will be deferring discussion on AU/AP EDI DWC-1 equivalents and other Acquired Claims issues until tomorrow. Electronic First Report of Injury or Illness

7 7 Pop Quiz:

8 8 If a Compensable Volunteer also had non-volunteer concurrent employment…

9 9 …What MTCs should be sent to report the Electronic First Report of Injury or Illness?

10 10 Answer: FROI 00 + SROI IP To report payment of indemnity based on wages from concurrent employment. To report payment of indemnity based on wages from concurrent employment.

11 11 SROI MTC IP (Initial Payment) The SROI MTC IP (Initial Payment) transaction implies that indemnity benefits are on-going until suspended.

12 12 POP QUIZ: Conversely, what transaction/MTC is used when the first payment on the claim is for a one-time lump sum payment or settlement?

13 13 ANSWER: MTC 00/PY

14 14 Lump sum payments / settlements will be discussed in more detail during tomorrows training.

15 15 Another POP Quiz: When is the 00/IP considered timely filed with the Division?

16 16 Electronic First Report of Injury or Illness Answer: It depends – For initial payments other than TP, IB or settlement, if LT is immediate and continuous, 00/IP is timely filed when it is received by DWC and assigned TA on or before 21 days after Claim Admin.s knowledge of the injury. For initial payments other than TP, IB or settlement, if LT is immediate and continuous, 00/IP is timely filed when it is received by DWC and assigned TA on or before 21 days after Claim Admin.s knowledge of the injury.

17 17 If LT is delayed or non- consecutive, 00/IP is timely filed with DWC when it is received by DWC and assigned TA on or before 13 days after the Claim Admin.s knowledge of the 8 th day of disability (a/k/a Initial Date of Lost Time.) If LT is delayed or non- consecutive, 00/IP is timely filed with DWC when it is received by DWC and assigned TA on or before 13 days after the Claim Admin.s knowledge of the 8 th day of disability (a/k/a Initial Date of Lost Time.) Electronic First Report of Injury or Illness Answer (contd):

18 18 To avoid late filing penalties, the EDI First Report of Injury or Illness (00/IP or equivalent) should be triggered immediately upon the Claim Admin.s disposition of the claim (payment or denial.) To avoid late filing penalties, the EDI First Report of Injury or Illness (00/IP or equivalent) should be triggered immediately upon the Claim Admin.s disposition of the claim (payment or denial.)

19 19 This will allow time for correction of potential errors and subsequent resubmission with eventual receipt/acceptance by DWC within the filing due dates specified in Rule 69L-56, F.A.C.

20 20 The specific timeframes for the timely submission of the 00/IP and other required electronic filings are set out in Rule 69L-56, F.A.C., the Event Table, and the MTC Filing Instructions document (all available on the Claims EDI web page.) The specific timeframes for the timely submission of the 00/IP and other required electronic filings are set out in Rule 69L-56, F.A.C., the Event Table, and the MTC Filing Instructions document (all available on the Claims EDI web page.) Electronic First Report of Injury or Illness

21 21 For FROI 00 with SROI IP combos (or equivalent), the FROI Date and Time Transmission Sent on the Batch Header must be PRIOR to the SROI Date/Time Transmission Sent. For FROI 00 with SROI IP combos (or equivalent), the FROI Date and Time Transmission Sent on the Batch Header must be PRIOR to the SROI Date/Time Transmission Sent. If the SROI is received and processed ahead of the FROI, both will reject. Electronic First Report of Injury or Illness

22 22 Also, for processing FROI 00/SROI IP combos (or equivalent), the Match Data in the FROI to SROI column of the Edit Matrix Match Data Tab, must match exactly from FROI to SROI. Also, for processing FROI 00/SROI IP combos (or equivalent), the Match Data in the FROI to SROI column of the Edit Matrix Match Data Tab, must match exactly from FROI to SROI. Electronic First Report of Injury or Illness

23 23 If the FROI 00 and SROI IP (or equivalent) do not combine as required in the previous 2 slides, the error messages in this case will be confusing… If the FROI 00 and SROI IP (or equivalent) do not combine as required in the previous 2 slides, the error messages in this case will be confusing… Electronic First Report of Injury or Illness

24 24 … because if they do not combo, they are processed separately as individual FROI & SROI filings, which have different requirements/errors. Example Error: JCN Missing - Even though JCN is not required for an 00/IP, it IS required for a standalone SROI IP. Electronic First Report of Injury or Illness

25 25 Now lets take a detailed look at the Benefits Segment on the SROI

26 26 The Benefits segment on the SROI consists of the following data elements (DNs):

27 27 Although you may not see this exact layout of data elements on your own system/screenyour companys program or vendor software should adhere to the submission requirements covered in the next several slides. Although you may not see this exact layout of data elements on your own system/screen, your companys program or vendor software should adhere to the submission requirements covered in the next several slides.

28 28 SROI BENEFITS Segment The Benefits segment of the SROI transaction is used to report indemnity benefits that are currently being paid or have been paid by the current Claim Administrator. The Benefits segment of the SROI transaction is used to report indemnity benefits that are currently being paid or have been paid by the current Claim Administrator.

29 29 SROI BENEFITS Segment If you have paid indemnity, a Benefits Segment for EVERY indemnity Benefit Type paid should be included on EVERY SROI transaction. If you have paid indemnity, a Benefits Segment for EVERY indemnity Benefit Type paid should be included on EVERY SROI transaction.

30 30 SROI BENEFITS Segment Exception: A Benefit Type Code (or Other Benefit Type Code) previously reported may be left off the current transaction if its disappearance is explained by the presence of certain other codes: Reduced Benefit Amount Code, Reduced Benefit Amount Code, Recovery Code (will discuss in detail later.) Recovery Code (will discuss in detail later.)

31 31 SROI BENEFITS Segment Correspondingly, the Benefit Type Amount (and Other Benefit Type Amount) reported on the current transaction must not be less than the $ previously reported unless a Reduced Benefit Amount Code or Recovery Code is reported. Correspondingly, the Benefit Type Amount (and Other Benefit Type Amount) reported on the current transaction must not be less than the $ previously reported unless a Reduced Benefit Amount Code or Recovery Code is reported.

32 32 All Data elements contained in the SROI BENEFITS Segment (e.g., Gross/Net Weekly Amounts, Start Date) are defined in the Data Dictionary, Section 6 of IAIABC R3 Implementation Guide.

33 33 The most current version of the IAIABC R3 Implementation Guide is located at IAIABC.org. The Guide is available for download FREE of charge to any employee of an IAIABC EDI Member. If you are not an EDI Member, you can purchase the Guide for $95. The Guide is available for download FREE of charge to any employee of an IAIABC EDI Member. If you are not an EDI Member, you can purchase the Guide for $95.

34 34 When and how data should be populated in the SROI Benefits segment is in the Variable Segment Population Rules, Section 4 of the IAIABC R3 Guide.

35 35 Variable Segment Population Rules for the SROI Benefits Segment

36 36 SROI BENEFITS Segment Only one Benefits segment per Benefit Type Code (BTC) is allowed. Only one Benefits segment per Benefit Type Code (BTC) is allowed. The applicable BTC must be included when a Benefits segment is present in the transaction. The applicable BTC must be included when a Benefits segment is present in the transaction.

37 37 SROI BENEFITS Segment The Benefits segment is populated with the current values at the time of transmission, based upon the Benefit Type Codes paid on the claim (snapshot). The Benefits segment is populated with the current values at the time of transmission, based upon the Benefit Type Codes paid on the claim (snapshot).

38 38 SROI BENEFITS Segment SROI BENEFITS Segment Exception: Benefit Payment Issue Date. If the 00/IP is filed late and multiple payments have been issued, the Benefit Payment Issue Date for the IP should correspond to the initial payment, not the current payment.

39 39 SROI BENEFITS Segment When an MTC is required to be sent at the Benefits level on the SROI (i.e., in the Benefits segment itself), the same MTC must be sent at the Claim level on the SROI. When an MTC is required to be sent at the Benefits level on the SROI (i.e., in the Benefits segment itself), the same MTC must be sent at the Claim level on the SROI.

40 40 SROI BENEFITS Segment Example: IP sent with 050 followed by 02 to change something in the 050 Benefits segment – Do not leave MTC IP in 050 Benefits segment on the 02. The MTC in the Benefits segment must match the MTC on the transaction.

41 41 SROI BENEFITS Segment 0 (zero) Benefits Segments are allowed for the following SROI MTCs: 0 (zero) Benefits Segments are allowed for the following SROI MTCs: CD - Compensable Death with No Dependents; CD - Compensable Death with No Dependents; VE - Volunteers; VE - Volunteers; PD - Indemnity Only (Partial) Denials. PD - Indemnity Only (Partial) Denials.

42 42 SROI BENEFITS Segment 0 (zero) Benefits Segments are also allowed if Reduced Benefit Amount Code is reported as: 0 (zero) Benefits Segments are also allowed if Reduced Benefit Amount Code is reported as: S (Settlement on Another DOI) or S (Settlement on Another DOI) or N (No Money Settlement). N (No Money Settlement).

43 43 SROI BENEFITS Segment Reduced Benefit Amount Code N was recently appropriated by the IAIABC for reporting settlements with no dollars paid, such as those due to waiver of a lien. Reduced Benefit Amount Code N was recently appropriated by the IAIABC for reporting settlements with no dollars paid, such as those due to waiver of a lien.

44 44 SROI BENEFITS Segment Where Reduced Benefit Amount Code N is reported, a Benefits segment will only be present on the transaction if indemnity benefits had been paid for the DOI prior to the settlement. Where Reduced Benefit Amount Code N is reported, a Benefits segment will only be present on the transaction if indemnity benefits had been paid for the DOI prior to the settlement.

45 45 SROI BENEFITS Segment 0 (zero) Benefits Segments are also allowed if OBT 430 (Unallocated Indemnity) is reported and the acquiring Claim Admin. has not yet issued its initial payment at the time of filing (e.g., SA.) 0 (zero) Benefits Segments are also allowed if OBT 430 (Unallocated Indemnity) is reported and the acquiring Claim Admin. has not yet issued its initial payment at the time of filing (e.g., SA.)

46 46 EventBenefitsSegments

47 47 Sweep DNs Event DNs

48 48 EVENT BENEFITS SEGMENT RULES A Claim Administrator must be prepared to send all data elements in the Benefits Segment as required per the Benefits Segment Req worksheet of FLs Element Requirement Table.

49 49 EVENT BENEFITS SEGMENT RULES Exception: If the Date Claim Admin. Had Knowledge of the Injury preceded its R3 go live date, Gross and Net Amounts and Effective Dates, and Benefit Period Start and Through Dates are NOT required (nor edited), even for Event Benefits Segments. (Since these data elements were not previously required on legacy paper or R1 filings)

50 50 EVENT BENEFITS SEGMENT RULES Note (exception to the exception): 1.Benefit Period Start Date is required for BTC 020 & BTC 240, and 2.Benefit Period Through Date is required for BTC 240 … even i f the Date Claim Admin. Had Knowledge of the Injury preceded its R3 go live date.

51 51 EVENT BENEFITS SEGMENT RULES MTC When a Benefit Type is starting, being changed from or to another benefit type being suspended; or reporting a lump sum payment for Benefit Type Code 0XX, MTC must be sent in the Event Benefits segment for the affected Benefit(s).

52 52 SROI Benefits segment

53 53 If MTC is sent in the Benefits segment, it will be edited as an Event Benefits segment. SROI Benefits segment

54 54 MTC is reported in the Benefits segment when a benefit type is being initiated or terminated (AB, AP, CB, CA, S1-8, P7, EP, ER, IP, or RB). EVENT BENEFITS SEGMENT EXAMPLE

55 55 All Benefits data elements are populated. Benefit Payment Issue Date is required for an IP, and certain APs, & PYs (0xx). EVENT BENEFITS SEGMENT EXAMPLE

56 56 EVENT BENEFITS SEGMENT RULES BENEFIT PERIOD START DATE – DN0088 For all MTCs that are initiating or reinstating a Benefit Type Code (AB, IP, RB, EP, ER, and CB): The Benefit Period Start Date is the first date of the uninterrupted period of benefit payments that corresponds to the Benefit Type Code.

57 57 EVENT BENEFITS SEGMENT RULES BENEFIT PERIOD START DATE – DN0088 For all MTCs that are NOT initiating or reinstating a Benefit Type Code (S1-8, P7, CA, PY with BTC 0XX): The Benefit Period Start Date is the earliest date for that Benefit Type Code regardless of whether or not multiple benefit periods have been paid for that Benefit Type Code.

58 58 EVENT BENEFITS SEGMENT RULES For MTC AP and all subsequent MTCs filed on acquired claims, the Benefit Period Start Date is the first date of the uninterrupted period of benefit payments by the acquiring Claim Administrator that corresponds to the Benefit Type Code.

59 59 Recap: If you have paid indemnity, a Benefits Segment for EVERY indemnity Benefit Type paid should be included on EVERY SROI transaction (unless RBAC or Recovery applicable.)

60 60 An MTC previously reported at the Benefit level that is not applicable to the current MTC being reported should not be left in the Benefits segment …

61 61 … For example: Do not leave MTC IP in the 050 Benefits segment if you are now sending MTC PY to report a full settlement (which will include a 500 Benefits segment). This will reject.

62 62 Recap: In FL, if MTC is reported in any Benefits segments, the segment will be considered an Event Benefits segment, which means all Event Benefits segment data elements will be required to be present…

63 63 … For e … For example: TT (050) previously paid; TT (050) previously paid; Benefits subsequently changed from TP (070) to IB (030). Benefits subsequently changed from TP (070) to IB (030). MTC CB is required in the 070 (TP) and the 030 (IB) segments. These are both Event Benefits segments…

64 64 Example (contd): … If the MTC is also sent in the old 050 TT segment, it too will be edited as an Event Benefits Segment, and therefore all data will be required and edited.

65 65 SweepBenefitsSegments

66 66 SWEEP BENEFITS SEGMENT RULES A Sweep Benefits Segment(s) must be sent in addition to any Event Benefit Segment(s), for different Benefit Type Code(s) previously been paid but not part of the Event that is currently being reported.

67 67 SWEEP BENEFITS SEGMENT RULES 02 (only if Benefits segment data is not changing and you dont want DWCs program to edit any BTCs),02 (only if Benefits segment data is not changing and you dont want DWCs program to edit any BTCs), 0404 PDPD PY reporting BTC 5XXPY reporting BTC 5XX Periodics: SA & FNPeriodics: SA & FN MTC is NOT included in the Benefits Segment for the following Sweep MTCs:

68 68 SWEEP BENEFITS SEGMENT RULES If the MTC is sent in a Sweep Benefits segment, the Benefits Segment will be edited as an Event Benefits segment. In this case, certain data elements will be expected to be present, and if not sent, will result in a rejection.

69 69 SWEEP BENEFITS SEGMENT RULES Example: 00/IP filed to report payment of TT; 00/IP filed to report payment of TT; CB filed to report change in benefits from TT to TP; CB filed to report change in benefits from TT to TP; This CB reflects 2 Event Benefits segments for TT and TP (each contains MTC CB). (continued next slide)…

70 70 SWEEP BENEFITS SEGMENT RULES Another CB is filed to report change from TP to IB; this CB also reflects 2 Event Benefits for TP and IB (again, each segment would contain MTC CB). Another CB is filed to report change from TP to IB; this CB also reflects 2 Event Benefits for TP and IB (again, each segment would contain MTC CB). The prior TT Benefits Segment is a Sweep Benefits Segment(s) that should be sent along with the two Event Benefits Segments (and would not contain MTC CB).

71 71 SWEEP BENEFITS SEGMENT RULES Benefit Type Code Benefit Type Code Benefit Period Start Date Benefit Period Start Date Benefit Period Through Date Benefit Period Through Date Benefit Type Claim Weeks Benefit Type Claim Weeks Benefit Type Claim Days Benefit Type Claim Days Benefit Type Amount Paid Benefit Type Amount Paid A Sweep Benefits Segment must include the following data elements:

72 72 SWEEP BENEFITS SEGMENT RULES MTC (if sent would imply Event Segment) MTC (if sent would imply Event Segment) Gross Weekly Amount Gross Weekly Amount Gross Weekly Amount Effective Date Gross Weekly Amount Effective Date Net Weekly Amount Net Weekly Amount Net Weekly Amount Effective Date Net Weekly Amount Effective Date Benefit Payment Issue Date Benefit Payment Issue Date A Sweep Benefits Segment will NOT include the following:

73 73 For MTCs (on non-acquired claims) that are not initiating or reinstating a Benefit Type Code (PY with BTC 5XX, FN, SA, and 04 & PD if preceded by payment): The Benefit Period Start Date is the earliest date for that Benefit Type Code, regardless of whether multiple benefit periods have been paid for that Benefit Type Code. For MTCs (on non-acquired claims) that are not initiating or reinstating a Benefit Type Code (PY with BTC 5XX, FN, SA, and 04 & PD if preceded by payment): The Benefit Period Start Date is the earliest date for that Benefit Type Code, regardless of whether multiple benefit periods have been paid for that Benefit Type Code. SWEEP BENEFITS SEGMENT RULES BENEFIT PERIOD START DATE

74 74 SWEEP BENEFITS SEGMENT RULES MTC When an MTC applies to the claim as a whole, the MTC is sent at the Claim Level only (A49) and is not populated in the Benefits segment. If MTC sent it will be edited as an Event segment.

75 75 Sweep DNs

76 76 Questions?

77 77 Caveats and Tips for Successfully Filing 00/IP

78 78 If you receive the error, If you receive the error, BOTH FROI & SROI MUST PASS EDITS TO ACCEPT FILING this means there was a fatal error on either the FROI or SROI, so you must correct the error(s) and re- send BOTH the FROI and SROI. Caveats and Tips for Successfully Filing 00/IP

79 79 We are also still seeing the following errors with great frequency: We are also still seeing the following errors with great frequency: NO MATCHING FIRST REPORT NO MATCHING FIRST REPORT NO MATCHING SUBSEQUENT REPORT NO MATCHING SUBSEQUENT REPORT Caveats and Tips for Successfully Filing 00/IP

80 80 These rejections are occurring when the FROI and SROI are not received and processed on the same day or when the FROI/SROI did not match, when a combo filing is required. Caveats and Tips for Successfully Filing 00/IP

81 81 It is critical these errors are resolved asap to avoid any resulting penalty for late filing with the Division. Caveats and Tips for Successfully Filing 00/IP

82 82 Other Errors Occurring on 00/IP Filings

83 83 We have been receiving DOBs yielding extremely young ages, which upon further investigation, were determined to be incorrect. We have been receiving DOBs yielding extremely young ages, which upon further investigation, were determined to be incorrect. Currently, our program generates a TA-FL if the DOB sent yields an age less than 13 years or greater than 85 years… Caveats and Tips for Successfully Filing 00/IP

84 84 … in which case the suspect DOB is not loaded to our database and you are expected to either revise your DOB or confirm if the DOB is correct. But because the IAIABC standard requires DOB < = DOI, our program has not been rejecting filings where the DOB defaulted to DOI, therefore yielding an age of 0. So, … Caveats and Tips for Successfully Filing 00/IP

85 85 … Beginning 4/30/10, DWCs program will now reject filings where the DOB (at the time of the DOI) yields an age < = 5, to minimize truly incorrect DOBs and later follow-up with our TPs. Note: DWC already returns a TR if the DOB yields an age of 100 years or more. Caveats and Tips for Successfully Filing 00/IP

86 86 Discrepancies in the EMPLOYEE NAME will be brought to your attention for correction in your database (Employee First and Last Name are included in our programs match data criteria.) Discrepancies in the EMPLOYEE NAME will be brought to your attention for correction in your database (Employee First and Last Name are included in our programs match data criteria.) Caveats and Tips for Successfully Filing 00/IP

87 87 DWC is statutorily required to collect the EEs address, so our program initially precludes the acceptance of filings where the EEs address = EMPLRs address. DWC is statutorily required to collect the EEs address, so our program initially precludes the acceptance of filings where the EEs address = EMPLRs address. This edit is included in FLs requirements in part because EAO sends an initial contact letter to the EE; therefore a proper address is needed (which is typically not the employers address.) This edit is included in FLs requirements in part because EAO sends an initial contact letter to the EE; therefore a proper address is needed (which is typically not the employers address.) Caveats and Tips for Successfully Filing 00/IP

88 88 Filings that reject for this error can be re-loaded by DWC upon receipt of confirmation the EEs and EMPLRs address are indeed one in the same. Filings that reject for this error can be re-loaded by DWC upon receipt of confirmation the EEs and EMPLRs address are indeed one in the same. Prior to re-loading, the EDI Team will Google the EEs address and compare it to the nature of the employers business and the EEs occupation to determine if the addresses are likely the same. Prior to re-loading, the EDI Team will Google the EEs address and compare it to the nature of the employers business and the EEs occupation to determine if the addresses are likely the same. Caveats and Tips for Successfully Filing 00/IP

89 89 In addition to a Benefits segment, FL also requires a Payment segment on the IP because we need to record the exact amount of the Claim Admin.s initial payment of indemnity (helpful to CPS.) In addition to a Benefits segment, FL also requires a Payment segment on the IP because we need to record the exact amount of the Claim Admin.s initial payment of indemnity (helpful to CPS.) Caveats and Tips for Successfully Filing 00/IP

90 90 The R3 Payment Issue Date (a/k/a Date First Payment Mailed - paper term) must be the date the initial payment was actually mailed (or left the Claim Administrators control.) The R3 Payment Issue Date (a/k/a Date First Payment Mailed - paper term) must be the date the initial payment was actually mailed (or left the Claim Administrators control.) Caveats and Tips for Successfully Filing 00/IP

91 91 If you are reporting the day the check is issued by your system, you must ensure the check is actually mailed that same day. The audit team WILL validate. Caveats and Tips for Successfully Filing 00/IP

92 92 If filing late, or re-sending an 00/IP that previously rejected, AND another indemnity check has been issued since the first installment… If filing late, or re-sending an 00/IP that previously rejected, AND another indemnity check has been issued since the first installment… Caveats and Tips for Successfully Filing 00/IP

93 93 … the Benefit Type Amount Paid should reflect the total cumulative amount of ALL indemnity paid to date at the time of filing, not just the amount of the initial indemnity (IP) check. Caveats and Tips for Successfully Filing 00/IP

94 94 However, the Payment Segment should only reflect the initial payment information, not subsequent payment information. Again, this is the segment from which DWC loads Date First Payment Mailed to its claims system, utilized by CPS. Again, this is the segment from which DWC loads Date First Payment Mailed to its claims system, utilized by CPS. Caveats and Tips for Successfully Filing 00/IP

95 95 Do not pay the waiting week only and therefore prematurely report the 00/IP to avoid potential late payment and/or filing penalties – This will reject … Do not pay the waiting week only and therefore prematurely report the 00/IP to avoid potential late payment and/or filing penalties – This will reject … Caveats and Tips for Successfully Filing 00/IP

96 96 … Payment of the waiting week early is gratuitous, and the claim is considered a medical only claim and not reportable until the employee has been disabled at least 8 days. Caveats and Tips for Successfully Filing 00/IP

97 97 Accuracy of Claim Type is extremely important.Claim Type must be correct in relation to the Initial Date Disability Began and RTW information… Accuracy of Claim Type is extremely important. Claim Type must be correct in relation to the Initial Date Disability Began and RTW information… Caveats and Tips for Successfully Filing 00/IP

98 98 If disability is NOT immediate and continuous (broken periods or delayed dis), Claim Type must be L (Became LT), which requires Initial Date of Lost Time and Date Claim Administrator Had Knowledge of Lost Time. If disability is NOT immediate and continuous (broken periods or delayed dis), Claim Type must be L (Became LT), which requires Initial Date of Lost Time and Date Claim Administrator Had Knowledge of Lost Time. Also, if the Employee RTWd within the waiting wk, Claim Type must = L.Also, if the Employee RTWd within the waiting wk, Claim Type must = L. Caveats and Tips for Successfully Filing 00/IP

99 99 Claim Type (continued): If the Initial Date Disability Began is the same as the DOI (or DOI + 1) and the Employee has not RTWd, Claim Type must be I (LT/indemnity immediate and continuous); If the Initial Date Disability Began is the same as the DOI (or DOI + 1) and the Employee has not RTWd, Claim Type must be I (LT/indemnity immediate and continuous); Caveats and Tips for Successfully Filing 00/IP

100 100 If Claim Type was incorrectly sent as I but should have been L, even if 8th Day data was included on the filing, such will not be edited/loaded and therefore not available to CPS. If Claim Type was incorrectly sent as I but should have been L, even if 8th Day data was included on the filing, such will not be edited/loaded and therefore not available to CPS. The filing will be treated as a straight lost time case (and you may need to file 02 to have penalty revoked.) The filing will be treated as a straight lost time case (and you may need to file 02 to have penalty revoked.) Caveats and Tips for Successfully Filing 00/IP

101 101 Pop Quiz:

102 102 What does the data element, Initial Date of Lost Time represent?

103 103 ANSWER: Employees 8 th Day of DisabilityEmployees 8 th Day of Disability

104 104 Initial Date of Lost Time is not the same as Initial Date Disability Began. Initial Date of Lost Time is not the same as Initial Date Disability Began. These are two different data elements. These are two different data elements. Caveats and Tips for Successfully Filing 00/IP

105 105 Since the Initial Date of Lost Time equates to the 8 th day of disability, it must always be sent as a date that is at least equal to, or more than the Initial Date Disability Began + 7 days. Since the Initial Date of Lost Time equates to the 8 th day of disability, it must always be sent as a date that is at least equal to, or more than the Initial Date Disability Began + 7 days. Caveats and Tips for Successfully Filing 00/IP

106 106 If the amount of time represented by the Start and Through Dates is more than the amount of Weeks/Days reported, a Non-Consecutive Period Code will be expected. If the amount of time represented by the Start and Through Dates is more than the amount of Weeks/Days reported, a Non-Consecutive Period Code will be expected. Note: This code is not required on a SROI MTC RB, or an IB only First Report. Caveats and Tips for Successfully Filing 00/IP

107 107 Non-Consecutive Period Code is often misunderstood. Non-Consecutive Period Code is often misunderstood. It is used to report if the disability period for a particular benefit type was non-consecutive, i.e., broken periods of disability within one Benefit Type. It is used to report if the disability period for a particular benefit type was non-consecutive, i.e., broken periods of disability within one Benefit Type. Caveats and Tips for Successfully Filing 00/IP

108 108 Reduced Benefit Amount Code – DWCs program now precludes this code from being sent on the first report of injury (since it is never applicable on the initial payment.) Reduced Benefit Amount Code – DWCs program now precludes this code from being sent on the first report of injury (since it is never applicable on the initial payment.) Caveats and Tips for Successfully Filing 00/IP

109 109 If 00/EP is initially reported, after which a SROI IP is sent to report the Claim Admin.'s Initial Payment of indemnity, Reduced Benefit Amount Code R must be reported if BTC 2xx is not included on the SROI IP. If 00/EP is initially reported, after which a SROI IP is sent to report the Claim Admin.'s Initial Payment of indemnity, Reduced Benefit Amount Code R must be reported if BTC 2xx is not included on the SROI IP. Caveats and Tips for Successfully Filing 00/IP

110 110 We will discuss Reduced Benefit Amount Codes in more detail relative to other SROI MTCs later in the training. Caveats and Tips for Successfully Filing 00/IP

111 111 We continue to see errors involving the Net Weekly Amount sent on the IP (as well as other SROIs). We continue to see errors involving the Net Weekly Amount sent on the IP (as well as other SROIs). Remember, the Net Weekly Amount should represent the weekly rate at which a particular BTC is being paid. Remember, the Net Weekly Amount should represent the weekly rate at which a particular BTC is being paid. It is NOT necessarily the Comp Rate. It is NOT necessarily the Comp Rate. Caveats and Tips for Successfully Filing 00/IP

112 112 If you are receiving errors for: If you are receiving errors for: NET < FL CALC GROSS AMT MINUS ADJ/CREDIT AMTS This means the Net Weekly Amount you are sending is not in line with the amount calculated by DWCs program (within 5¢). Caveats and Tips for Successfully Filing 00/IP

113 113 The FL CALC GROSS AMT is determined for each BTC in accordance with the Average Wage reported on the SROI; our program next subtracts any weekly adjustment or credit amount reported (if still being applied).The FL CALC GROSS AMT is determined for each BTC in accordance with the Average Wage reported on the SROI; our program next subtracts any weekly adjustment or credit amount reported (if still being applied). Caveats and Tips for Successfully Filing 00/IP

114 114 The FL CALC GROSS AMT formula (pre-adjustment or credit) for each BTC is set out in the Edits Matrix, specifically, the FL Calculation (Proprietary) tab.The FL CALC GROSS AMT formula (pre-adjustment or credit) for each BTC is set out in the Edits Matrix, specifically, the FL Calculation (Proprietary) tab. Caveats and Tips for Successfully Filing 00/IP

115 115 The expected FL CALC GROSS AMOUNT computed by DWCs program is displayed on the Errors tab in the data warehouse under Comparison Amount Per Edit.The expected FL CALC GROSS AMOUNT computed by DWCs program is displayed on the Errors tab in the data warehouse under Comparison Amount Per Edit. Just scroll to right while on a particular error row (see next slide.) Caveats and Tips for Successfully Filing 00/IP

116 116 Caveats and Tips for Successfully Filing 00/IP

117 117 If you are receiving errors for: If you are receiving errors for: NET $.05 OVER FL CALC GROSS MINUS ADJ/CREDIT AMTS This means that the Net Weekly Amount you are sending is more than 5¢ over the amount calculated by our program. Caveats and Tips for Successfully Filing 00/IP

118 118 Example: FL CALC GROSS AMT for a TT Cat (051) Benefits segment would be determined as 80% of AWW (subject to Max CR). If you instead reported 66 2/3% of AWW, this edit would be invoked. Caveats and Tips for Successfully Filing 00/IP

119 119 Also, if your SROI contains two Benefits Segments, one for TT (050) and one for IB (030), there should be a different Gross and Net Weekly Amounts for each segment, since each of these benefit types are paid at different weekly rates. Also, if your SROI contains two Benefits Segments, one for TT (050) and one for IB (030), there should be a different Gross and Net Weekly Amounts for each segment, since each of these benefit types are paid at different weekly rates. Caveats and Tips for Successfully Filing 00/IP

120 120 Again, the Gross and Net Weekly Amounts are not the Comp Rate. Again, the Gross and Net Weekly Amounts are not the Comp Rate. For TT, the weekly rate happens to be the same amount as the Comp Rate (66 2/3% of AWW). But you would not necessarily report this same amount for all other BTCs. For TT, the weekly rate happens to be the same amount as the Comp Rate (66 2/3% of AWW). But you would not necessarily report this same amount for all other BTCs. Caveats and Tips for Successfully Filing 00/IP

121 121 POP QUIZ: True or False: DWC defaults to a value of 5 if Number of Days Worked Per Week is not sent.

122 122 Answer:False Number of Days Worked Per Week is required unless BTC 030 (IB) is the only benefit reported on an IP or AP. Since IBs are paid in whole weeks only, a daily rate is not computed.

123 123 If you are receiving errors for: If you are receiving errors for: WKLY COMP AMT NOT CORRECT FOR AWW The Weekly Comp Amount (Comp Rate) is statutory & should be always be reported as 66 2/3 % of the AWW (+ or – 5¢) for DOIs on or after 8/1/79. *** Even if you were ordered to pay a higher weekly rate for TT (050). Caveats and Tips for Successfully Filing 00/IP

124 124 If the 00/IP reports TP (070) benefits, Initial RTW Date (and other related RTW fields, including RTW Type Code A or R) must be sent since a return to work release is required to establish eligibility for TP benefits. If the 00/IP reports TP (070) benefits, Initial RTW Date (and other related RTW fields, including RTW Type Code A or R) must be sent since a return to work release is required to establish eligibility for TP benefits. Caveats and Tips for Successfully Filing 00/IP

125 125 The Initial RTW Date represents the first day the EE actually RTW (A) or was released to RTW ( R) after the accident, not following the initial period of disability. The Initial RTW Date represents the first day the EE actually RTW (A) or was released to RTW ( R) after the accident, not following the initial period of disability. Caveats and Tips for Successfully Filing 00/IP

126 126 If the EE continued to work restricted duty following the accident and TP was effective immediately (no days off work), the Initial RTW would be either the DOI or DOI +1 (depending if Empr paid for DOI.) If the EE continued to work restricted duty following the accident and TP was effective immediately (no days off work), the Initial RTW would be either the DOI or DOI +1 (depending if Empr paid for DOI.) Caveats and Tips for Successfully Filing 00/IP

127 127 If the 00/IP reports BTC 030 IB Only, the Initial RTW Date with the applicable RTW Type Code (A- Actual or R- Released) are required... If the 00/IP reports BTC 030 IB Only, the Initial RTW Date with the applicable RTW Type Code (A- Actual or R- Released) are required... Caveats and Tips for Successfully Filing 00/IP

128 128 …This will ensure DWC applies the correct IB payment rate (i.e., the FL Calc Gross Amt.)…This will ensure DWC applies the correct IB payment rate (i.e., the FL Calc Gross Amt.) If Actual RTW Date is not sent when applicable, DWCs program will compute the full IB rate.If Actual RTW Date is not sent when applicable, DWCs program will compute the full IB rate. Caveats and Tips for Successfully Filing 00/IP

129 129 The calculation for determining FL Calc Gross Amt for IBs (030) was recently amended to allow for the payment of EITHER a 37.5% or a 75% rate when the EE has actually returned to work, based on recent court case…. The calculation for determining FL Calc Gross Amt for IBs (030) was recently amended to allow for the payment of EITHER a 37.5% or a 75% rate when the EE has actually returned to work, based on recent court case…. Caveats and Tips for Successfully Filing 00/IP

130 130 …The First DCA found in the case of Seminole County Govt v. Eric Baumgardner (2/5/10), that F. S (3)(c) does not allow the Claim Admin. to reduce IBs by 50% if the Claimant is working but not earning 100% of the AWW, even if the reason for the reduced earnings is unrelated to the accident. …The First DCA found in the case of Seminole County Govt v. Eric Baumgardner (2/5/10), that F. S (3)(c) does not allow the Claim Admin. to reduce IBs by 50% if the Claimant is working but not earning 100% of the AWW, even if the reason for the reduced earnings is unrelated to the accident.

131 131 If the initial payment is for Impairment Income Benefits (030) paid in a lump sum, you would send a SROI PY (with FROI ) instead of a SROI IP. If the initial payment is for Impairment Income Benefits (030) paid in a lump sum, you would send a SROI PY (with FROI ) instead of a SROI IP. Lump Sum Payment/Settlement Code (i.e. A – Advance) is not required here because lump sum payments of IBs are sometimes made in arrears for back IBs due versus an advance of future IBs due and owing. Lump Sum Payment/Settlement Code (i.e. A – Advance) is not required here because lump sum payments of IBs are sometimes made in arrears for back IBs due versus an advance of future IBs due and owing. Caveats and Tips for Successfully Filing 00/IP

132 132 Caveats and Tips for Successfully Filing 00/IP BTC 030 IB Only paid in a lump sum via 00/PY will be discussed in more detail when we cover SROI MTC PY filings. BTC 030 IB Only paid in a lump sum via 00/PY will be discussed in more detail when we cover SROI MTC PY filings.

133 133 Acknowledgement Free Form Text Messages for Claim Administrators

134 134 Where applicable, the following additional information is provided by DWC on the Acknowledgement in the Free Form Text field: POSSIBLE COVERAGE EXEMPTION ON FILE FOR SSN and NO 02 IN BEN SEG-NOT EDITED/LOADED

135 135 To Follow-up on Possible Exemptions: Go to Proof of Coverage database on web: https://secure.fldfs.com/WCAPPS/Compliance_poc/wPages/query.asp https://secure.fldfs.com/WCAPPS/Compliance_poc/wPages/query.asp Search by the EE Name or SSN. Search by the EE Name or SSN. Review Exemption on file to see if the Employer listed on the Exemption is the same as the accident Employer. If so, the EE should technically not be receiving WC benefits. Review Exemption on file to see if the Employer listed on the Exemption is the same as the accident Employer. If so, the EE should technically not be receiving WC benefits.

136 136 Lets complete a SROI for Scenario 1-A-8 (New) in your Handouts…

137 137 Electronic First Report of Injury or Illness Initial Payment – 00/IP BTC 070 with Multiple Initial RTW Dates on same IP (Scenario 1-A-8)

138 138 Relative to this scenario, an IRR was recently submitted requesting clarification/modification of DP Rule in order to address the correct Initial RTW date that should be reported if both a Released and Actual RTW Date occur before the first payment.

139 139 Currently, there is no clear guidance from the IAIABC as to how to report multiple Initial RTW. The following scenario presents FLs current position until we receive further direction from the IAIABC.

140 140 The SROI IP will contain partial data excerpted from the SROI, and includes: 1 Benefits Segment and 1 Benefits Segment and 1 Payments Segment. 1 Payments Segment.

141 Transaction Set ID A9Subsequent Report 0002Maint. Type CodeIPInitial Payment 0003MTC Date Jan.23, Jurisdiction CodeFL 0006Insurer FEIN Claim Administrator Postal Code Initial Date Disability Began Jan. 1, Current Return to Work Date N/A

142 Wage Period Code 01Weekly 0064 Number of Days Worked Per Week5 0031Date of Injury Jan. 1, Claim Admin. Claim Number WC Jurisdiction Claim NumberN/A 0074Claim Type CodeI Indemnity/ Lost Time

143 143 R22 Data Elements 0001Transaction Set IDR22 N/A Date Claim Administrator Had Knowledge of Lost Time (Clm Admins Knowledge of 8 th Day of Dis for FL) Claim Administrator Claim NumberWC Claim Administrator FEIN

144 Claim Administrator Name OLD RELIABLE INSURANCE COMPANY 0140Claim Administrator Claim Rep Name Angie,,Adjuster Angie Adjuster 0137Claim Admin. Claim Rep Phone Number (850) Employee ID Type Qualifier S Social Security Number 0042Employee SSN

145 Employee Last Name SMITH 0044 Employee First Name JOHN 0045 Employee Middle Name/Initial J 0255 Employee Last Name SuffixJR 0052 Employee Date of Birth May 1, Reduced Benefit Amount CodeN/A

146 Return To Work With Same Employer Ind YYes N/A Non-Consecutive Period Code0212 N/A Current Date Last Day Worked0145 N/A Current Date Disability Began Initial Date Last Day Worked Jan. 1, Return To Work Type Code AActual

147 Physical Restrictions Ind. YYes 0134 Calculated Weekly Compensation Amount $ Wage Effective Date Jan. 1, Type of Loss Code 01Trauma 0058 Employment Status Code 1Full Time

148 Initial Return to Work Date Jan. 10, Full Wages Paid For Date Of Injury Indicator NNo 0273Employer Paid Salary in Lieu of Comp. Indicator NNo 0286Average Wage $ Initial Date of Lost Time (8 th Day) N/A 0200 Claim Admin. Alternate Postal Code (Mailing)

149 149 Variable Segment Counters 0288 Number of Benefits 01 1 Occurrence 0283 Number of Payments01 1 Occurrence 0282 Number of Other Benefits 02 2 Occurrences 0289 Number of Benefit ACR Number of Recoveries00

150 Number of Reduced Earnings Number of Concurrent Employers Number of Full Denial Reason Code Number of Denial Reason Narratives Number of Suspension Narratives00

151 151 Variable Segments Benefits1 Occ 0085Benefit Type Code070 Temporary Partial 0002Maint. Type CodeIPInitial Payment 0174Gross Weekly AmtN/A for TP 0175 Gross Weekly Amount Effective Date N/A for TP 0087Net Weekly AmountN/A for TP 0211 Net Weekly Amount Effective Date N/A for TP

152 Benefit Period Start Date Jan. 1, Benefit Period Through Date Jan. 21, Benefit Type Claim Weeks Benefit Type Claim Days Benefit Type Amount Paid $ Benefit Payment Issue Date Jan. 23, 2010

153 153 Payments 1 Occ 0222 Payment Reason Code070 Temporary Partial 0217PayeeJOHN J SMITH JR 0218Payment Amount $ Payment Covers Period Start Date Jan. 1, Payment Covers Period Through Date Jan. 21, Payment Issue Date Jan. 23, 2010 P&I reported under OBT 311 and 321

154 154 Questions?

155 155 More on Other First Report / EDI DWC-1 Equivalent MTCs

156 156 Other First Report/EDI DWC-1 Equivalents Recap: EDI DWC-1 Equivalent MTCs other than 00/IP are used when indemnity benefits are not initially being paid by the Claim Admin., but a report of injury is due to DWC for a lost time case (e.g., FROI 04.)

157 157 EDI DWC-1 Equivalents The following SROIs (sent with FROI 00), will still require a Benefits segment: EP – Employer Paid EP – Employer Paid PY – Lump Sum Payment/Settlement PY – Lump Sum Payment/Settlement

158 158 Initial Payment Equivalents (Sent with FROI 00 or AU): However, there will not be any Benefits Segments on the following SROI MTCs (sent with FROI 00),since no indemnity was paid on the claim. However, there will not be any Benefits Segments on the following SROI MTCs (sent with FROI 00), since no indemnity was paid on the claim. CD (Compensable Death, CD (Compensable Death, VE (Compensable Volunteer, and VE (Compensable Volunteer, and PD (Partial/Indemnity Only Denial). PD (Partial/Indemnity Only Denial).

159 159 POP QUIZ: Which MTC(s) are sent to report an Electronic First Report of Injury or Illness where salary was paid in lieu of compensation?

160 160 Answer: MTC 00/EP EMPLOYER PAID BENEFITS

161 161 69L (22), F.A.C. defines Employer Paid Salary in Lieu of Compensation as the employer paid the employee salary, wages, or other remuneration for a period of disability for which the insurer would have otherwise been obligated to pay indemnity benefits. 69L (22), F.A.C. defines Employer Paid Salary in Lieu of Compensation as the employer paid the employee salary, wages, or other remuneration for a period of disability for which the insurer would have otherwise been obligated to pay indemnity benefits. EMPLOYER PAID BENEFITS

162 162 This does NOT include the waiting week if the employee was not disabled for 22 or more days. This does NOT include the waiting week if the employee was not disabled for 22 or more days. EMPLOYER PAID BENEFITS

163 163 EMPLOYER PAID BENEFITS 00/EP – Initial Payment Equivalent: Represents the first report of payment of an indemnity benefit other than a lump sum payment/settlement that has been paid by the employer in lieu of compensation. Represents the first report of payment of an indemnity benefit other than a lump sum payment/settlement that has been paid by the employer in lieu of compensation.

164 164 EMPLOYER PAID BENEFITS The EE has received only salary in lieu of compensation from the employer at the time of filing. The EE has received only salary in lieu of compensation from the employer at the time of filing. The Claim Administrator has not paid any indemnity benefits at the time of filing. The Claim Administrator has not paid any indemnity benefits at the time of filing. 00/EP – Initial Payment Equivalent:

165 165 A 00/EP filing must contain only 2xx benefits segment(s). 240 Employer Paid Unspecified Indemnity benefits 240 Employer Paid Unspecified Indemnity benefits EMPLOYER PAID BENEFITS 250 Employer Paid TT benefits 250 Employer Paid TT benefits 270 Employer Paid TP benefits 270 Employer Paid TP benefits

166 166 Also valid, but not as typical: 210 Employer Paid Death benefits 210 Employer Paid Death benefits 230 Employer Paid Impairment Income benefits 230 Employer Paid Impairment Income benefits 242 Employer Paid Voc Rehab (TT – R&E) 242 Employer Paid Voc Rehab (TT – R&E) 251 Employer Paid TT Catastrophic (80%) 251 Employer Paid TT Catastrophic (80%) EMPLOYER PAID BENEFITS

167 167 If the initial payment of indemnity benefits are paid by the Employer as a full settlement, BTC 524 would be reported via MTC 00/PY (vs. 00/EP). EMPLOYER PAID BENEFITS

168 168 Benefit Type Codes 210, 230, 242, 250, 251, 270 should be used if the Claim Admin. knows the specific benefit type for which the injured worker was paid salary in lieu of comp (Benefit Type Amount Paid is reqd for these BTCs.) If the specific benefit type is unknown, BTC 240 should be used. EMPLOYER PAID BENEFITS

169 169 Data Population Rules for Employer Paid Benefits

170 170 Caveats and Tips for Successfully Filing 00/EP

171 171 Do not send SROI EP if, at the time of filing, the only compensation the EE received was salary in lieu of comp (BTC 2xx) for the waiting week (Days 1-7). Do not send SROI EP if, at the time of filing, the only compensation the EE received was salary in lieu of comp (BTC 2xx) for the waiting week (Days 1-7). Caveats and Tips for Successfully filing 00/EP

172 172 POP QUIZ: If the EE has received payment from the Employer for Days 1 thru 7 and payment from the Claim Admin. for Days 8 thru 14, what MTC(s) should be filed w/DWC? If the EE has received payment from the Employer for Days 1 thru 7 and payment from the Claim Admin. for Days 8 thru 14, what MTC(s) should be filed w/DWC? Caveats and Tips for Successfully filing 00/EP

173 173 ANSWER:00/IP Caveats and Tips for Successfully filing 00/EP

174 174 Here, the 00/IP (sent at Day 14) may include the 2xx Benefits segment for Days 1 thru 7. Here, the 00/IP (sent at Day 14) may include the 2xx Benefits segment for Days 1 thru 7. But because salary was not paid beyond the waiting week, it cannot be considered salary in lieu of comp (since Days 1-7 were not yet payable at the time of filing.) Caveats and Tips for Successfully filing 00/EP

175 175 If BTC 2xx was not included on the 00/IP and the EE was eventually disabled for 22 or more days such that the waiting week does become payable/reportable… If BTC 2xx was not included on the 00/IP and the EE was eventually disabled for 22 or more days such that the waiting week does become payable/reportable… Caveats and Tips for Successfully filing 00/EP

176 176 … BTC 2xx should appear on the next SROI to account for payment of the waiting week. In this situation, a SROI CB is not required to introduce the new 2xx benefits (so long as the Start Date of the 2xx segment is the earliest Start Date of all benefits reported.) Caveats and Tips for Successfully filing 00/EP

177 177 If you issue payment after the Empr, where the EE was disabled for 22 days or more, but the 00/IP is being filed late, the IP should include both the 2xx segment along with the segment reporting benefits paid by the Claim Admin (providing you did not fully reimburse the employer for all salary paid.) … If you issue payment after the Empr, where the EE was disabled for 22 days or more, but the 00/IP is being filed late, the IP should include both the 2xx segment along with the segment reporting benefits paid by the Claim Admin (providing you did not fully reimburse the employer for all salary paid.) … Caveats and Tips for Successfully filing 00/EP

178 178 … Here, Days 1 thru 7 paid by the Employer does constitute salary in lieu of compensation that the Claim Administrator would have otherwise had to pay (since the EE was disabled for 22 or more days.) … Here, Days 1 thru 7 paid by the Employer does constitute salary in lieu of compensation that the Claim Administrator would have otherwise had to pay (since the EE was disabled for 22 or more days.) Caveats and Tips for Successfully filing 00/EP

179 179 If you receive a penalty because you incorrectly filed an 00/IP and meant to file 00/EP, you can send a SROI 02 to revise the benefit picture and change the earliest paid indemnity to BTC 2xx; … If you receive a penalty because you incorrectly filed an 00/IP and meant to file 00/EP, you can send a SROI 02 to revise the benefit picture and change the earliest paid indemnity to BTC 2xx; … Caveats and Tips for Successfully filing 00/EP

180 180 … however, the SROI 02 must be the next accepted filing. Also, MTC 02 must be included in the Benefits segment. Otherwise, DWCs program will not edit/load the Benefits segment(s). Also, MTC 02 must be included in the Benefits segment. Otherwise, DWCs program will not edit/load the Benefits segment(s). Caveats and Tips for Successfully filing 00/EP

181 181 Also, Reduced Benefit Amount Code R must be present on the 02 to explain the disappearance of the previously reported BTC 2xx. Also, Reduced Benefit Amount Code R must be present on the 02 to explain the disappearance of the previously reported BTC 2xx. Caveats and Tips for Successfully filing 00/EP

182 182 After you confirm the 02 was accepted (see filing results in Data Warehouse next day), you can request a re-evaluation of a penalty that may have resulted from the incorrect initial benefit information. After you confirm the 02 was accepted (see filing results in Data Warehouse next day), you can request a re-evaluation of a penalty that may have resulted from the incorrect initial benefit information. Caveats and Tips for Successfully filing 00/EP

183 183 If the 02 is the next accepted filing, the following fields will be updated in DWCs database automatically (so the Claims EDI Team will not have to manually revise DWCs claim record prior to CPS re-evaluation): If the 02 is the next accepted filing, the following fields will be updated in DWCs database automatically (so the Claims EDI Team will not have to manually revise DWCs claim record prior to CPS re-evaluation): Caveats and Tips for Successfully filing 00/EP

184 184 Salary Contd in Lieu of Comp Ind. Salary Contd in Lieu of Comp Ind. BTC 240 (Salary) Through Date BTC 240 (Salary) Through Date Original BTC Original BTC Claim Admin. Knowledge of Injury Claim Admin. Knowledge of Injury Payment Issue Date Payment Issue Date Pen & Int Amount Paid in 1 st Payment (OBTs 311 and 321) Pen & Int Amount Paid in 1 st Payment (OBTs 311 and 321) DNs Changed by 02 if Next Accepted Filing:

185 185 If the 02 is not the next accepted filing after the 00/IP, these fields will need to be manually updated by the EDI Team (upon request by the CPS Admin.) to replace the initial payment data with the correct information. If the 02 is not the next accepted filing after the 00/IP, these fields will need to be manually updated by the EDI Team (upon request by the CPS Admin.) to replace the initial payment data with the correct information. Caveats and Tips for Successfully filing 00/EP

186 186 Employer Paid Salary In Lieu of Compensation Indicator (DN-273) should be reported as Y only if Employer is currently paying salary in lieu of comp. Employer Paid Salary In Lieu of Compensation Indicator (DN-273) should be reported as Y only if Employer is currently paying salary in lieu of comp. If Employer discontinues salary and Claim Admin. picks up payment, the Indicator should be changed to N. Caveat sand Tips for Successfully filing 00/EP

187 187 If you subsequently reimburse the employer for all salary paid in lieu compensation, Reduced Benefit Amount Code R – Reclassification should be sent on the next transaction to explain why the 2xx Benefits segment is no longer present. If you subsequently reimburse the employer for all salary paid in lieu compensation, Reduced Benefit Amount Code R – Reclassification should be sent on the next transaction to explain why the 2xx Benefits segment is no longer present. Caveats and Tips for Successfully filing 00/EP

188 188 If the employer actually paid salary in lieu of comp (for more than the ww), but the 00/IP was filed late and the Claim Admin. has already reimbursed the employer for all prior employer paid benefits, there will never be a 2xx segment on any EDI transaction. As a result, … If the employer actually paid salary in lieu of comp (for more than the ww), but the 00/IP was filed late and the Claim Admin. has already reimbursed the employer for all prior employer paid benefits, there will never be a 2xx segment on any EDI transaction. As a result, … Caveats and Tips for Successfully filing 00/EP

189 189 … you will need to supply other documentation to satisfy the CPS Specialist that salary was initially paid and that the initial payment was not late. Afterwards, the EDI Team will be asked by CPS Admin. to update DWCs system to reflect the initial payment of indemnity as salary in lieu of comp.

190 190 If salary in lieu of comp was initially reported in error or mis-coded from a paper DWC-1 or R1 EDI filing: If salary in lieu of comp was initially reported in error or mis-coded from a paper DWC-1 or R1 EDI filing: Rather than sending Reduced Benefit Amount Code R to reconcile the problem, contact the EDI Team, which can manually modify the initial filing information on DWCs database. Caveats and Tips for Successfully filing 00/EP

191 191 Recap: For R3 EDI filings: An MTC 02 is required to report corrected initial payment information. An MTC 02 is required to report corrected initial payment information. If intervening EDI transactions were accepted prior to the 02, an EDI Team member will need to manually update DWCs database upon verification of the corrected data on the 02. If intervening EDI transactions were accepted prior to the 02, an EDI Team member will need to manually update DWCs database upon verification of the corrected data on the 02. Caveats and Tips for Successfully filing 00/EP

192 192 We are seeing many rejections of 00/EP filings that appear to be medical only. We are seeing many rejections of 00/EP filings that appear to be medical only. Remember, the Start Date of 2xx must be at least Day 8 of disability. You may need to either change an inaccurate Initial Date Disability Began or Start and Through Dates. Caveats and Tips for Successfully filing 00/EP

193 193 POP Quiz: What MTC should be filed with DWC if the employer ceases to pay salary in lieu of compensation and you start paying instead?

194 194 Answer: SROI MTC IP

195 195 IP after EP If you are making your initial payment of indemnity (not a lump sum payment/settlement) after Empr paid salary in lieu of comp: If you are making your initial payment of indemnity (not a lump sum payment/settlement) after Empr paid salary in lieu of comp: A SROI MTC IP must be sent after the MTC EP that reported the initial payment of Employer Paid benefits.

196 196 If your initial payment, after the Employer paid benefits, is for a Final Settlement, send SROI PY (instead of IP.) If your initial payment, after the Employer paid benefits, is for a Final Settlement, send SROI PY (instead of IP.)

197 197 And if your initial payment, after the Employer paid benefits, is a lump sum payment that is not a final settlement (e.g., advance), send PY followed by an IP to show payment of ongoing benefits (EP – PY – IP.) And if your initial payment, after the Employer paid benefits, is a lump sum payment that is not a final settlement (e.g., advance), send PY followed by an IP to show payment of ongoing benefits (EP – PY – IP.)

198 198 Also, if you will be continuing payment (after the Employer paid) and a SX was previously filed that reported the suspension of employer paid benefits, a SROI IP (vs. RB) should be filed with DWC to report your initial payment of indemnity (EP – Sx - IP.) Also, if you will be continuing payment (after the Employer paid) and a SX was previously filed that reported the suspension of employer paid benefits, a SROI IP (vs. RB) should be filed with DWC to report your initial payment of indemnity (EP – Sx - IP.)

199 199 In these cases, the standalone SROI MTC IP, PY represent an Electronic Notice of Action/Change, EDI DWC-4 equivalent, required in Rule 69L (3), F.A.C. In these cases, the standalone SROI MTC IP, PY represent an Electronic Notice of Action/Change, EDI DWC-4 equivalent, required in Rule 69L (3), F.A.C. DWC-4 or explanatory letter is required to be sent to the EE and Employer.

200 200 EP after IP If the Employer elects to pay indemnity benefits, e.g., Impairment Income benefits, AFTER the Claim Administrator paid indemnity benefitsa SROI EP must be filed after MTC IP. If the Employer elects to pay indemnity benefits, e.g., Impairment Income benefits, AFTER the Claim Administrator paid indemnity benefits, a SROI EP must be filed after MTC IP. See Rule 69L (5), F.A.C. (No DWC-4 or letter required.)

201 201 EP after Sx EP is also required if the employer paid benefits after an Sx that reported suspension of indemnity benefits previously paid by the Claim Admin (IP – Sx - EP) … EP is also required if the employer paid benefits after an Sx that reported suspension of indemnity benefits previously paid by the Claim Admin (IP – Sx - EP) … See Rule 69L (5), F.A.C. (No DWC-4 or letter required.)

202 202 … SROI ER would only be applicable in this situation if the employer had previously paid (EP – IP – Sx – ER.) See Rule 69L (6), F.A.C. (No DWC-4 or letter required.)

203 203 Exception to filing an EP or ER: Exception to filing an EP or ER: If the employer elects to pay a lump sum payment/settlement, you would send MTC PY with BTC 524 (Employer Paid Lump Sum Payment/Settlement.) If the employer elects to pay a lump sum payment/settlement, you would send MTC PY with BTC 524 (Employer Paid Lump Sum Payment/Settlement.)

204 204 Questions?

205 205 POP QUIZ: What MTC is used to report a Totally Denied Electronic First Report of Injury or Illness?

206 206 ANSWER: FROI MTC 04 Full (Total) Denial EDI DWC-1 Equivalent required to be filed with DWC per Rule 69L (2).

207 207 FROI MTC 04 Full (Total) Denial FROI 04 represents a total denial of all indemnity and medical benefits, including denials based on compensability. FROI 04 represents a total denial of all indemnity and medical benefits, including denials based on compensability.

208 208 FROI MTC 04 Full (Total) Denial This is the only EDI DWC-1 equivalent that does not require a corresponding SROI MTC to be paired with a FROI MTC. This is the only EDI DWC-1 equivalent that does not require a corresponding SROI MTC to be paired with a FROI MTC.

209 209 Even if a claim is classified as medical only in your system, if compensability of the claim is being denied, you must still report the claim to DWC, since the entire claim, including any potential indemnity, is denied. Even if a claim is classified as medical only in your system, if compensability of the claim is being denied, you must still report the claim to DWC, since the entire claim, including any potential indemnity, is denied. FROI MTC 04 Full (Total) Denial

210 210 The corresponding Electronic Notice of Denial, EDI DWC-12 equivalent, is also due, and reported on the same FROI 04. The corresponding Electronic Notice of Denial, EDI DWC-12 equivalent, is also due, and reported on the same FROI 04. FROI MTC 04 Full (Total) Denial

211 211 FROI MTC 04 - Full (Total) Denial To report the EDI DWC-12 equivalent, the FROI 04 must contain: To report the EDI DWC-12 equivalent, the FROI 04 must contain: Full Denial Reason Code, Full Denial Reason Code, Full Denial Effective Date, and Full Denial Effective Date, and Denial Reason Narrative. Denial Reason Narrative. Note: A paper copy of DWC-1 and DWC-12 must be produced for the EE & Employer.

212 212 FROI MTC 04 - Full (Total) Denial Full Denial Reason Code should identify all of the reasons the claim was denied (up to five different codes can be sent.) Full Denial Reason Code should identify all of the reasons the claim was denied (up to five different codes can be sent.) Code 3F (Statute of limitations expired) is precluded unless MTC Date is >= one year after the DOI. Code 3F (Statute of limitations expired) is precluded unless MTC Date is >= one year after the DOI.

213 213 FROI MTC 04 - Full (Total) Denial Also, Full Denial Reason Code 5B (Right to Reserve) can not be the only Full Denial Reason Code sent. Also, Full Denial Reason Code 5B (Right to Reserve) can not be the only Full Denial Reason Code sent.

214 214 FROI MTC 04 - Full (Total) Denial Full Denial Effective Date is the date from which the Claim Admin. is denying all benefits for the claim (e.g., DOI). Full Denial Effective Date is the date from which the Claim Admin. is denying all benefits for the claim (e.g., DOI). Can not be sent as a future date (i.e., later than the date the 04 was received by DWC.) Can not be sent as a future date (i.e., later than the date the 04 was received by DWC.)

215 215 FROI MTC 04 - Full (Total) Denial Denial Reason Narrative is required and must contain supporting documentation for the denial and must not repeat the text description of the Denial Reason Code. Denial Reason Narrative is required and must contain supporting documentation for the denial and must not repeat the text description of the Denial Reason Code. EAO will require an 02 Change transaction if the Denial Reason Narrative is insufficient. EAO will require an 02 Change transaction if the Denial Reason Narrative is insufficient.

216 216 FROI MTC 04 - Full (Total) Denial If a Full Denial Claim (FROI 04) begins as a Medical Only case, Claim Type M should be sent to represent a Medical Only Case for which compensability is being denied… If a Full Denial Claim (FROI 04) begins as a Medical Only case, Claim Type M should be sent to represent a Medical Only Case for which compensability is being denied…

217 217 Claim Type M should only be sent on a FROI 04 where initial disposition was a compensable medical only claim that was subsequently denied in full (e.g., 3 months after the DOI). Claim Type M should only be sent on a FROI 04 where initial disposition was a compensable medical only claim that was subsequently denied in full (e.g., 3 months after the DOI). It should not be sent on a FROI 04 for which indemnity was claimed at the time of initial disposition (14 days of knowledge.) It should not be sent on a FROI 04 for which indemnity was claimed at the time of initial disposition (14 days of knowledge.) FROI MTC 04 - Full (Total) Denial

218 218 If denials are ever re-included in CPS in the future, Claim Type M may serve to differentiate this type of denial from a straight lost time denial that can be evaluated for timely filing. If denials are ever re-included in CPS in the future, Claim Type M may serve to differentiate this type of denial from a straight lost time denial that can be evaluated for timely filing. FROI MTC 04 - Full (Total) Denial

219 219 Note: Claim Type L (MO to LT) would not be applicable in this situation because there may not be any actual or claimed disability dates to report if compensability is being denied in general, so... FROI MTC 04 - Full (Total) Denial

220 220 …there would not be any associated 8th day of disability information to report, which is required if Claim Type = L. …there would not be any associated 8th day of disability information to report, which is required if Claim Type = L. FROI MTC 04 - Full (Total) Denial

221 221 We inspected FROI 04 filings that reported Claim Type M and found that many were sent within 14 days of the DOI, in which case Claim Type M is not applicable. We inspected FROI 04 filings that reported Claim Type M and found that many were sent within 14 days of the DOI, in which case Claim Type M is not applicable. We will therefore be implementing a new edit effective Sept. 1, 2010 that will preclude this. FROI MTC 04 - Full (Total) Denial

222 222 Filing Caveats and Tips for Successfully Filing FROI 04

223 223 We dont see that many rejections associated with FROI 04s since there arent as many data elements on the FROI compared to the SROI, but the next few slides will identify the most frequently occurring types of errors for FROI 04s.. We dont see that many rejections associated with FROI 04s since there arent as many data elements on the FROI compared to the SROI, but the next few slides will identify the most frequently occurring types of errors for FROI 04s.. Caveats and Tips for Successfully Filing 04:

224 224 Mainly, we are seeing potential duplication of denials, where a FROI 04 was sent, but either a DWC-1 or SROI (from same Claim Admin.) was already filed. Mainly, we are seeing potential duplication of denials, where a FROI 04 was sent, but either a DWC-1 or SROI (from same Claim Admin.) was already filed. If the denial is not a duplicate and still needs to be filed, it must be sent as a SROI 04 (not another FROI 04.) If the denial is not a duplicate and still needs to be filed, it must be sent as a SROI 04 (not another FROI 04.) Caveats and Tips for Successfully Filing 04:

225 225 Duplicate Denial errors are also occurring when more than one FROI 04 is sent in the same batch. Duplicate Denial errors are also occurring when more than one FROI 04 is sent in the same batch. Note: Unnecessary SROI 04s are also being sent after a FROI 04 was already filed, where no intervening MTC was filed to accept liability after the FROI 04 and before the SROI 04. Caveats and Tips for Successfully Filing 04:

226 226 FROI 04s are also rejecting where Nature of Injury Code = 60 – 80 ( Occupational Disease or Cumulative Injury ), but Type of Loss Code = 01 (Traumatic). FROI 04s are also rejecting where Nature of Injury Code = 60 – 80 ( Occupational Disease or Cumulative Injury ), but Type of Loss Code = 01 (Traumatic). Here, Type of Loss Code should = 02 (Occupational Disease) or 03 (Cumulative Injury - Other than Disease). Here, Type of Loss Code should = 02 (Occupational Disease) or 03 (Cumulative Injury - Other than Disease). Caveats and Tips for Successfully Filing 04:

227 227 Some FROI 04s are missing the Employers Address and FEIN, which are excused only if you are denying the claim on grounds of no coverage (Full Denial Reason Code 3A-H.) Some FROI 04s are missing the Employers Address and FEIN, which are excused only if you are denying the claim on grounds of no coverage (Full Denial Reason Code 3A-H.) Caveats and Tips for Successfully Filing 04:

228 228 Recap: Full Denial Reason Code 5B (Right to Reserve) cannot be the only Full Denial Reason Code sent. Also, Full Denial Reason Code 3F (Statute of limitations expired) cannot be reported unless MTC Date is at least 1 year after the DOI. Caveats and Tips for Successfully Filing 04:

229 229 Questions?

230 230 POP QUIZ: What MTC is used to report an Indemnity Only Denied Electronic First Report of Injury or Illness?

231 231 ANSWER: FROI 00 + SROI PD (Partial Denial) EDI DWC-1 Equivalent required to be filed with DWC per Rule 69L (2)(c), F.A.C.

232 232 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent A FROI 00 and SROI PD should be filed when the claim is found to be compensable, but indemnity benefits are denied in whole and only medical benefits will be paid. A FROI 00 and SROI PD should be filed when the claim is found to be compensable, but indemnity benefits are denied in whole and only medical benefits will be paid.

233 233 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent The same SROI PD sent with FROI 00 will also accomplish the reporting of the Electronic Notice of Denial, EDI DWC-12 equivalent, since it must contain: Partial Denial Code (A or E only), and Partial Denial Code (A or E only), and Denial Reason Narrative to provide details about why indemnity benefits will not be paid. Denial Reason Narrative to provide details about why indemnity benefits will not be paid.

234 234 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent PARTIAL DENIAL CODE identifies which portion of the claim is being denied (not the reason it is denied). PARTIAL DENIAL CODE identifies which portion of the claim is being denied (not the reason it is denied).

235 235 A Denying Indemnity in whole, but not Medical (Indemnity Only Denied Case) B Denying Indemnity in part, but not Medical E Denying Indemnity in whole and Medical in part (Indemnity Only Denial) G Denying both Indemnity and Medical in part Partial Denial Codes for FL

236 236 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent The Partial Denial Code should identify which portion of the claim is currently being denied (vs. evaluating if any indemnity and medical benefits have been paid in the past). The Partial Denial Code should identify which portion of the claim is currently being denied (vs. evaluating if any indemnity and medical benefits have been paid in the past).

237 237 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent For example:If indemnity benefits were previously paid and the Claim Admin. decided to deny all future indemnity but not deny all medical, they would send a Partial Denial Code A or E …For example: If indemnity benefits were previously paid and the Claim Admin. decided to deny all future indemnity but not deny all medical, they would send a Partial Denial Code A or E …

238 238 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent o indicate that ALL indemnity is currently being denied (and not Partial Denial Code B or G on the basis that some indemnity had been paid in the past.) … to indicate that ALL indemnity is currently being denied (and not Partial Denial Code B or G on the basis that some indemnity had been paid in the past.)

239 239 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent Denial Reason Narrative is required to convey the specific benefits and reasons for the denial, and should not repeat the information already represented by the code itself. Denial Reason Narrative is required to convey the specific benefits and reasons for the denial, and should not repeat the information already represented by the code itself.

240 240 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent Again, the narrative should NOT be defaulted to the text description of the code. Again, the narrative should NOT be defaulted to the text description of the code. This will result in additional correspondence from EAO and you will be required to send another transaction (MTC 02).This will result in additional correspondence from EAO and you will be required to send another transaction (MTC 02).

241 241 Partial (Indemnity Only) Denial EDI DWC-1 Equivalent MTC PD (Partial Denial) is not used in conjunction with MTC PD (Partial Denial) is not used in conjunction with Full Denial data elements: Full Denial Reason CodeFull Denial Reason Code Full Denial Effective DateFull Denial Effective Date DENIED

242 242 If indemnity benefits were previously paid and you later changed disposition and denied ALL future indemnity and ALL future medical, you would report a SROI 04 – Full (Total) Denial. If indemnity benefits were previously paid and you later changed disposition and denied ALL future indemnity and ALL future medical, you would report a SROI 04 – Full (Total) Denial. Partial (Indemnity Only) Denial

243 243 Caveats and Tips for Successfully Filing FROI 00 + SROI PD

244 244 If a First Report of Injury or Illness is not already on file with DWC (paper or EDI), a Partial (Indemnity Only) Denial 00/PD can only be sent with Partial Denial Code A or E. If a First Report of Injury or Illness is not already on file with DWC (paper or EDI), a Partial (Indemnity Only) Denial 00/PD can only be sent with Partial Denial Code A or E. Only Codes A and E represent ALL indemnity is being denied. Only Codes A and E represent ALL indemnity is being denied. Caveats and Tips for Successfully Filing 00/PD

245 245 Partial Denial Codes C or D are never applicable in FL because they represent a denial of medical in whole or part, but not indemnity. Partial Denial Codes C or D are never applicable in FL because they represent a denial of medical in whole or part, but not indemnity. Partial Denial Codes used for FL filings must address some aspect of indemnity denial (all or part). Partial Denial Codes used for FL filings must address some aspect of indemnity denial (all or part). Caveats and Tips for Successfully Filing 00/PD

246 246 Partial Denial Code F should also never be sent because it represents a denial of all medical where indemnity will continue to be paid. Partial Denial Code F should also never be sent because it represents a denial of all medical where indemnity will continue to be paid. This is N/A in FL since indemnity cant be paid without on-going medical substantiation. This is N/A in FL since indemnity cant be paid without on-going medical substantiation. Caveats and Tips for Successfully Filing 00/PD

247 247 If you originally filed a 00/PD with PD Code A or E & you subsequently decide to pay some or all indemnity, you must file a SROI IP with a Denial Rescission Date. If you originally filed a 00/PD with PD Code A or E & you subsequently decide to pay some or all indemnity, you must file a SROI IP with a Denial Rescission Date. Caveats and Tips for Successfully filing 00/PD

248 248 If some indemnity benefits are still being partially denied after the IP, another PD will also need to be filed after the IP to indicate that some indemnity is still being denied. If some indemnity benefits are still being partially denied after the IP, another PD will also need to be filed after the IP to indicate that some indemnity is still being denied. Caveats and Tips for Successfully filing 00/PD

249 249 If you need to report a change in disposition, e.g., going from Partial Denial Code B or G (some indemnity denied) to A or E (all indemnity denied) and no new benefits are being initiated, you would file another PD with the new PD Code. If you need to report a change in disposition, e.g., going from Partial Denial Code B or G (some indemnity denied) to A or E (all indemnity denied) and no new benefits are being initiated, you would file another PD with the new PD Code. Caveats and Tips for Successfully filing 00/PD

250 250 However, if disposition changes from A or E (full indemnity denial) to B or G (denying indemnity in part), you will need to also file an IP (or PY) right behind the PD to report the initiation of indemnity benefits (since you are no longer denying all indemnity.) However, if disposition changes from A or E (full indemnity denial) to B or G (denying indemnity in part), you will need to also file an IP (or PY) right behind the PD to report the initiation of indemnity benefits (since you are no longer denying all indemnity.) Caveats and Tips for Successfully filing 00/PD

251 251 If a Partial Denial Code needs to be changed because the previous PD Code was sent incorrectly, this can be done with MTC 02 (e.g., changing A to E or B to G.) If a Partial Denial Code needs to be changed because the previous PD Code was sent incorrectly, this can be done with MTC 02 (e.g., changing A to E or B to G.) Caveats and Tips for Successfully filing 00/PD

252 252 However, if you are sending an 02 to change the PD Code to B or G (indemnity denied in part) and indemnity benefits will be commencing for the first time, both of these actions cannot be communicated on the 02 alone… However, if you are sending an 02 to change the PD Code to B or G (indemnity denied in part) and indemnity benefits will be commencing for the first time, both of these actions cannot be communicated on the 02 alone… Caveats and Tips for Successfully filing 00/PD

253 253 …You will need to also send another transaction (e.g., IP, PY) to communicate the initiation of indemnity benefits since neither an 02 or PD can initiate benefits. If the claim is still being partially denied, another PD (after IP, PY, etc.) will have to be sent. If the claim is still being partially denied, another PD (after IP, PY, etc.) will have to be sent. Caveats and Tips for Successfully filing 00/PD

254 254 Recap: A Partial Denial Code can be changed on an 02 or PD, but neither transaction will represent the initiation of indemnity benefits. Caveats and Tips for Successfully filing 00/PD

255 255 There is no specific DN for partial denial date, so FL uses the MTC Date associated with the SROI PD filing for comparison to other data. There is no specific DN for partial denial date, so FL uses the MTC Date associated with the SROI PD filing for comparison to other data. e.g., DEN RESC DTE MUST BE >= DEN EFF DTE OR PD MTC DTE Caveats and Tips for Successfully filing 00/PD

256 256 Denial Rescission Date represents an action date (i.e., the date you took the action to rescind benefits), not an effective date of the rescinded benefits. Denial Rescission Date represents an action date (i.e., the date you took the action to rescind benefits), not an effective date of the rescinded benefits. Caveats and Tips for Successfully filing 00/PD

257 257 Questions?

258 258 POP QUIZ: If an EDI DWC-1 equivalent has been filed and you subsequently deny indemnity, what MTC is used to report the Electronic Notice of Denial?

259 259 ANSWER: To report the subsequent denial of indemnity: SROI 04 (if also denying medical) SROI 04 (if also denying medical)or SROI PD SROI PD


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