3 FL EDI Reporting requirements are defined in the Trading Partner Tables: 1.Required Report(s) 2.Data needed on the Report(s) 3.Applied Editing
4 The FL EDI Trading Partner Tables are used to convey FLs EDI reporting requirements. Although they may appear technical and are used by IT staff and EDI Vendors to determine FLs requirements, they were written by and for business staff.
5 These very important requirements documents can be found on the Claims EDI webpage, and are your resource for determining when a transaction should be filed and why it may have errored.
6 These are the Requirement Tables
7 FL Supplement Overview: Tracks all monthly additions or corrections to the requirement tables. Check periodically for updates to this Supplement and all Tables.
8 What is an Event?
9 An Event is a business circumstance that occurs in the life of a WC Claim which requires the reporting of EDI information to DWC. These circumstances reflect FLs requirements, including: First Report of Injury events First Report of Injury events Subsequent Report events Subsequent Report events Periodic events Periodic events
10 2. Initial Payment or Equivalent or Equivalentwith 11. Changes (Non-Indemnity) 9. Lump Sum Payment(s) 9. Lump Sum Payment(s) 1. Establish Claim 4. Suspension of all Benefits 3. Changes to Benefits/Amnts Benefits Claim Event Flow Claim Event Flow in FL Claim Business Events 10.Periodic Reports 12.Cancel 8. Claim Closure
11 This training has been redesigned to follow this claim event flow, regardless of whether an MTC is in the Primary or Secondary Implementation.
FL identifies all of the transactions (MTCs) that are required for reporting specific business events on its FL identifies all of the transactions (MTCs) that are required for reporting specific business events on its Event Table.
14 Due to the national standard format and sequencing requirements, FL requires the reporting of more business events (MTCs) than were required via paper forms.
15 Example: Florida requires the submission of a FROI MTC 00 f or First Reports of Injury or Illness based on the insurers mandate date … f or First Reports of Injury or Illness based on the insurers mandate date … Event Table Interpreting the FL Event Table
16 … when disability is immediate & continuous & lost time is greater than seven (7) days. Event Table Interpreting the FL Event Table
17 The filing must receive a TA within 21 calendar days after the claim administrators knowledge of the injury. Event Table Interpreting the FL Event Table
18 A DWC-1 or IA-1 (ACORD 4) form must also be sent to the employee & employer Event Table Interpreting the FL Event Table
19 In addition to reporting typical business claim Events, FL requires the claim administrator to report the cost status of the claim via Periodic (Claim Cost) Reports
21 What is the Paper Equivalent of a Periodic Report for FL?
22 Answer: DWC-13 DWC-13 Claim Cost Report
24 What are the Periodic MTCs accepted by FL?
25 Answer: MTC SA & FN MTC SA & FN
26 Event Table FL Periodic Reports FN Final – Submitted when Claim Administrator determines no further benefits will be paid. FN Final – Submitted when Claim Administrator determines no further benefits will be paid. SA Sub-Annual – Submitted every 6 months after the DOI, as defined on FLs Event Table. SA Sub-Annual – Submitted every 6 months after the DOI, as defined on FLs Event Table.
27 We will now look at the online copy of FLs Event Table…. Event Table Interpreting the FL Event Table
28 In addition to the Event Table, FL describes its business events in the MTC Filing Instructions. This document (created by Karen Kubie ) is a quick reference tool displaying what MTCs to use in reporting required business events to FL. Event Table MTC Filing Instructions
31 FL Trading Partner Tables Data needed on the Report(s)
32 Element Requirements The FL Element Requirement Table describes the data elements required for each electronic event (MTC) documented on the Event Table.
33 Element Requirements Data Element requirements are defined for each transaction (FROI or SROI) at the Maintenance Type Code (MTC) level.
34 Element Requirements Requirement Codes express FLs requirement severity by data element and report type (FROI or SROI). The following slides define FLs requirement codes.
35 Element Requirements The Element Requirement Table contains 6 worksheets: FROI Element Requirements FROI Element Requirements FROI Conditions (for MCs) FROI Conditions (for MCs) SROI Element Requirements SROI Element Requirements SROI Conditions (for MCs) SROI Conditions (for MCs) Benefit Segment Requirements Benefit Segment Requirements Benefit Conditions (for MCs) Benefit Conditions (for MCs)
37 Element Requirements Fatal. The data element is essential to process the transmission/transaction. F =
38 Element Requirements Exclude. The data element is not applicable to the standard requirements for the MTC and may or may not be sent. X = Edits will NOT be applied, nor will the data be loaded for FL.
39 Element Requirements Mandatory. The data element must be present and must pass all edits (documented in the Edit Matrix) or the transaction will be rejected. M =
40 Element Requirements Mandatory/Conditional. The data element becomes mandatory under conditions documented on the applicable Conditional Requirements worksheets. MC = If the defined condition exists, the data element becomes mandatory and mandatory rules apply.
41 Element Requirements Data Elements defined as M or MC (and the condition applies) are required fields. If they are not present on the transaction, the transaction will receive a Mandatory Field Not Present error (Error # 001).
42 Element Requirements If Applicable/Available. Data should be sent if available or applicable to the claim. IA = If present, data will be edited for valid value and/or format. If the data passes the edits, the data will be loaded. If the data does not pass the edit, the data will not be loaded, and no error will be returned by FL.
43 Element Requirements Not Applicable. The data element is not applicable to FLs requirements for the MTC, and may or may not be sent. FL will not be editing or loading these data elements for this MTC. NA =
44 Element Requirements For DNs that are on both the FROI and SROI, FL has identified which transaction (FROI Or SROI, or Both) from which it will edit/load data, and from which the data will be ignored (N/A).
45 Element Requirements Interpreting Requirement Tables FLs Claim Number is not required on a FROI 00, 04, AQ or AU, but is Mandatory on a FROI 01 or 02.
46 Element Requirements FL Conditional Requirements Table Conditional Requirement Code Data Element Number and Name Business Conditions
47 Element Requirements Additional requirement codes were developed for the MTC 02 (Change) transaction. These will be discussed later in the training.
48 Element Requirements A Benefits segment is expected when indemnity benefits have been paid on the claim, for each applicable Benefit Type Code value indicated in the Edit Matrix. Only one Benefits segment can be sent for each Benefit Type Code.
49 Element Requirements Event Benefits Requirements are described on the Event Benefits Segment Requirement Table. Event Benefits Requirements are described on the Event Benefits Segment Requirement Table.
50 Element Requirements Restricted. The data element value will not be accepted by FL. R = For example, FL does not accept Benefit Type Code 090 (PI) (Permanent Partial Disfigurement) for DOIs 12/31/93
51 Element Requirements Restricted Benefit Types for FL Restricted Benefit Types for FL
52 Element Requirements DNs in the Benefits segment are required based on the MTC as well as the Benefit Type Code being paid. DNs in the Benefits segment are required based on the MTC as well as the Benefit Type Code being paid. Net Weekly Amount
53 Element Requirements Data defined as N/A on the Element Requirement Table, or was not required by the Condition will not be edited, processed or loaded to DWCs system if sent for that MTC. This is commonly misunderstood.
54 Element Requirements Example: Gross/Net Amounts are not required for MTC SA or FN. If these data elements are sent incorrectly, they will not be errored. However, if Gross/Net Amounts are sent wrong on the next Event where they ARE required (CA, CB, etc.) they WILL be errored.
55 Element Requirements Although the same data element may be on both the FROI and SROI, the Element Requirement Table will depict on which transaction the data is required. The other transaction will list the requirement as N/A, which means it will not be edited, processed or loaded to DWCs system if sent for that MTC.
56 Element Requirements Example: Claim Type is not looked at on the FROI 00, but is required on the corresponding SROI IP. If it is only sent on the FROI and not the SROI, they will both reject.
57 Element Requirements We will now look at the online copy of FLs Element Requirement Table….
59 FL Trading Partner Tables AppliedEditing
60 Edit Matrix The Edit Matrix details the edits applied by FL.
61 Pop Quiz: If a Transaction successfully passes all edits, what Application Acknowledgement Code is sent?
62 Answer: TA Transaction Accepted
63 Pop Quiz: If a Transaction fails an edit, what Application Acknowledgement Code is sent?
64 Answer: TR Transaction Rejected
65 Edit Matrix 1. DN-Error Message Table 2. Value Table 3. Match Data Table Sequencing Table 4. Sequencing Table The FL Edit Matrix consists of 8 worksheets: 5. Duplicate Processing ( Proprietary)
66 7. FL Min_Max Table ( Proprietary) 8. FL Calculation Table (Proprietary) Three proprietary worksheets (5., 7., and 8.) were added by FL to express additional editing. Edit Matrix 6. Population Restrictions
67 The 1 st Tab FL DN-Error Message Table (L Table)
69 FL DN-Error Message Table Contains standard logical edits developed for Release 3. Assists the claim administrator in determining what caused a specific error. (FL refers to this as the L Table.) Edit Matrix
70 Edit Matrix FL DN-Error Message Table Release 3 Data Element Numbers and Names are listed down the left columns.
71 Edit Matrix FL DN-Error Message Table Error Message Numbers and associated descriptions are listed across the top of the table.
72 Edit Matrix FL DN-Error Message Table DN Numbers and Error Message Numbers are returned on the Acknowledgement to communicate errors.
73 Edit Matrix FL DN-Error Message Table The spreadsheet is populated with edit defaults by IAIABC. F = Fatal Technical data elements are essential for a transaction to be processed.
74 Edit Matrix FL DN-Error Message Table L = Edit applies to the data elements based on the requirements indicated on the Element Requirement Table. FL added some Ls to table (where allowed).
75 FL has added two proprietary codes: FL = Edit results in a nonfatal error which will be documented on the FL Claims EDI Data Warehouse. IA = Edit will be run. If edit fails, no error will be returned and data will not be loaded. Edit Matrix FL DN-Error Message Table
76 Edit Matrix FL DN-Error Message Table
77 Edit Matrix FL DN-Error Message Table FL has remapped some current R1 Error Codes to new or different Release 3 Error Codes.
78 FL Value Table
79 FL Value Table FL Value Table Conveys the code values that are expected to be reported to FL and code values that may be suppressed. Edit Matrix
81 The FL Quick Code Reference Guide assists in interpreting FLs Value Table in the Edit Matrix. FL Value Table Edit Matrix FL Quick Code Reference (FL DWC Website)
82 The Value Table is separated into two sections: Section 1: If a Data Element is collected by FL but a certain code value is grayed out (i.e., Not Statutorily Valid in FL), the filing will be rejected if that value is sent. FL Value Table Edit Matrix
83 FL Value Table – Section 1 Reflects the FROI and SROI Maintenance Type Codes (MTCs) FL will accept. Edit Matrix
84 FL Value Table – Section 1 FL does not accept FROI MTC CO or UI, or SROI MTC CO or RE. Edit Matrix
85 Section 1 (contd): If a Data Element is not collected by FL (reflected as N in Capture? column) and code values are grayed out, a filing will not be rejected if sent with those values. FL Value Table Edit Matrix
86 FL Value Table – Section 1 Ex: FL does not require or process Initial Treatment Codes. Edit Matrix
87 Section 2: If a Data Element is statutorily valid in FL (e.g., physician payments), but not required to be reported, the corresponding code value(s) is grayed out on the table, and the filing will not be rejected if sent with that value. FL Value Table Edit Matrix
88 FL Value Table – Section 2 Section 2: FL will NOT process the grayed out values; however, they ARE statutorily valid (e.g. atty fees). Edit Matrix
89 FL Value Table – Section 2 Ex: 330 (Total Employers Legal Expenses) Ex: 340 (Total Claimants Legal Expenses) Clm Admins may suppress these values. Edit Matrix
FL Match Data Table
93 FL Match Data Table Describes the data elements that will be used by FL to determine if the transaction will create a new claim, or be associated with an existing claim in DWCs database. Edit Matrix
94 FL Match Data Table If you receive Error # 117, Match Data Value Not Consistent With Value Previously Reported, check this table to see which data elements are being used as match data. Edit Matrix
95 FL Match Data Table Match criteria will be also applied between FROI and SROI combo filings. If any of the match data is different between the FROI and SROI, they will not be paired together for processing. Edit Matrix
96 FL Match Data Table DWC has added a column to the Match Data table to identify how we are matching to combine FROI with corresponding SROIs. Edit Matrix
97 Match Data Rules Standard Match Data Rules are described in Section 4 of the IAIABC R3 Implementation Guide.
FL Sequencing Table
99 Edit Matrix FL Sequencing Table The FL Sequencing Table elaborates on standard error messages related to transaction sequencing (error # ).
101 Transaction Sequencing Standard minimum Transaction Sequencing limitations are described in Section 4 of the IAIABC R3 Implementation Guide.
102 Transaction Sequencing Understanding Transaction Sequencing in Section 4 of the IAIABC R3 Imp. Guide is necessary for understanding the FL Sequencing Table.
103 Edit Matrix FL Sequencing Table The FL Sequencing Table illustrates the sequence in which business events (MTC) typically occur during the life of a claim and what MTC must have preceded the subsequent MTC.
Initial Payment or Equivalent or Equivalentwith 11. Changes (Non-Indemnity) 9. Lump Sum Payment(s) 9. Lump Sum Payment(s) 1. Establish Claim 4. Suspension of all Benefits 3. Changes to Benefits/Amnts Benefits Claim Event Flow Claim Event Flow in FL Transaction Sequencing 10.Periodic Reports 12.Cancel 8. Claim Closure
105 Edit Matrix FL Sequencing Table Now lets try to interpret the Edit Matrix Minimum Sequencing edits Now lets try to interpret the Edit Matrix Minimum Sequencing edits.
106 Edit Matrix FL Sequencing Table FL accepts FROI 00 (with SROI) or FROI 04 to establish a claim. No FROI sequencing edits are applied
107 Shows the minimum sequencing edits that will be applied for an IP Edit Matrix FL Sequencing Table or initial payment equivalent MTC.
108 Element Error Text (DN0291) is the FL error message text sent on the AKC which clarifies the Error Message Code Invalid Event Sequence. Edit Matrix FL Sequencing Table
109 If you do not understand what is meant by the 50 byte error text, you should look it up for more explanation. Edit Matrix FL Sequencing Table
FL Duplicate Processing
112 Edit Matrix FL Duplicate Processing
113 Edit Matrix FL Duplicate Processing In addition to duplicate errors (#057), there are sequencing (#063) and matching errors (#117) in this table.
114 Edit Matrix FL Duplicate Processing Although we do not accept a 00/IP after a previous 00/IP, we WILL accept a 00/IP after a paper DWC-1; however, we will process this as an 00/IP SROI ONLY and not as a First Report on your Report Card/Statistics.
FL Population Restrictions
116 Edit Matrix FL Population Restrictions All FL data element edits are documented in this worksheet.
118 Each Population Restriction contains: Edit Matrix The DN # and Name; The DN # and Name; Population Restrictions
119 Edit Matrix The Error # and Error IAIABC Message description; Population Restrictions
120 Edit Matrix The specific text describing the edit; and The specific text describing the edit; and Population Restrictions If you do not understand the 50 byte error message you received, this is the column that explains how the edit was applied.
121 Edit Matrix The FL-specific text clarifying the IAIABC Error Message Text. The FL-specific text clarifying the IAIABC Error Message Text. Population Restrictions
128 FL Calculation Table (Proprietary) Edit Matrix This table will be used to validate the Gross Weekly Amount (based on the Wage sent) and the Benefit Type Amount Paid expected from the Claim Administrator ( based on the weeks/days sent.)
129 FL Calculation Table (Proprietary) Edit Matrix DWC bases all financial calculations on the Average Wage that is sent. This includes calculations of Calculated Weekly Comp Amount, Gross Weekly Amount, Net Weekly Amount and Benefit Type Amount Paid.
130 FL Calculation Table (Proprietary) Edit Matrix For Example: If the Comp Rate sent is correct for the claim, but the Average Wage is incorrect for the claim, the transaction will reject (TR), due to the fact that the Comp Rate will not equal 66 2/3% of the Average Wage sent.
131 How do you know which Table/Tab to look at to research an error?... Error 001 – Element Requirement Table (including Conditions Tab) Error 057 – Edit Matrix: Pop Rest and Duplicate Tab Error 063 – Edit Matrix: Pop Rest, Sequencing and Duplicate Tab Error Edit Matrix: Pop Rest and Match Data Tab All Other Error #s: Pop Restrictions Tab
132 Edit Matrix We will now look at the online copy of FLs Edit Matrix….
134 How Will EDI Errors Be Communicated to Claim Administrators?
135 The Division will acknowledge every EDI R3 transaction received with the standard EDI Acknowledgement format: AKC. AKC Report
136 The AKC acknowledgement will identify how many transactions passed edits (TA -Transaction Accepted); how many failed edits (TR -Transaction Rejected); and the specific error(s) that caused the transaction to reject.
137 FL does not use the TE – Transaction Accepted with Errors Acknowledgement Code; however, certain errors will display in the warehouse as TA-FL and must be addressed by the claim administrator.
138 Acknowledgement results from the previous days transmission(s) will be posted by 9:00 a.m. the following morning in the EDI Data Warehouse (will be discussed more during the training.)
139 Transmissions received on or before 9:00 p.m., E.S.T., will be processed by DWC the same day the transmission was sent. Transmissions will be acknowledged the next calendar day (usually by 9:00 a.m. E.S.T.)
140 Transmissions received after 9:00 p.m. EST will be processed by DWC the following calendar day, and will be acknowledged the day after the transmission is processed.
141 If you need to confirm if or when a particular filing or group of filings were received by the Division, you can Search for Batches in the Data Warehouse to determine when the FROI and/or SROI batch was received (Click on the Batch ID for batch details.
144 FL processes transmissions 7 days a week, including holidays.
145 If a transaction is improperly rejected by the Division, the entire batch will be re-processed and re- acknowledged using the ARC Acknowledgement format. (see the technical training PowerPoint for more details on the Acknowledgement Process)
146 If a transaction is improperly rejected by FL, the Claim Administrator will receive credit for the date the transaction was originally received by the Division.
147 FL provides EDI Claim Administrators the capability of viewing all FROIs & SROIs received, via the on-line Claims EDI Data Warehouse.
148 The on-line Claims EDI Data Warehouse will assist claim administrators in resolving EDI errors faster, and may also assist in resolving issues with the Centralized Performance System (CPS). Claims EDI Warehouse
149 More detailed information regarding the on-line Claims EDI Data Warehouse is provided later in the EDI training class. Claims EDI Warehouse
150 What is a JCN List and why do I need one?
151 JCN stands for Jurisdiction Claim Number and is assigned by DWC to a specific accident for a specific claim administrator.
152 JCNs must be sent on all Subsequent reports, even on legacy cases that started prior to EDI. So where do you get these numbers?
153 Claim Administrators are able to obtain a listing of JCNs for all their Open claims, or those closed on or after , via the warehouse.
154 The JCN List contains the Date Prepared for the last DWC 1, 4, 12 and/or 13 on file with DWC. The JCN List contains the Date Prepared for the last DWC 1, 4, 12 and/or 13 on file with DWC. An updated listing is created weekly. An updated listing is created weekly. Only the last 3 lists generated are kept on the EDI Warehouse. Only the last 3 lists generated are kept on the EDI Warehouse. Note: The list can be downloaded to a text delimited file and modified as needed.
155 Jurisdiction Claim Number (JCN) Lists are discussed in more detail later in the training.
156 FL BUSINESS SCENARIOS
158 FL SCENARIO ASSUMPTIONS
159 General scenario assumptions are included in the scenarios to assist in understanding the sample data that is presented. General scenario assumptions are included in the scenarios to assist in understanding the sample data that is presented. FL SCENARIO ASSUMPTIONS
160 The FL Scenarios were enhanced from the IAIABC scenarios in the R3 Implementation Guide. The FL Scenarios were enhanced from the IAIABC scenarios in the R3 Implementation Guide. All the 2001 dates were moved forward to 2007 (the next year where all dates fell on the same day of the week). FL SCENARIO ASSUMPTIONS
161 Calculated Weekly Compensation Amount is the Comp. Rate, and is 66 2/3% of the Average Wage. Calculated Weekly Compensation Amount is the Comp. Rate, and is 66 2/3% of the Average Wage. The statutory comp rate max is not accurate per FL law. The statutory comp rate max is not accurate per FL law. FL SCENARIO ASSUMPTIONS
162 Scenarios are presented in uppercase text. However, data may be sent to FL in mixed case format (except between FROI/SROI combos for match data.) Scenarios are presented in uppercase text. However, data may be sent to FL in mixed case format (except between FROI/SROI combos for match data.) FL SCENARIO ASSUMPTIONS The Industry Code must be a 2002 or 2007 NAICS code. The Industry Code must be a 2002 or 2007 NAICS code. Payment of indemnity benefits is based upon a 5 day work week Payment of indemnity benefits is based upon a 5 day work week
163 FL Scenarios contain required sample data elements pertinent to the scenario. These data are identified as M (Mandatory) or MC (Mandatory/Conditional) on the FL Element Requirement Table. FL Scenarios contain required sample data elements pertinent to the scenario. These data are identified as M (Mandatory) or MC (Mandatory/Conditional) on the FL Element Requirement Table. FL SCENARIO ASSUMPTIONS
164 Additional data elements may be present in the scenario if they are identified as IA (If Applicable/Available) on the Element Requirement Table (e.g., Middle Initial and Suffix). Additional data elements may be present in the scenario if they are identified as IA (If Applicable/Available) on the Element Requirement Table (e.g., Middle Initial and Suffix). FL SCENARIO ASSUMPTIONS
165 Although Claim Administrators may send additional data elements marked NA (Not Applicable), such data will not be edited or loaded by FL, and therefore not presented in the scenarios. Although Claim Administrators may send additional data elements marked NA (Not Applicable), such data will not be edited or loaded by FL, and therefore not presented in the scenarios. FL SCENARIO ASSUMPTIONS
166 Note: Do not use the FL Business Scenarios to determine if a data element is required for a particular MTC. The Element Requirement Table is the official source of FLs data element requirements per MTC and the conditions under which the data must be present.
167 FL SCENARIO PROFILES
168 Unless otherwise noted in the scenario narrative, the basic scenario profile information for all scenarios will be as follows…. FL Scenario Profiles
169 Injured Employee DescriptionData Name:John James Smith, Jr. SSN: DOI:June 15, 2007 DOB:May 1, 1953 Empmnt Status: Full Time FL Scenario Profiles
170 Injured Employee DescriptionData Class Code:2802 (Carpenter) Days Worked/Week:5 Wage:$15.00 Wage Period:Hourly (FROI) FL Scenario Profiles
171 Employer/Insured DescriptionData Employer:Acme Construction Inc. FEIN: Physical Location:32 Meadowbrook Lane Anytown, FL Industry (NAICS): FL Scenario Profiles
173 A FROI must be paired with the applicable SROI that is reporting the initial payment or equivalent, unless the FROI is reporting a Full Denial (MTC 04), Cancel (MTC 01), Change (MTC 02) or Acquired Claim (MTC AQ). FL SCENARIOS
174 Complete Scenario for FROI/SROI Combo MTC 00 with IP Disability Immediate & Continuous Rule 69L (1)(a)1., F.A.C.
175 NEW CLAIM: Lost Time Case Where Disability is Immediate and Continuous If the Initial Payment of Indemnity Benefits will be made by the Claim Administrator, and Indemnity Benefits other than TP or IB or settlement will be paid, an Indemnity Benefits other than TP or IB or settlement will be paid, an Electronic First Report of Injury or Illness is due. Electronic First Report of Injury or Illness is due.
176 NEW CLAIM: Lost Time Case Where Disability is Immediate and Continuous Send: FROI 00 with SROI IP Due: 21 Days after Claim Administrators Knowledge of the Injury Note: Also provide FORM DWC-1 or IA-1 to the employee & employer.
177 To avoid late filing penalties for an Electronic First Report of Injury or Illness, the EDI DWC-1 should be triggered immediately upon the CAs disposition of the claim (payment or denial), to allow time for correction of potential errors and resubmission and subsequent receipt/acceptance by the Division within the filing due dates specified in Rule 69L-56, F.A.C.
178 FROI 00 Scenario Narrative Employee fell from ladder at employers warehouse on 6/15/07. Employee fell from ladder at employers warehouse on 6/15/07. Employee broke his leg. Employee broke his leg. Foreman witnessed the accident. Foreman witnessed the accident. Employee treated and released from the Emergency Room. Employee treated and released from the Emergency Room.
179 Employee earned $15.00 an hour working 40 hours a week. Employee earned $15.00 an hour working 40 hours a week. Employer reported injury to insurer on 6/17/07. Employer reported injury to insurer on 6/17/07. FROI 00 Scenario Narrative
180 FROI MTC 00 SCENARIO Claim Administrator reported the loss to DWC on 6/29/07.
181 Insurer is identified. Claim Administrator details are provided (remainder are on R21). FROI MTC 00 SCENARIO
182 Employer/Insured information is reported. The Employers name is on the R21 The rest of the Employers address is on the R21 NAICS Code FROI MTC 00 SCENARIO
183 If applicable, Policy Number should be reported, but Effective Date & Expiration Date are not required. FROI MTC 00 SCENARIO
184 Details of the accident are included. Employee broke leg falling from a ladder. FROI MTC 00 SCENARIO
185 Employer reported injury to claim administrator on 6/17/07. FROI MTC 00 SCENARIO
186 The rest of the Employees name and address is on the R21 Details about injured employee are sent. FROI MTC 00 SCENARIO
187 Date the initial disability began & other FROI fields must be reported on the SROI. Manual Risk Class Code is only on the FROI. FROI MTC 00 SCENARIO
188 Employee earned $15.00 an hour and worked 5 days a week. Employee has not returned to work. FROI MTC 00 SCENARIO
199 Employer Mailing Address information is not required. FROI MTC 00 SCENARIO
200 Claim Type Code and EP Salary Indicator are to be reported on the SROI. FROI MTC 00 SCENARIO
201 Variable Segment Counters include: Two Accident/Injury Narratives, and One Witness segment. FROI MTC 00 SCENARIO
202 Accident description exceeds 50 characters; two segments are needed to send entire narrative description. FROI MTC 00 SCENARIO
203 Variable Segment Population Rules for FROI ACCIDENT/INJURY DESCRIPTION NARRATIVES SEGMENT: No more than 10 (50 byte narrative text) segments per claim, and the number of segments sent must equal the Number of Accident/Injury Description Narratives segment counter. No more than 10 (50 byte narrative text) segments per claim, and the number of segments sent must equal the Number of Accident/Injury Description Narratives segment counter.
204 If the Accident Description Narrative segments are 50 characters each, and this Accident Description is 161 characters…
205 …how many segments must be sent to report the entire Accident Description Narrative? a. 1 Segment b. 2 Segments c. 3 Segments d. 4 Segments
206 ANSWER = d (4 segments) DNData Element Name DataBegEnd 0038Accident/Injury Description Narrative AS HELEN WAS LEAVING HER WORK SITE (BLDG 500) SHE Accident/Injury Description Narrative WAS WAITING FOR HER HUSBAND TO PICK HER UP ON THE Accident/Injury Description Narrative STEPS OF THE BLDG. AS SHE LEANED AGAINST THE RAIL Accident/Injury Description Narrative ING & FELL *If the last segment is less than 50 characters, it should be padded with spaces to complete the 50 character segment. *
207 Foreman Jones was the only witness. FROI MTC 00 SCENARIO
208 Variable Segment Population Rules for FROI WITNESSES SEGMENT: No more than 5 witnesses per claim, and the number of segments sent must equal theNumber of Witnesses segment counter. No more than 5 witnesses per claim, and the number of segments sent must equal theNumber of Witnesses segment counter.