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1 Florida Division of Workers’ Compensation Claims EDI Release 3 CB Training CB Training2014.

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Presentation on theme: "1 Florida Division of Workers’ Compensation Claims EDI Release 3 CB Training CB Training2014."— Presentation transcript:

1 1 Florida Division of Workers’ Compensation Claims EDI Release 3 CB Training CB Training2014

2 2 Overview  Review of Event vs. Sweep  Introduction to the SROI MTC CB  Filing Requirements  Timely Filing  Caveats and Tips for filing SROI MTC CB  Common Errors  Scenario TT to TP, TP back to TT, then TT to IB  Hot Topic – New & Updated R3 Data Elements for 2014  Questions

3 3 “EVENT” BENEFITS SEGMENT RULES “Event”BenefitsSegments

4 4 A Claim Administrator must be prepared to send all data elements in the Benefits Segment, if required, on the “Event Benefits” worksheet of FL’s Element Requirement Table.

5 5 “EVENT” BENEFITS SEGMENT RULES  MTC  Gross Weekly Amount  Gross Weekly Amount Effective Date  Net Weekly Amount  Net Weekly Amount Effective Date  Benefit Type Code  Benefit Period Start Date  Benefit Period Through Date  Benefit Type Claim Weeks  Benefit Type Claim Days  Benefit Type Amount Paid  Benefit Payment Issue Date (IP, AP, PY with BTC 0xx only) An “Event” Benefits Segment must and will include the following data elements:

6 6 “EVENT” BENEFITS SEGMENT RULES When a Benefit Type is affected by the “Event” being reported, the MTC is sent in the Benefits Segment of the Benefit that is being: Started, Changed (to/from), Suspended ~ OR ~ ~ OR ~ When reporting a lump sum payment with Benefit Type Code 0xx.

7 7 When a Benefit Type is not affected by the “Event” being reported (older/previously reported benefits), the MTC is not required to be sent in the Benefits Segment for the older/previously reported benefit type(s). This Benefits Segment is called a “Sweep” Benefits Segment and will be discussed later in this presentation.

8 8 MTC’s THAT WILL CONTAIN “EVENT” BENEFITS SEGMENT(s) FOR FL AB – Add Concurrent Benefit Type AP – Acquired/Payment CB – Change in Benefit Type EP – Employer Paid ER – Employer Reinstatement IP – Initial Payment RB – Reinstatement of Benefits

9 9 MTC’s THAT WILL CONTAIN “EVENT” BENEFITS SEGMENT(s) FOR FL PY - Payment Report (BTC 0xx ONLY) (When the lump sum payment specifies a rate and time period). CA - Change in Benefit Amount SROI 02 – Change (if changing data in Benefits Segment) P7 – Partial Suspension, Benefits Exhausted Sx – Suspension

10 10 SROI Benefits Segment If a SROI MTC CB is sent, then an MTC CB must be sent in the Benefits Segment of the affected benefits.

11 11 In FL, when an MTC is placed in a Benefits Segment, it is edited as an “Event” Benefits Segment, requiring Gross and Net Weekly Amounts, Effective Dates and Benefit Payment Issue Date (when required).

12 12 MTC is reported in the Benefits Segment when a benefit type is being affected by the “Event” (AB, AP, CB, CA, S1-8, P7, EP, ER, IP, or RB). “EVENT” BENEFITS SEGMENT EXAMPLE

13 13 All Benefits data elements are populated. Benefit Payment Issue Date is required for an IP. “EVENT” BENEFITS SEGMENT EXAMPLE

14 14 Reminder: A Payment Segment is also required to be sent on a SROI MTC IP. The Payment Issue Date (Payment Segment) is the data element equivalent of FL’s “Date First Payment Mailed” on paper. CPS uses this date to calculate timeliness of the initial payment.

15 15 Event DN’s

16 16 BENEFITS SEGMENT “Sweep” Benefits Segments

17 17 “SWEEP” BENEFITS SEGMENT RULES  Benefit Type Code  Benefit Period Start Date  Benefit Period Through Date  Benefit Type Claim Weeks  Benefit Type Claim Days  Benefit Type Amount Paid A “Sweep” Benefits Segment must and will only include the following data elements:

18 18 “SWEEP” BENEFITS SEGMENT RULES  MTC  Gross Weekly Amount  Gross Weekly Amount Effective Date  Net Weekly Amount  Net Weekly Amount Effective Date  Benefit Payment Issue Date A “Sweep” Benefits Segment will NOT include the following:

19 19 MTC’s THAT WILL NOT CONTAIN ANY “EVENT” BENEFITS SEGMENT(s) FOR FL SROI 02 – Change (when no change (“Event”) is occurring in the Benefits Segment) SROI 04 – Denial PD – Partial Denial SA – Sub-Annual FN – Final MTC

20 20 Reminder: If an MTC is present in the Benefits Segment, that would typically be considered a Sweep Benefits Segment, FL will edit the Benefits Segment as an Event Benefits Segment. If an MTC is present in the Benefits Segment, that would typically be considered a Sweep Benefits Segment, FL will edit the Benefits Segment as an Event Benefits Segment.

21 21 “SWEEP” BENEFITS SEGMENT RULES “Sweep” Benefit Segment(s) will be sent along with any “Event” Benefit Segment(s) if older/previously reported benefits are not part of the “Event” that is currently being reported.

22 22 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Payment Issue Date 050 TEMPORARY TOTAL 1/1/121/28/12401, TEMPORARY PARTIAL CB /29/ /29/12 2/11/ PERM PART SCHEDULED CB /15/ /15/12 2/28/ For example: Changing benefit type from 070 (TP) to 030 (IB).

23 23 Sweep DN’s

24 24 Change in Benefit Type SROI MTC “CB” See Rule 69L (3), F.A.C.

25 25 If indemnity benefits are continuing but the Benefit Type being paid changes to a different Benefit Type, an Electronic Notice of Action or Change, SROI CB, is required to be filed with the Division. Change in Benefit Type

26 26 Change in Benefit Type  Indemnity benefits are currently being paid,  The Benefit Type Code currently being paid changes (or is reclassified),  Benefits are not currently suspended. SROI MTC “CB” is typically used when:

27 27 A previous requirement to report a change in benefit type did not exist for paper; therefore, a form DWC-4 is not required to be provided to the employer or employee. Change in Benefit Type

28 28 However, if any of the following circumstances occur when changing a benefit type, a paper DWC-4 is required… Change in Benefit Type

29 29  Return to Work Date,  RTW Type Code,  Physical Restrictions Indicator,  Date of Maximum Medical Improvement,  Permanent Impairment Rating,  PT Date Accepted/Adjudicated,  Date of Death Change in Benefit Type

30 30 When is an MTC CB Due?

31 31 An MTC CB will be considered timely filed with the Division if received and is assigned a Transaction Acknowledgement Code of “TA” on or before 14 days after payment (for a different benefit type) is mailed. Timely Filing

32 32 Note: The previous filing requirement was to receive a “TA” on or before 14 days after “knowledge of change in benefits.” However, because many automated systems do not trigger an MTC until a payment has been issued, the new requirement is on or before “14 days after payment mailed.” (Rule will be revised to reflect change.) Timely Filing

33 33 Electronic Notice of Action or Change SCENARIO SROI MTC CB Change in Benefits Initial Payment (IP) was for 050 (TT) benefits MTC CB change from 050 (TT) to 070 (TP) MTC CB change from 070 (TP) back to 050 (TT) MTC CB change from 050 (TT) to 030 (IB)

34 34 Electronic Notice of Action or Change SROI MTC CB Change in Benefits From 050 (TT) to 070 (TP)

35 35 Change in Benefit Type Example: 00/IP Reports initial payment of 050 (TT) benefits:  050 Benefits paid  1/1/12 – 1/28/12 CB Reports a change from 050 (TT) benefits ending 1/28/12 to 070 (TP) benefits starting 1/29/12:  070 Benefits paid  1/29/12 - 2/11/12

36 36 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Benefit Payment Issue Date 050 TEMPORARY TOTAL CB /1/ /1/12 1/28/12401, TEMPORARY PARTIAL CB /29/ /29/12 2/11/ SROI MTC “CB” Change in Benefit Type from TT to TP For Example:

37 37 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Benefit Payment Issue Date 050 TEMPORARY TOTAL CB /1/ /1/12 1/28/12401, TEMPORARY PARTIAL CB /29/ /29/12 2/11/ An MTC CB is required in the Benefit Segment for both benefit types 050 (TT) and 070 (TP) because two events are occurring: 050 (TT) is ending and 070 (TP) is beginning.

38 38 Electronic Notice of Action or Change SROI MTC CB Change in Benefits Continuing… From 070 (TP) back to 050 (TT)

39 39 Change in Benefit Type Example: New CB reports a change from 070 (TP) benefits ending 2/11/12 going back to 050 (TT) benefits starting 2/12/12:  050 Benefits paid  2/12/12 – 2/25/12

40 40 Only one Benefits Segment can be sent per Benefit Type Code; therefore, the Benefit Period Start Date for BTC 050 (on the MTC CB) should be the start of the current period of 050 (TT) benefits. Change in Benefit Type

41 41 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Benefit Payment Issue Date 050 TEMPORARY TOTAL CB /1/ /1/12 2/12/122/25/ TEMPORARY PARTIAL CB /29/ /29/12 2/11/ SROI MTC “CB” Change in Benefit Type from TP to TT Previous TT Segment: Current benefit picture: Cumulative Current

42 42 The Benefit Period Start and Through Dates are for the most recent uninterrupted period of benefits. The Benefit Type Claim Weeks, Days and Benefit Type Amount Paid are cumulative for the life of the claim. Change in Benefit Type

43 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Benefit Payment Issue Date 050 TEMPORARY TOTAL CB /1/ /1/12 2/12/122/25/ TEMPORARY PARTIAL CB /29/ /29/12 2/11/ An MTC CB is required in the Benefits Segment for both benefit types 050 (TT) and 070 (TP) because two events are occurring: 070 (TP) is ending and 050 (TT) is beginning (subsequent period).

44 44 Electronic Notice of Action or Change SROI MTC CB Change in Benefits Continuing… From 050 (TT) to 030 (IB) Employee RTW making pre-injury wages

45 45 Change in Benefit Type Example: New CB reports a change from 050 (TT) benefits ending 2/25/12 to 030 (IB) benefits starting 2/26/12:  030 Benefits paid  2/26/12 – 3/10/12 (1 st PYMT)  Date of MMI: 2/25/12  PI Rating: 2%  Actual RTW Date: 2/26/12 (no restrictions)

46 46 BTCBenefit TypeMTC Gross Weekly Amt. Gross Eff. Date Net Weekly Amt. Net Eff. Date Start Date Through Date WeeksDaysAmt. Paid Benefit Payment Issue Date 050 TEMPORARY TOTAL CB /1/ /1/122/12/122/25/12602, TEMPORARY PARTIAL 1/29/122/11/ PERM PART SCHEDULED CB /26/ /26/12 3/10/ An MTC CB is required in the Benefit Segment for both 050 (TT) and 030 (IB) because two events are occurring: 050 (TT) is ending and 030 (IB) is beginning. An MTC CB is not required in the Benefit Segment for 070 (TP) because it is a sweep segment.

47 47 Caveats and Tips for Successfully Filing SROI MTC CB

48 48 Caveats and Tips for Successful Filing of CB The following information can either be reported on a MTC 02* or included on the MTC CB (if further benefits will be paid), whichever event is due first:  Return to Work information* FROI 02 (Initial RTW) or SROI 02 (Latest RTW Status Date)  Date of MMI* (SROI 02)  PI Rating* (SROI 02)

49 49 An S1 (Suspension – Return to Work) is not required to report Return to Work information, unless ALL benefits are being suspended. Caveats and Tips for Successful Filing of CB

50 50 For example:  If 070 (TP) benefits will be paid in 14 days, the IRTW info can be reported on the MTC CB.  If 070 (TP) benefits are anticipated to be paid, but not necessarily within 14 days, the IRTW info can be reported on a FROI 02. Caveats and Tips for Successful Filing of CB

51 51 A suspension transaction (S1-7) is only required when ALL indemnity benefits are being suspended. Payment of any ongoing indemnity after a suspension will require an MTC ER or RB (reinstatement). Caveats and Tips for Successful Filing of CB

52 52 Caveats and Tips for Successful Filing of CB  When the Change in Benefits also involves a corresponding change in the weekly amount at which the new BTC will be paid, you do not need to file a CA & CB.  You can report both changes on a single CB transaction.

53 53 Normally, an MTC CB requires two “Event” Benefit Segments to report changes to the benefits affected by the MTC CB transaction:  The Benefit Type that is ending and  The Benefit Type that is beginning. Therefore… Caveats and Tips for Successful Filing of CB

54 54 Caveats and Tips for Successful Filing of CB An MTC CB should only be present in the 2 Benefit Segments where benefits are being changed. The Benefit being changed “from” and the Benefit being changed “to.”

55 55 Caveats and Tips for Successful Filing of CB Errors occur when the MTC is put in the Benefit Segments that are not being affected by the change in benefit type because…

56 56 Caveats and Tips for Successful Filing of CB …if an MTC is placed in a Benefits Segment, it is edited as an “Event” Benefit Segment, requiring Gross and Net Weekly Amounts and Effective Dates that otherwise would not be required and/or edited.

57 57 Caveats and Tips for Successful Filing of CB Exceptions: There are two circumstances where an MTC CB will only be present in 1 Benefit Segment. 1.All benefits are being fully reclassified to a BTC that has not been previously reported. 2.Reclassifying 030 (IB) to 020 (PT).

58 58 Caveats and Tips for Successful Filing of CB Exception 1: In the circumstance where 050 (TT) benefits were initially paid; however, 070 (TP) benefits were actually due instead…

59 59 Caveats and Tips for Successful Filing of CB An MTC CB should be filed to show the change to 070 (TP) benefits. The Reduced Benefit Amount Code “R” (Reclassification of Benefits) is required to show that all previously reported 050 (TT) benefits were fully reclassified to 070 (TP) benefits. (A BTC 050 Benefit Segment will no longer be present).

60 60 Caveats and Tips for Successful Filing of CB Exception 2: In the circumstance where 050 (TT) benefits were paid, followed by 030 (IB) benefits, which were later fully reclassified to 020 (PT)…

61 61 Caveats and Tips for Successful Filing of CB There will be 2 Benefits Segments (050 and 020) but only 1 will be an event Benefit Segment (PT). This will require an MTC CB to be present in the 020 (PT) Benefit Segment only. The “disappearance” of 030 (IB) would need to be explained via Reduced Benefit Amount Code “R” (Reclassification of Benefits).

62 62 Common Errors Encountered With MTC SROI CB

63 63 NO SROI ER OR RB PREVIOUSLY ON FILE ( ) Common Errors

64 64 NO SROI ER OR RB PREVIOUSLY ON FILE This error occurs when a CB is received after a suspension (S1-7) and no intervening ER or RB (reinstatement of benefits) is on file with the Division. (i.e. benefits were never reinstated following the suspension) Common Errors

65 65 NO SROI ER OR RB PREVIOUSLY ON FILE If benefits were reinstated after the last suspension, but no reinstatement has been reported to the Division, an MTC ER or RB will need to be submitted. (Rejected MTC CB should be resubmitted as an MTC ER or RB) Common Errors Info is correct…

66 66 NO SROI ER OR RB PREVIOUSLY ON FILE Please do not assume you must always send the MTC referenced in the error message. If an ER or RB is sent in response to the error when benefits have not truly been reinstated, you will be unable to file another suspension using the same Suspension Effective Date. Therefore… Common Errors 2/25/14: This is no longer the case as the claim admin can only report previously paid back benefits on a SROI 02. Slides 66 & 67 can be deleted.

67 67 NO SROI ER OR RB PREVIOUSLY ON FILE New process: If a previous suspension (S1-7) was filed in error, an MTC RB will need to be submitted to report payment of additional benefits. The EDI Team will no longer manually remove suspension transactions from the Division’s database. Common Errors

68 68 Common Errors INITIAL RTW DATE MUST BE CHANGED VIA AN 02 OR S1 ( )

69 69 INITIAL RTW DATE MUST BE CHANGED VIA AN 02 OR S1 The Initial Return to Work Date (IRTW) must match the IRTW Date that was previously reported unless the IRTW Date is being changed via a FROI 02 or S1. Common Errors

70 70 INITIAL RTW DATE MUST BE CHANGED VIA AN 02 OR S1 If the IRTW Date was previously reported incorrectly, then a FROI 02 must be sent to change the IRTW Date. Once the FROI 02 has been accepted, the MTC CB (with the correct IRTW Date) can be resubmitted. Common Errors

71 71 BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED ( ) Common Errors

72 72 Common Errors BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED This error occurs when the MTC CB reports a Benefit Type Amount Paid for a particular benefit type that is less than the Benefit Type Amount Paid reported on the last accepted SROI.

73 73 Common Errors BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED Check that the Benefit Type Amount Paid sent on the rejected CB is the correct amount. If Benefit Type Amount Paid is correct and less than previously reported, one of the following situations will apply…

74 74 Common Errors BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED 1) If benefits were partially reclassified to another benefit type, Then resubmit the MTC CB with Reduced Benefit Amount Code = “R”.

75 75 Common Errors BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED 2) If benefits were partially recovered due to an overpayment or voided/returned check, Then resubmit the MTC CB with recovered monies in the applicable Recovery Code (830 & 880).

76 76 Common Errors BENEFIT TYPE AMOUNT PAID < PREVIOUSLY REPORTED 3) If the Benefit Type Amount Paid was previously reported incorrectly, Then resubmit the MTC CB with Reduced Benefit Amount Code = “D” (Decrease in Indemnity).

77 77 NON-CONSECUTIVE PERIOD CODE MISSING ( ) **This code is no longer “Mandatory” ; however, if sent the data will be edited/loaded. Common Errors

78 78 Common Errors NON-CONSECUTIVE PERIOD CODE MISSING This error occurs when the number of calendar weeks represented by the Benefit Period Start Date through the Benefit Period Through Date is greater than the total number of Benefit Type Claim Weeks reported.

79 79 Common Errors NON-CONSECUTIVE PERIOD CODE MISSING Check that the Benefit Type Claim Weeks, Days sent on the rejected CB are correct. If the Benefit Type Claim Weeks, Days are not correct, resubmit the MTC CB with the corrected information.

80 80 Common Errors NON-CONSECUTIVE PERIOD CODE MISSING If Benefit Type Claims Weeks, Days are correct, one of the following situations will apply… = 4

81 81 Common Errors NON-CONSECUTIVE PERIOD CODE MISSING 1) If the Waiting Period includes more than one period of disability and the previously reported Non-consecutive Period Code = “W” was dropped from the MTC CB, Then resubmit the MTC CB with the Non-Consecutive Period Code = “W”.

82 82 Common Errors NON-CONSECUTIVE PERIOD CODE MISSING 2) If the Benefit Period Start Date through the Benefit Period Through Date do not represent a continuous period of disability, Then resubmit the MTC CB with the Non-Consecutive Period Code = “B”.

83 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED ( ) Common Errors 83

84 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED This error occurs when the newly reported benefit type has a Benefit Period Start Date prior to a Benefit Period Start Date on file. Common Errors 84

85 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED This occurs most often when:  Events are reported out of sequence.  Attempting to report a different BTC paid for the Waiting Period with a Benefit Period Start Date that is not equal to the Initial Date Disability Began. Common Errors 85

86 86 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED Events should not be reported out of sequence. If a Benefit Type Code (BTC) previously reported was accidentally left off the last accepted transaction, … Common Errors

87 87 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED … those benefits must be “re-added” by filing a SROI ‘02’ (Change) with an ‘02’ in the Benefits Segment. Common Errors

88 88 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED The Division allows a change in benefit type (MTC CB) to report a different benefit type paid for the Waiting Week provided the Benefit Start Date is the same as the Initial Date Disability Began. Common Errors

89 89 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED The Initial Date Disability Began is always the first day qualifying as a day of disability in the first period of disability. This will be the first day of the waiting period. Common Errors

90 90 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED 1) If you are attempting to add a different BTC paid for the Waiting Week and receive this error, Then check that the Benefit Period Start Date is correct. Common Errors

91 91 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED 2) If the Benefit Period Start Date is correct, Then check that the Initial Date Disability Began is equal to the Start Date. The Benefit Period Start Date and Initial Date Disability Began must be the same, even if there was a Non-Consecutive Waiting Period. Common Errors

92 92 BTC ENDING MUST HAVE BEEN PREVIOUSLY REPORTED If the Initial Date Disability Began is not equal to the Start Date, then submit a SROI 02 with no MTC 02 in the Benefits Segment to correct the Initial Date Disability Began. Once the SROI 02 has been accepted, the MTC CB can be resubmitted. Common Errors

93 93

94 94 When correcting the Initial Date Disability Began in this circumstance, why should an MTC 02 not be present in the Benefits Segment? Question:

95 95 Because: a different benefit type has been paid for the waiting week and is present on the transaction and the MTC CB has not yet been accepted to report the different waiting week benefit type. Therefore, the MTC 02 cannot be present in the Benefits Segment so that the system will not evaluate any Benefit Segment to find that a different waiting week benefit type has been introduced. Answer:

96 96 If an MTC 02 is present in the Benefits Segment and the new waiting week benefit type is present, it will reject for Number of Benefits cannot be > what is on file, because an MTC CB has not yet been accepted to introduce the different waiting week benefit type. After the MTC 02 has been accepted, resubmit the MTC CB. Answer:

97 97 Hot Topic

98 New IAIABC Release 3 Data Elements for 2014

99 A code that indicates Employer Paid Unspecified Benefits, Benefit Type Code (BTC) 240, were the only benefits paid prior to acquisition. Employer Paid Salary Prior to Acquisition Code (DN 0203)

100 Benefit Type Amount Paid cannot be required on BTC 240 because the employer continued salary in lieu of compensation and the claim administrator does not know the particular benefit amount paid by the employer. Employer Paid Salary Prior to Acquisition Code (DN 0203)

101 Since Benefit Type Amount Paid cannot be required on BTC 240, no dollars can be carried over into OBT 430 (Total Unallocated Prior Indemnity Benefits). Employer Paid Salary Prior to Acquisition Code (DN 0203)

102 The Employer Paid Salary Prior to Acquisition Code “E” was created to explain why OBT 430 is not present on the acquiring transaction. Employer Paid Salary Prior to Acquisition Code (DN 0203)

103 Florida began accepting this code on September 25, This code is not required; however, it will eliminate a rejection when reporting a claim that has been acquired and only BTC 240 had previously been paid. Employer Paid Salary Prior to Acquisition Code (DN 0203)

104 Updated IAIABC Release 3 Data Elements for 2014

105 Originally: Current Date Disability Began, Current Date Last Day Worked and Current Return to Work Date were defined to relate to the most recent, subsequent, uninterrupted period of benefit payments (benefit period). Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

106 The IAIABC recently changed Current Return to Work Date to Latest Return to Work Status Date (effective 1/1/2014) because the definition of “current” was widely misunderstood. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

107 Prior to the name and definition change, Current Return to Work Date was intended to represent the date the employee actually returned to work, or was released to return to work, following a subsequent period of disability. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

108 The prior Current Return to Work Date was not intended to report the date the Return to Work Type Code and/or Physical Restrictions Indicator changed when there was no subsequent period of disability; however, CRTW Date was being used for this purpose. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

109 For example: The injured worker’s DOA was 6/28/10 and she had surgery on that date, so the Initial Date Disability Began was 6/28/10. On 7/11/10, the claim administrator sent a 00/IP to report the first payment of Temporary Total (050) benefits. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

110 The doctor released the injured worker to light duty on 8/9/10, so the Initial Return to Work Date was 8/9/10. The employer could not accommodate the injured worker’s restrictions, so Temporary Partial (070) benefits were paid. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

111 The claim administrator sent an MTC CB (Change in Benefit Type) reporting the change from Temporary Total (050) to Temporary Partial (070) and reported the Initial Return to Work (8/9/10), RTW Type Code & Physical Restrictions Indicator: Return to Work Type Code = R (Released) Return to Work Type Code = R (Released) Physical Restrictions Indicator = Y (Yes) Physical Restrictions Indicator = Y (Yes) Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

112 On 9/19/10, the doctor changed the injured worker’s release (to full duty - no restrictions) and the claim administrator suspended all indemnity benefits. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

113 An MTC S1 (Suspension – RTW) was sent to suspend indemnity, report the date the employee was released to full duty and update the RTW Type Code and Physical Restrictions Indicator: Return to Work Type Code = A (Actual) Return to Work Type Code = A (Actual) Physical Restrictions Indicator = N (No) Physical Restrictions Indicator = N (No) Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

114 This 9/19/10 date (effective date of the change to Return to Work Type Code and Physical Restrictions Indicator) was reported by some claim administrators as an update to the Initial Return to Work Date and was reported by some as a Current Return to Work Date. From: Return to Work Type Code = R (Released) Physical Restrictions Indicator = Y (Yes) Physical Restrictions Indicator = Y (Yes) To: Return to Work Type Code = A (Actual) Physical Restrictions Indicator = N (No) Physical Restrictions Indicator = N (No) Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

115 Reporting this effective date (9/19/10) as a Current Return to Work Date was not the intent of original definition because there was not a subsequent period of disability followed by a subsequent return to work. Florida edited for the presence of a subsequent period of disability and this caused confusion and rejections. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

116 The data element name and definition were changed to Latest Return to Work Status Date, which now represents either the most recent date the employee returned to work after the Initial Return to Work Date (and is no longer tied to a subsequent period of disability) OR … Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

117 … the “effective date” of the most recent change to the Return to Work Type Code and/or Physical Restrictions Indicator. Therefore, the 9/19/10 date will now be the appropriate Latest Return to Work Status Date. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

118 Florida implemented this change for all transactions received by the Division on or after January 1, 2014, pursuant to the current IAIABC Supplement. Latest Return to Work Status Date - DN 0072 (formerly Current Return to Work Date)

119 119 ALL questions, either Business or Technical, should be sent via to: This address is copied to all members of the EDI team. It is the quickest and most efficient way for us to respond to your concerns.

120 120 Questions?

121 121


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