Indiana Worker's Compensation Board - EDI Implementation …



Indiana Worker's Compensation Board - EDI Implementation Plan

1. Authority Under Indiana Code 22-3-4-13, the IWCB has the authority to require all insurance carriers, companies who carry risk without insurance, and third party administrators to report accident information (FROI's) to the Board using electronic data interchange (EDI). Electronic transmitting of claims will begin no later than June 30, 2000 unless an implementation plan approved by the Board is in place on or before June 30, 2000.. After Dec 31, 2000, EDI will be the only means of reporting FROI's. The Board will use release 1 of the IAIABC EDI standard until further notice.

2. IWCB Contacts The following contacts are available for assistance in implementing this

plan:

Rob Howell

Manager of Information Systems

(317) 233-0396

rhowell@wcb.state.in.us

402 W. Washington St, Rm W196

Indianapolis, IN 46204

3 Standards The IWCB will use standards set forth by the International Association of Industrial Accident Boards and Commissions. These standards allow for consistency and

continuity for reporting concerns. The Board will accept both flat and ANSI X12 formats with a preference for flat files. The Board feels that flat files provide a simpler model of the file format

and provide easier integration into our system.

4. Documentation The following documents are attached:

A. Indiana Summary Requirements Table - Statement of required data fields (DN's)

with specified data type, position, and length for the different uses (MTC's) of FROI.

B. Transmission Profile - Detailed information of both receiver and sender. This form

shares contact information, FEIN's, VAN used, and EDI profile.

C. Event Table for 148 - Specifies different events that can trigger a FROI.

D. Edit Matrix Table - Defines errors codes for individual fields.

5. Testing The FROI test will consist of 30 claims with 90% accuracy. The claims will be transmitted over at least a 3-day period to afford a good test environment. The testing process for FROI's will consist of parallel testing with hard copies if real time data is used. If a reporting concern does not have sufficient volume to reach the 30 claim test then dummy or past data can be used. The board must know ahead of time if this method is used and cannot be combined with 'real' data. After a successful test phase the carrier will be allowed to begin production EDI and

hard copy follow-up can desist. The Board reserves the right to place reporting concerns on

probation and even withdraw reporting privileges if poor data reporting practices begin.

6. Selecting a VAN & Software Transmittal of the claims is done through 3rd party VANS

(Value Added Network) which collect, send, and receive acknowledgements. Some VANS offer

their own software, while other VANS will recommend compatible software. The Board can supply basic information to assist this process. The VANs currently being received at the Board are: IBM Global (Advantis), ATT (Celerity), HealthTech (ROES) and Claimport. We feel that these VANS collectively offer sufficient choices for all reporting concerns.

7. Key Data The following key fields from the Summary Elements Requirement Table are

central to the Board's successful processing of data and for creating statistics:

• DN 0006 Insurer FEIN This element must be a nine character numeric entry

that must match any previous entries in our database. All digits of the

FEIN cannot be the same.

• DN 0016 Employer FEIN This element must be a nine character numeric entry

that must match any previous entries in our database. All digits of the

FEIN cannot be the same.

• DN 0027 Insured Location Number This field represents an individual company

location that is generated by the Employer. This field must be included.

• DN 0031 Date of Injury This field must be consistent through all reporting

uses.

• DN 0042 Employee SSN This element must be a nine character numeric entry

that must match any previous entry in our database. All digits of the SSN

cannot be the same.

8. Acknowledgments The Board is currently testing its acknowledgment generation

process. When the testing phase is complete all reporting concerns will receive a

generated acknowledgment.

9. Glossary

|148 |Transaction Set ID |

|Board |The Indiana Worker's Compensation Board |

|DN's |Element Data Number |

|EDI |Electronic Data Interface |

|FEIN |Federal Employer's Identification Number |

|Flat File |File Format |

|FROI |First Report of Injury |

|IAIABC |International Association of Industrial Accident Boards and Commissions |

|IWCB |Indiana Worker's Compensation Board |

|MTC |Maintenance Type Code |

|SSN |Social Security Number |

|VAN |Value Added Network |

|X-12 |Specific File format approved and standardized by an international |

| |organization that allows for consistency from organization to organization. |

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