1. 1 Claims EDI R3 Data Warehouse Featured Functionality

2. 2 The DWC Claims EDI Data Warehouse reflects the raw data exactly as sent by the claim administrator, with a few formatting exceptions (e.g. dates displayed in readable format). The DWC Claims EDI Data Warehouse reflects the raw data exactly as sent by the claim administrator, with a few formatting exceptions (e.g. dates displayed in readable format). It does not imply that the EDI filing was accepted and loaded to DWC’s accident database.

3. 3 Customer Administrator Responsibilities

4. 4 Maintaining Trading Partner Accounts The EDI Team establishes the initial data warehouse administrator account for each Trading Partner. Afterwards, this designated “Customer Administrator” is responsible for the maintenance of their company’s account.

5. 5 Maintaining Trading Partner Accounts Maintaining Trading Partner Accounts Access to a Trading Partner’s warehouse account should be “revoked” when an employee no longer works for your company. Access Denied

6. 6 From the Main Menu click on Maintain My Company’s Log In Accounts.

7. Find the user you wish to revoke and click on their user id. 7

8. 8 Place a check mark in the Revoked box and a date and time revoked will be automatically added.

9. 9 Click Save and Close. The user will no longer have access; however, their notes will remain as the last note author.

10. 10 An account can be deleted if it was established in error or if the employee has not entered “notes” An account can be deleted if it was established in error or if the employee has not entered “notes” in the warehouse. in the warehouse. The “Delete this User” button will be enabled if the criteria mentioned above is met. if the criteria mentioned above is met.

11. 11 Click Delete this User. The user’s account will be deleted and will no longer have access to the Claims EDI Data Warehouse.

12. Having trouble logging into the Warehouse?

13. Password Help If you receive this error message…

14. Click on the “Forgot your password” link Password Help

15. Enter your 9 digit Trading Partner ID Enter your email address Password Help

18. Enter your 9 digit Trading Partner ID Enter your User ID Password Help

19. The system generates a password that is valid for 24 hours Write down or select/copy the generated password Password Help

20. Enter or paste the generated password Password Help

21. Click “Change my Password” Password Help

22. Enter or paste the generated password Enter a new password and confirm Password Help

24. 24 POP QUIZ: If a transaction receives a TR, and I don’t understand why, what do I do next?...

25. 25 ANSWER: … Login to the Data Warehouse and look up the filing.

26. 26

27. 27 Search for an individual claim Claims EDI Data Warehouse

28. 28 Search for an individual claim or query by date ranges. Claims EDI Data Warehouse

29. 29 Search for an individual claim or query by date ranges. Claims EDI Data Warehouse

30. 30 Let’s look at a “Rejected Record” Click on EE name hyperlink to see details of filing. Note: You can sort on any column header (defaults to Div Rec’d + Date/Time Processed.)

31. 31 Caution: There may be more than one page of transactions per query. Be sure to hit the ‘Next’ key to scroll to the next page, or enter the page number you want to see.

32. 32 This is a test case. Click on Errors There are 3 Tabs of Data

33. 33 Errors are noted on the Errors Tab SROI has 1 error; FROI rejected because SROI was not accepted.

34. 34 Fatal Errors are in Red

35. 35 What do you do if you do not understand the error? Note the Element # (0066) and Error # (064)

36. 36 Go to your copy of the Edit Matrix. Most recent version is posted on DWC’s Claims EDI webpage at http://www.myfloridacfo.com/wc/edi_clms.html

37. 37 Click on the ‘Population Restrictions’ tab in the spreadsheet.

38. 38 Find the DN # and Error # from the Error tab in the warehouse, in the 3 rd column of the Population Rest.

39. 39 Read the details of the error in the 5 th column.

40. 40 This error indicates that the Full Wages Paid for Date of Injury Indicator was sent as “N”. However, since the Initial Date Disability Began is > than the D/A it should = “Y”.

41. 41 In this example, since the rejection was for an EDI DWC-1, the Claim Administrator must quickly correct the error and resubmit both the FROI 00 and SROI IP to achieve a “TA” within the timeframes required by rule.

42. 42 Search by Element/Error Code

43. The feature allows you to research how many claims have rejected (or received a TA-FL) for a particular DN/Error combination. **We recommend your query include a reasonable date range to avoid locking up the system. 43 Search by Element/Error Code Search by Element/Error Code

44. 44 Search by Element/Error Code Search by Element/Error Code

45. 45 Search by Element/Error Code Search by Element/Error Code Drop Down Box with all DN/Error Combinations

46. 46 As with all Search Results, you can import the results into Excel. Search by Element/Error Code Search by Element/Error Code

47. 47 Let’s Look At Another Error Example Filing in the Warehouse…

48. 48

49. 49  The error, “BOTH FROI & SROI MUST PASS EDITS TO ACCEPT FILING” means: When submitting an original First Report (MTC 00), you are required to submit a corresponding SROI initial payment or equivalent, so When submitting an original First Report (MTC 00), you are required to submit a corresponding SROI initial payment or equivalent, so If either transactions fails edits, both transactions will automatically fail for this reason. If either transactions fails edits, both transactions will automatically fail for this reason.

50. 50 In this example the SROI failed, so the FROI was not accepted. All 001 Error requirements/conditions are documented in the Element Requirement Table. Note DN 0196.

51. 51 Go to your copy of the Element Requirement Table. Most recent version is posted on the Claims EDI webpage at http://www.myfloridacfo.com/wc/edi_clms.html

52. 52 Click on SROI Elements Tab…and find DN 0196. The requirement code = MC, which means you must look at the SROI Conditions Tab

53. 53 Click on SROI Conditions Tab…and find DN 0196.

54. 54 Reminder: How to research errors? 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 117 - Edit Matrix: Pop Rest and Match Data, and Duplicate Tabs All Other Error #’s: Pop Restrictions Tab

55. 55 Some Errors for Error # 063 are found in the Sequencing Tab of the Edit Matrix.

56. 56 Most Errors for Error # 057, and some for #063 and 117 are found in the Duplicate Processing Tab of the Edit Matrix.

57. 57 ‘ TR’ Acknowledgement Code means your “transaction rejected” and must be resent. A TR can not be fixed with an MTC 02 Change. A TR can not be fixed with an MTC 02 Change. Please do not write notes or ask questions related to TR records via the warehouse; instead email the EDI Team at claims.edi@myfloridacfo.comPlease do not write notes or ask questions related to TR records via the warehouse; instead email the EDI Team at claims.edi@myfloridacfo.comclaims.edi@myfloridacfo.com Transaction Rejected Status

58. 58 Important: Do not alter any factual data or Benefit/Payment information in an attempt to pass an edit. Do not alter any factual data or Benefit/Payment information in an attempt to pass an edit. Thoroughly research the problem and either correct the inaccurate data and re-send the transaction, or email the EDI team if you suspect our program/edit is at fault. Thoroughly research the problem and either correct the inaccurate data and re-send the transaction, or email the EDI team if you suspect our program/edit is at fault.

59. 59 Note: If inaccurate data results in in a CPS penalty, the Claim Administrator must send MTC 02 (or other appropriate MTC) to correct the data. After the MTC is accepted, notify the CPS specialist to re-evaluate the penalty.

60. 60 If you already investigated an error and still do not understand it, please send an email to claims.edi@myfloridacfo.com, rather than individual EDI team members. claims.edi@myfloridacfo.com This email copies all team members.

61. 61  When sending emails, please: Create a subject line specific to the error; do not include SSN’s; Create a subject line specific to the error; do not include SSN’s; Provide the JCN or your Claim number; Provide the JCN or your Claim number; Provide the MTC and Received Date; & Provide the MTC and Received Date; & Clarify which error in which table you do not understand.Clarify which error in which table you do not understand. Note: We can not address questions relative to problems in your company’s or vendor’s software.

62. 62 The Claims EDI Team receives approximately 50+ emails per day; therefore, if you have not received an answer or some acknowledgement of your emailed question within 2 business days, please resubmit.

63. 63 Responding to Reconciliation (Non-Fatal) Errors TA-FL’s

64. 64  FL’s program also contains edits that identify data considered to be “suspect”, but which does not warrant rejecting the filing. These edits generate “Reconciliation Errors” These edits generate “Reconciliation Errors” Reconciliation (Non-Fatal) Errors

65. 65  ‘Reconciliation Errors’ are assigned an Acknowledgement Code of ‘TA’ on the AKC; But are displayed as ‘TA-FL’ in the data warehouse. But are displayed as ‘TA-FL’ in the data warehouse. FL does not use ACK Code ‘TE’ – Transaction Accepted with Errors. FL does not use ACK Code ‘TE’ – Transaction Accepted with Errors. Reconciliation (Non-Fatal) Errors

66. 66  FL also does not accept MTC ‘CO’ – Correction. Instead, non-fatal ‘TA-FL’ errors are addressed via the data warehouse in conjunction with MTC 02 - Change (or other applicable MTC/response). Instead, non-fatal ‘TA-FL’ errors are addressed via the data warehouse in conjunction with MTC 02 - Change (or other applicable MTC/response). Reconciliation (Non-Fatal) Errors

67. 67  DWC sends email notification (next day) to the Claim Admin re: the posting of all non-fatal errors in the data warehouse. Claim Admin should rectify the error on or before 21 days after the date the error was posted to the data warehouse (see Rule 69L-56.300(1)(i), F.A.C.) Claim Admin should rectify the error on or before 21 days after the date the error was posted to the data warehouse (see Rule 69L-56.300(1)(i), F.A.C.) Reconciliation (Non-Fatal) Errors

68. 68  TA-FL errors will not be identified on the ACK or in the warehouse if the transaction is rejected (TR). Only one Ack code can be returned on the AKC. Only one Ack code can be returned on the AKC. Therefore, you may receive a TA-FL error after rectifying a TR. Therefore, you may receive a TA-FL error after rectifying a TR. Reconciliation (Non-Fatal) Errors

69. 69 How do I quickly find all my TA-FL error messages to see what needs to be addressed? Reconciliation (Non-Fatal) Errors

70. 70 Responding to Reconciliation Errors On the Search page you can select the Processing Result to display only OPEN TA-FL errors.

71. 71 Alternatively, you can retrieve all OPEN TA-FL’s (for a specified time period) by selecting ‘Open Reconciliation Errors Listing’ under ‘Notification Listings’.

72. 72 There is also a feature in the warehouse that allows you to generate a listing of all TA-FL errors by type and the specific claims that received those errors. ‘Claims EDI (TA-FL) Errors Detail Report’… Reconciliation (Non-Fatal) Errors

73. 73 The Claims EDI (TA-FL) Errors Detail Report was added in response to a suggestion from a Trading Partner.

74. 74 From the Main Menu, first select ‘Report Cards and Statistical Reports’

75. 75 Then select, ‘Generate TA-FL Detail Report’.

76. 76 Fill in your search criteria (date range, office location )

77. 77 You will receive a ‘Claims EDI (TA-FL) Errors Detail Report’. Results are presented in EE Name order (alpha) and then by TA-FL # (ascending).

78. 78 Summaries of TA-FL errors by count, form type, and error # are provided at the end of the report:

79. 79 Now let’s return to looking up TA-FL’s via the Search screen…

80. 80 Responding to Reconciliation Errors On the Search Results screen you can see that there are internal reconciliation errors that are open.

81. 81 Responding to Reconciliation Errors If the last note author is blank or is an EDI Team Member, then the Claim Admin knows they must address the error, if it is still open.

82. 82 Responding to Reconciliation Errors If the last note author is the Claim Admin, then an EDI Team Member will review the response and determine if the error can be closed. Angie Adjuster

83. 83 Responding to Reconciliation Errors Reconciliation Errors are in Yellow

84. 84 Claim Admin’s should check the error for which they are typing a response. Responding to Reconciliation Errors If there is more than 1 error, you must Select each error and respond separately.

85. 85 Claim Admin’s must type a response to the selected error message to advise how the error will be rectified. Responding to Reconciliation Errors

86. 86 DWC response Claim Admin response An EDI Team member will type a response back to the Claim Admin. Responding to Reconciliation Errors

87. 87 Claim Admin response The Claim Admin can check the “Intend to send 02 transaction to correct” box, to indicate an 02 will be sent. Responding to Reconciliation Errors

88. 88 Responding to Reconciliation Errors When the error has been rectified an EDI Team Member will close the error.

89. 89 On the Search Results screen you can see the last person to respond to a message and the status of the errors. The overall error status will remain open until ALL errors have been addressed and closed. Responding to Reconciliation Errors Angie Adjuster

90. 90 Click on the “Save results as tab delimited text file”, click “Save”, change the file extension to “.xls”. The data will be imported into an excel spreadsheet.

91. 91 Responding to Reconciliation Errors  If the same Reconciliation Error is generated on more than 1 transaction for the same claim: If error was fixed via MTC 02, you only need to respond on the most recent TA-FL (helpful to note if there are other identical TA-FL errors); If error was fixed via MTC 02, you only need to respond on the most recent TA-FL (helpful to note if there are other identical TA-FL errors); An EDI Team member will close all identical errors for earlier transactions. An EDI Team member will close all identical errors for earlier transactions.

92. 92 Responding to Reconciliation Errors Note:  If the Reconciliation Error generated requires an MTC 02 to correct data in the Benefits, Payment, ACR, OBT or Recovery segment….

93. 93 Responding to Reconciliation Errors … an MTC 02 must be included in the Benefits segment(s), or the changes in the segment(s) will not be edited or loaded.

94. 94 Responding to Reconciliation Errors  If MTC 02 is not sent in the Benefits segment, the following statement will appear in blue above the Benefits segment in the Data Warehouse…

95. 95 Responding to Reconciliation Errors If you send an 02 to change the Payment Issue Date of the initial payment (a/k/a Date 1 st Payment Mailed) …,

96. 96 Responding to Reconciliation Errors … an MTC 02 must be sent in the Benefits segment, AND A Payments segment must be sent with the corrected date. A Payments segment must be sent with the corrected date. This date will not be corrected from the Benefits segment.This date will not be corrected from the Benefits segment.

97. 97 Overpayment filings: Filings that only have an overpayment and no other reconciliation error associated with it will reflect ‘OVER PMT’ in the Error Status column. However, if the overpayment is related to a > than Max Parameter edit on a particular benefit a TA-FL error will be received.

98. 98 Overpayment only = OVER PMT Overpayment only = OVER PMT O/P + non-reconciled non-fatal error = OPEN O/P + non-reconciled non-fatal error = OPEN

99. 99  O/P’s are currently still posted to the ‘Errors’ tab, but DWC does not require a response to these ‘errors’.  At some point in the future, O/P’s will be identified in a “Notification Listing’ via the Main Menu.

100. 100 In addition to the ‘OVER PMT’ Error Status, non-fatal ‘PERM TOT’ errors are also posted in the warehouse to identify possible PT Errors.

101. 101 …Filings with non-fatal reconciliation errors that pertain to PT cases are identified as ‘PERM TOT’ in the Error Status column. ** Sort by Error Status

102. 102 DWC’s PT Section also receives internal reports regarding filing discrepancies, and may solicit responses from the Claim Administrator via letter or email.

103. Report Card

104. (SA Rankings) After numerous requests from Trading Partners, the Division has updated the EDI Report Card to include “Missing SA Rankings”.

105. Report Card (SA Rankings) When a Trading Partner runs the Report Card, a comparison can be made to the industry with regards to Missing SAs.

106. Report Card (SA Rankings) The EDI Team has modified the Report Card to rank those SAs that are late as well as missing.

107. “Missing” SA does not necessarily mean an SA is late. “Missing” means the Division was expecting an SA, but an SA was not accepted by the SA’s due date. For example, if the injured worker’s date of accident is 1/1/12, the SA is considered missing if it was not accepted on or before 7/1/12 (due date). Missing SA (Sub-Annual)

108. An MTC SA is considered late if it was not accepted on or before 30 days after the SA’s due date. For example, if the injured worker’s date of accident is 1/1/12, the SA is considered late if it was not accepted on or before 8/1/12. Missing SA (Sub-Annual)

109. Report Card (SA Rankings) Listed below is an example of how the new Missing SA Rankings will appear on the Report Card:

110. Report Card (Reoccurring Errors) Along with the new Missing SA Rankings, the Division has also included reoccurring errors on the Report Card. The report will list the top 10 reoccurring errors, per MTC, for the date range selected.

111. Report Card (Reoccurring Errors) Listed below is an example of how reoccurring errors will appear on the Report Card:

112. Report Card The two new reports can be found at the bottom of the report card below the “Top 10 Reject Errors”. Follow the steps listed below to access this report…

113. Report Card Log into the Warehouse

114. Report Card Click on Report Cards & Statistical Reports

115. Report Card Click on Generate Claims EDI Report Cards

116. Report Card Select the Date Range & Filing Type/MTC

117. Top 10 Reoccurring Errors

118. Missing SA Rankings

119. 119 Rejected But Not Successfully Resubmitted List

120. 120 Rejected Not Resubmitted List  EDI DWC-1 equivalents (e.g., 00/IP, 04, etc.) that reject and have not been successfully resubmitted will be included when this query is run. Claim Admin.’s can and should check this list frequently and resubmit any outstanding rejections. Claim Admin.’s can and should check this list frequently and resubmit any outstanding rejections.

121. 121 Rejected Not Resubmitted List  Email the EDI Team if the EDI DWC-1 was re-filed (TA’d) under a different SSN or DOI from that on the Rejected Not Resubmitted List. Provide the EE’s Name, File # and Div Rec’d Date for the rejected filing, so the transaction(s) can be excluded from the listing. Provide the EE’s Name, File # and Div Rec’d Date for the rejected filing, so the transaction(s) can be excluded from the listing.

122. 122 Rejected Not Resubmitted List  Also notify the EDI Team if an EDI DWC-1 that rejected was actually sent in error and will never be re- sent (e.g., Medical Only), so the transaction(s) can be removed from the list.

123. 123 Rejected Not Resubmitted List The Rejected Not Resubmitted listing is updated every Saturday.

124. 124 Claim Admin Selects Rejected Not Resubmitted List

125. 125 All outstanding TR’s will be returned (EDI DWC-1, SA & FN)

126. 126 The Rejected But Not Resubmitted Listing includes Incomplete EDI DWC-1 filings (i.e. 00 sent without the SROI)

127. 127 Other Features in the Claims EDI Data Warehouse

128. 128 Quick Search: If your query returns a listing of various filings, and you want to drill down to just the filings for one EE in the list, Click on a BOLDED hyperlink to obtain historical filing information for the EE.

129. 129 Quick Search Hyperlinks  Partner ID: Returns all filings found for that EE Name;  DAN (if applicable): Returns all filings found for that DAN;  Claim Admin Claim #: Returns all filings found for that claim #; and  JCN: Returns all filings for JCN.

130. 130 For example, click on the ‘Partner ID’ for the desired EE:

131. 131 All filings for DOI’s, Claim #’s, JCN’s associated with that EE Name you have sent to DWC will be presented.

132. 132 Search by MTC/Filing Type You can retrieve all 00/IP filings, FROI 04 filings, etc., and further narrow down the results by selecting a date range and processing result (e.g., Rejected).

133. 133 On the main ‘Search” screen, click on any MTC/MTC combo from the drop down menu under “Filing Type’.

134. 134 In this example, all rejected 00/IP’s for the selected time period are presented.

135. 135 Indicator of Last Viewed Record Indicator of Last Viewed Record To help keep track of previously viewed records (such as when you are going down a list of various filings for the same or different EE), the EE name hyperlink will change colors (blue to purple).

136. 136 When you return to the list, the ‘purple’ will indicate which Henny Penny filing you’ve already viewed.

137. 137 SSN has been masked for security reasons (along with EE address, nature of injury, and accident description for confidential profiles.) SSN has been masked for security reasons (along with EE address, nature of injury, and accident description for confidential profiles.) DAN will be displayed. DAN will be displayed. Social Security Number (SSN) Division Assigned Number (DAN)

138. 138 If the filing consists of both FROI and SROI MTC’s / tabs, the data warehouse view will default/open to the SROI tab first. Helpful Hint

139. 139 ALL Questions, either Business or Technical, should be sent via email to claims.edi@myfloridacfo.com claims.edi@myfloridacfo.com This email 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.

140. 140 Questions?