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1 POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

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Presentation on theme: "1 POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?"— Presentation transcript:

1 1 POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

2 2 ANSWER: FROI MTC 01

3 3 Cancel / Jurisdiction Transfer Rules See Rule 69L , F.A.C.

4 4  FROI MTC 01 is required to be filed with DWC to report the cancellation of the claim in its entirety. It is not used to cancel an individual MTC sent in error. It is not used to cancel an individual MTC sent in error. FROI 01 - Cancel Rules

5 5  FROI 01 (Cancel) should be sent if a First Report of Injury or Illness has been filed with DWC (paper or EDI), but the claim is subsequently determined to be ‘non- reportable’ because… FROI 01 - Cancel Rules

6 6... t he claim is actually a Medical Only Case. In this case, the FROI 01 should report Claim Type “B” (Became Medical Only).In this case, the FROI 01 should report Claim Type “B” (Became Medical Only). FROI 01 - Cancel Rules

7 7  FROI 01 should also be sent if: The claim was reported multiple times under different SSN’s/DOI’s & the claim filed with the incorrect SSN/DOI needs to be cancelled (i.e., duplicate submission), in which case… The claim was reported multiple times under different SSN’s/DOI’s & the claim filed with the incorrect SSN/DOI needs to be cancelled (i.e., duplicate submission), in which case… FROI 01 - Cancel Rules

8 8 … you will probably want to keep the one filed with DWC the earliest & file MTC 02 to correct SSN/DOI as applicable; then file the FROI 01 to cancel the other one. FROI 01 - Cancel Rules

9 9  FROI 01 should also be sent if the claim was transferred to another jurisdiction and no indemnity benefits were ever paid/reported to DWC because… FROI 01 - Cancel Rules

10 10 … Claim was initially denied (FROI 04, 00/PD), or Claim was initially denied (FROI 04, 00/PD), or Claim was reported as compensable death, no dependents or volunteer (00/CD, 00/VE).Claim was reported as compensable death, no dependents or volunteer (00/CD, 00/VE). FROI 01 - Cancel Rules

11 11  Under these circumstances, SROI S8 (Jurisdiction Change) is not applicable because there are no indemnity benefits being suspended. FROI 01 - Cancel Rules

12 12  Per IAIABC standard Cancel Rules, when FROI 01 is filed, DWC will flag the associated claim in its database as “cancelled”. This means the claim This means the claim is no longer considered to be “on file” with DWC. FROI 01 - Cancel Rules

13 13 As such, the claim will be removed from DWC’s online Claims Database on the web. As such, the claim will be removed from DWC’s online Claims Database on the web. FROI 01 - Cancel Rules

14 14 ‘Match Data’ keys (including JCN) so DWC can locate the correct claim in its database. (Designated as “M” – Mandatory on FL’s ERT.) ‘Match Data’ keys (including JCN) so DWC can locate the correct claim in its database. (Designated as “M” – Mandatory on FL’s ERT.) Fatal technical data elements (Designated as “F” - Fatal on FL’s ERT.) Fatal technical data elements (Designated as “F” - Fatal on FL’s ERT.)  FROI 01 requires limited data: FROI 01 - Cancel Rules

15 15 Caveats and Tips for Successfully Filing FROI 01 – Cancel Transactions

16 16 Caveats and Tips for Filing FROI 01  FROI 01 should not be used to cancel a claim due to a deficiency in a Claim Admin.’s system that doesn’t allow changes to key data (e.g., SSN, DOI, Claim #, etc.), and instead requires the establishment of another file under the correct key information. MTC 02 should be used to correct keys. MTC 02 should be used to correct keys.

17 17 Caveats and Tips for Filing FROI 01  FROI 01 should also not be used to cancel a claim when the wrong MTC was sent (e.g., 00/PD sent when really a FROI 04 should have been sent or 00/EP was sent when 00/IP was sent). Solution will vary depending on what MTC was sent incorrectly. Sometimes EDI Team intervention is required to “push through” the subsequent MTC. Solution will vary depending on what MTC was sent incorrectly. Sometimes EDI Team intervention is required to “push through” the subsequent MTC.

18 18  To “un-cancel” a previously accepted FROI 01, the Claim Admin. must file a new Electronic First Report or Injury or Illness via: FROI MTC 00 (or AU) + SROI, orFROI MTC 00 (or AU) + SROI, or FROI 04, depending on the situation.FROI 04, depending on the situation. Caveats and Tips for Filing FROI 01

19 19 Caveats and Tips for Filing FROI 01  After cancellation/re-establishment, the Claim Admin. will NOT receive credit for the original filing date for the claim that was cancelled. The new FROI/SROI filing will be evaluated for timeliness by DWC. The new FROI/SROI filing will be evaluated for timeliness by DWC.

20 20 Caveats and Tips for Filing FROI 01  If the FROI 01 was filed in error and the entire claim was never intended to be cancelled, contact the Claims EDI Team for assistance.

21 21 Caveats and Tips for Filing FROI 01 Caveats and Tips for Filing FROI 01 If the 01 was filed in error and SROI’s are now rejecting, depending on the circumstances, DWC may be able to remove the ‘cancel’ status so SROI’s can be re-loaded. If the 01 was filed in error and SROI’s are now rejecting, depending on the circumstances, DWC may be able to remove the ‘cancel’ status so SROI’s can be re-loaded.

22 22 Caveats and Tips for Filing FROI 01  If a claim is cancelled in DWC’s system, no further transactions can be accepted unless the claim is re-established with DWC or “un-cancelled” by DWC.

23 23 Caveats and Tips for Filing FROI 01  Do not send FROI 01 when: All indemnity benefits have been voided/cancelled/returned because EE can not be located;All indemnity benefits have been voided/cancelled/returned because EE can not be located; Instead send MTC “S6”, Suspension - Claimant’s Whereabouts Unknown.Instead send MTC “S6”, Suspension - Claimant’s Whereabouts Unknown.

24 24 Caveats and Tips for Filing FROI 01  Also, do not send FROI 01 when: A claim is transferred from FL to another jurisdiction after indemnity payments have been made on the claim;A claim is transferred from FL to another jurisdiction after indemnity payments have been made on the claim; Instead send MTC “S8”, Suspension - Jurisdiction Change.Instead send MTC “S8”, Suspension - Jurisdiction Change.

25 25 If a claim is being transferred TO FL …. Cancel/Transfer Rules

26 26  The FROI/SROI or FROI 04 sent to establish the claim with FL should include Late Reason Code "L4" (Late Notification, Jurisdiction Transfer). Cancel/Transfer Rules

27 27  If filing a 00/IP to report the claim, the Payment Issue Date in the Payment segment on the SROI IP should reflect the date associated with the first payment in FL. Cancel/Transfer Rules

28 28 SROI MTC “S8” Suspension, Jurisdiction Change

29 SROI MTC “S8” Suspension, Jurisdiction Change MTC “S8” is used to report the suspension of all indemnity benefits when a claim is transferred to another jurisdiction after indemnity benefits have been initiated, i.e.,  Another state’s workers’ comp Act, Or,  U.S. Longshoremen’s and Harbor Workers’ Compensation Act, Or,

30 SROI MTC “S8” Suspension, Jurisdiction Change  Federal Employers’ Liability Act, Or,  Federal Employees’ Compensation Act, Or,  Jones Act.

31 31  No further EDI filings (e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC “S8”. (e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC “S8”. SROI MTC “S8” Suspension, Jurisdiction Change

32 32 Reminder: Jurisdiction Transfer Claim administrator then sends the following to the appropriate state (if applicable):  FROI MTC “00”  SROI MTC “IP” (or other applicable SROI)

33 33 If a claim is transferred TO FL from another jurisdiction (i.e., a different state, or compensation act, etc.)… Reminder: Jurisdiction Transfer

34 34  The claim administrator should send FROI 00 and SROI IP (or other FROI/SROI filing equivalent), and  Report Late Reason Code “L4” – Late Notification, Jurisdiction Transfer. Reminder: Jurisdiction Transfer

35 35  If no indemnity was paid (e.g., 04, 00/PD, 00/CD, or 00/VE on file), or indemnity was paid but check(s) was returned/voided/cancelled prior to the change in jurisdiction, the Claim Admin. should send:  MTC 01 to Cancel the claim with the Division (since indemnity is not being suspended) and not an S8.

36 36 Questions?

37 37 Other Helpful Hints and “Lessons Learned”

38 38 OTHER HELPFUL HINTS  Numeric fields that are not populated on a transaction, should be sent as spaces and not zeros. Zero is a valid value for some numeric fields. Zero is a valid value for some numeric fields.

39 39 OTHER HELPFUL HINTS  Upper or Lower Case? Data can be sent in mixed case format; however, Data can be sent in mixed case format; however, DWC’s ‘match criteria’ requires case be the same between FROI & SROI combos (either all upper case, or all lower, or identical mixed text.) DWC’s ‘match criteria’ requires case be the same between FROI & SROI combos (either all upper case, or all lower, or identical mixed text.)

40 40 OTHER HELPFUL HINTS  DWC has a “relational database” and stores one EE Name, SSN & DOB. If your system stores multiple names for different DOI’s, an EDI filing could reject if the EE Name does not match name on file an earlier filing (or from a different claim admin.)

41 41 OTHER HELPFUL HINTS  Note: FL Recently relaxed match data requirements on Middle Initial/Name (i.e., no longer required if on file or previously sent. If middle Initial/Name is not consistent with what is on file you will receive a TA-FL.

42 42 OTHER HELPFUL HINTS  If DWC receives a FROI/SROI from one Claim Admin., and afterwards a FROI 04 denial from a different Claim Admin., a new JCN is NOT established for the denied claim. However, …

43 43 OTHER HELPFUL HINTS … if two Claim Admin.’s pay on the same claim, two different JCN’s are established. If FL’s “relational database” reflects a different name for the EE, the EDI team will contact each of the Claim Admin’s to reconcile the correct EE name. If FL’s “relational database” reflects a different name for the EE, the EDI team will contact each of the Claim Admin’s to reconcile the correct EE name.

44 44 Which MTC’s to Send When…

45 45 ScenarioMTC Claim Admin paid disability days 1-7 only in first check. EP filed; IP filed; Sx filed; and now the Employer is paying IB’s. IP filed; Sx filed; and now the Employer is paying IB’s. EP filed; IP filed; and now the Employer is paying IB’s. NONE ER EP CB

46 46 ScenarioMTC DWC1 filed (paper); CA filed (R3) with incomplete benefit picture; SA filed & rejected because “# Benefits > than what is on file”. CB rejects because “No SROI ER or RB on file” (previously filed Sx ) IP filed with TT; TT ended due to rls to RTW; TP to be determined Incorrect MTC filed (Do NOT file FROI 01 Cancel) CB then re-file SA (non- standard) ER or RB 02 to rpt RTW CONTACT EDI Team

47 47 ScenarioMTC FROI 04 filed with Denial Narrative incomplete (per EAO) IP filed with TT; TT ended & TP started and new AWW/Comp Rate which affected TT & TP IP filed with TT; CB filed to change from TT to TP; Sx filed; MMI reached & IB benefits to be commenced weekly. … (after above situation) IB paid in full. 02 CB RB S7

48 48 ScenarioMTC Paying TP; reached MMI and given PI%; actually RTW w/Restrictions; need to pay IB Filed FROI 04; and now realized should’ve been “indemnity only” denial. SA filed; and now realized Weeks and Benefit Amount reported incorrectly. FN filed; SA filed to reopen; ongoing indemnity benefits to pay. CB if paying wkly, or PY if lump sum PD SA RB

49 49 ScenarioMTC IP filed with wrong BTC PT awarded during period TT was already paid, plus JCC revised AWW/CR. Benefit Period Start Date of a BTC was reported in error in the past. CB with RBAC ‘R’, no CA needed MTC 02, or CB with RBAC ‘R’ will also work MTC 02 (CB or RB is not required)

50 50 ScenarioMTC Sx already filed; previously reported BTC info (type and period paid) now determined to be incorrect. IP reported TT; CB filed to add TP paid for waiting week. What MTC is filed to show the continuation of TT? None TT is already ‘on file’. MTC 02, but can’t add new BTC or advance Thru Date. (Do Not Send RB)


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