Division of Workers Compensation E.D.I. Rule 69L-56 Linda Yon, EDI Coordinator Phone:

Draft Rule proposals 69L-56 Florida Administrative Code

A Draft of the EDI Rule 69L-56 F.A.C. is currently available on the Divisions Website. This rule addresses the EDI requirements of submitting Proof of Coverage data & Claims data to the Division.

A Workshop on this Rule draft will be held on Tuesday, September 28, 2004, at 10 a.m. at the Division of Workers Compensation, Room 104J, Hartman Building in Tallahassee.

A Draft of the 69L-56 rules will be on the web

Overview of proposed changes to 69L-56 Revised EDI Trading Partner Forms. All new form numbers are preceded with DFS-F5 per DFS guidelines For Proof of Coverage, revised rule to incorporate the IAIABC Release 2 Proof of Coverage Implementation Guide, and to adopt a revised FL POC EDI Implementation Manual.

Transferred Proof of Coverage cancellation/non-renewal requirements from 69L to this rule, and added new language to address the recent statutory change for a cancellation requested by the Insured. Overview of proposed changes to 69L-56 Proof of Coverage Changes

Effective , (4) F.S. was amended to read "Notwithstanding the provisions of s (3), if cancellation of a policy providing coverage for workers' compensation and employers liability insurance is requested by the insured, such cancellation shall be effective on the date the carrier sends the notice of the cancellation to the insured" Rule 69L-56 is being amended to reflect this statutory change.

Overview of proposed changes to 69L-56 Proof of Coverage Changes Transferred Proof of Coverage reporting requirements from 69L to this rule, and added new language to address the cancellation/non-renewal filing requirements when the cancellation/non-renewal is requested by the Insured.

As of March 1, 2005, EDI transactions will only be accepted via Secure Socket Layer/File Transfer Protocol (SSL/FTP) for POC EDI, and via Secure Socket Layer/File Transfer Protocol (SSL/FTP) or the Advantis Value Added Network (VAN) for Claims EDI. Overview of proposed changes to 69L-56 For Claims and POC

If an insurer contracts with a third party vendor to electronically send transactions to the Division on the insurers behalf, or uses a third party vendors software product for electronically sending transactions to the Division, the insurer shall remain responsible for the timely filing of electronic form equivalents and any penalties and fines that may result from untimely electronic filings.

Overview of proposed changes to 69L-56 Electronic Supplement to the First Report of Injury For Claims EDI Insurers presently submitting the First Report of Injury (DFS-F2-DWC-1) via EDI, will be required to submit an Electronic Supplement to the First Report of Injury for each claim reported as a Medical Only which became a Lost Time Case. (EDI Claim Type L)

Overview of proposed changes to 69L-56 Electronic Supplement to the First Report of Injury For Claims EDI This requirement will remain in place from the compliance date of the 69L-3 rules, through the date the insurer begins submitting the FROI electronically in the new IAIABC Release 1.2 format. After the insurer is submitting data in the R1.2 format, the Supplement to the FROI format will no longer be required.

EDI Claims Filing Requirement for ALL Insurers

The requirement to implement Claims EDI will begin with the electronic form equivalent for the DFS-F2-DWC-1, First Report of Injury or Illness Claims EDI Filing Requirement

The requirement to implement Claims EDI is anticipated to also include the electronic form equivalent for the DFS-F2-DWC-13, Claim Cost Report Claims EDI

Proposed EDI Claims Implementation Requirement: The Division proposes to divide insurers/self-insurers into three implementation groups, based on insurer code number. - Lowest one third in the series will implement first. - Middle one third in the series will implement next. - Highest one third in the series will implement last.

The first group is to begin testing 6 months after the effective date of the rule and be in production no later than 1 quarter after that. Sample Claims EDI Implementation Schedule Example: If Effective Date of Rule: First Group Must Begin Testing: First Group Must Be In Production:

The second group is to begin testing no later than nine months after the effective date of the rule, and be in production no later than one quarter after that date. Proposed Claims EDI Implementation Schedule

The third group is to begin testing no later than 12 months after the effective date of the rule, and be in production no later than one quarter after that date. Proposed Claims EDI Implementation Schedule

Paper forms will be accepted after the insurers EDI FROI/SROI implementation date for unique and exceptional filing situations only, that can not be handled electronically.

Claims EDI transactions must be filed with the Division using the national IAIABC Claims EDI Release 1.2 format.

The Release 1.2 Claims Implementation Guide can be downloaded from the IAIABCs website in the near future. This guide contains the transaction record layouts, data dictionary, scenarios, trading partner requirements, etc.

Then click on Implementation Guides

Floridas Workers Compensation EDI Implementation Manuals are available under the Electronic Data (EDI) link on the Divisions website. They provide all the FL specific requirements, including required fields, edits and error messages.

The FL Claims EDI manual is currently under revision to match the requirements of new Claims rule 69L-3. It will be available on the web upon completion, which will be prior to the filing of the rule requiring the electronic reporting of EDI First/Sub Reports.

Ensuring Data Quality

Since EDI is a computer-to- computer exchange of information, the data is less likely to have errors; however, the data is only as good as it is initially input into the database. All EDI programs at the Division have standard edits that are applied to ensure data quality.

The Division will acknowledge every EDI transaction sent by the Insurer, on the standard EDI Acknowledgement Transaction. This report tells the Insurer how many records passed edits and how many failed edits, and what the errors were that caused the record to reject.

The Division identifies all edits utilized in any EDI program in the FL EDI Implementation Manuals. It is recommended that Insurers also edit their data before it is sent to the Division, so that the data will pass edits and the transaction will be accepted as timely filed.

Once an Insurer is submitting reports electronically, it is recommended to pay close attention to the Acknowledgement report received daily, so Insurers can identify which records rejected, and quickly correct and resubmit them. ACK Report

EDI Acknowledgement Report Recent additions to the Acknowledgement Report now provide EDI Insurers with the following information: If a DWC-1 record is accepted and there is a Coverage Exemption on file for that injured worker (same SSN), the words EXEMPT will be sent back in a text field of the Acknowledgement Report for that record, indicating an exemption is on file.

EDI Acknowledgement Report The Claims Handler should then further research this exemption information in the Divisions POC online database to see if the exemption on file is for the same employer as the injury being reported. It is possible to have more than one job, but to only have an exemption for one of those jobs.

EDI Acknowledgement Report Another recent addition to the Acknowledgement Report is the addition of the code NODWC1 in the free form text field. If a DWC-13 (Claim Cost Report) is electronically filed and accepted; however, there is no DWC-1 on file for that record, this code will let the claims- handling entity know that a DWC-1 (First Report of Injury) needs to be filed.

In addition to the daily Acknowledgement report, the Division issues two monthly reports for Claims transactions to help an Insurer know where it stands with errors. Rejected Cases Not Resubmitted Successfully Report Report Card of Error Percentages and top 5 recurring errors

EDI Contacts at DWC Linda Yon EDI Coordinator Karen Kubie Claims EDI Tonya Granger POC EDI