PAYMENT PROCESSING OVERVIEW - …



APPENDIX LClaims Data InterfaceOverviewAgencies under the Governor’s jurisdiction report work-related injuries through a self-service portal into the Commonwealth’s enterprise computer system. Injury claims data is entered by supervisors or approved workers’ compensation representatives. When a workers’ compensation representative enters the claim, it is entered from a paper form completed by the supervisor. The current form is available on the website and instructions are provided within this Appendix.The work-related injury specialist receives an email notification through the enterprise computer system when a new claim is entered. This allows the specialist to review the data and obtain any additional information that may be helpful to the Contractor before the claims information is interfaced to the Contractor.Each night, with the exception of Saturday and Sunday, whether or not the specialist has reviewed the claim data, all claims data entered is batched into an interface file and made available to the Contractor. Incident only/first aid claims are not sent to the Contractor, but are maintained in the enterprise computer system in the event that the claimant needs to seek medical treatment or begins losing time from work at a later time. For agencies that do not use the enterprise computer system, injury data is recorded on the paper claim form, and the form is either faxed or emailed as an attachment to the Contractor, or if the Contractor has an injury reporting tool, it could be entered to the Contractor’s system. The fax/email options could be used in a rare case when the enterprise computer system would not be available.Based on the claims data received, the Contractor shall complete and file the LIBC-344 form with the Bureau of Workers’ Compensation in accordance with their procedures, and a copy must be provided to the specialist and claimant.Claim ChangesWorkers’ compensation representatives and work-related injury specialists have the ability to change claim data in the enterprise computer system after the data is interfaced. If data is changed, the entire claim is resent, and it is the responsibility of the Contractor to determine what data has changed so that the Contractor’s system can be updated. Recurrences of previously reported claims are not sent through the interface. Notification is typically provided directly to the adjuster by email or telephone.Interface Transfer FileDelivery of file occurs by FTP transfer from the Commonwealth’s Public FTP Server, using credentials provided by the Commonwealth. Files will be in an XML format provided by the Commonwealth, and named according to Commonwealth specifications. Files will be encrypted. Exact file formats will be provided by OA upon execution of the contract. Fields that will be transferred are at least those provided on the claim reporting form. The current file specifications are provided with this appendix for informational purposes.Testing RequirementsCommonwealth testing standards require Unit Testing along with end-to-end Integration testing by the Office of Administration, Bureau of Integrated Enterprise Systems to ensure all functionality and interfaces work properly. A formal signoff by the Commonwealth on full system testing is required to assure a quality implementation. The Contractor shall allow enough time to complete this testing and include this timeline in a full project plan that shall be submitted with the proposal. At a minimum the awarded Contractor shall plan on all testing to be completed with formal signoff on system interfaces and functionality 30 days in advance of the implementation date. Should testing not be completed by this date due to awarded Contractor delays, daily negotiations to solve the problems will begin between the Commonwealth and the Contractor’s project manager. Upon completion of successful system testing the Commonwealth will provide formal notification that system functionality and interface testing is complete and the system is acceptable.Interface File SpecificationsThis specification is provided for information purposes. It is subject to modifications, and the final format specifications will be provided upon award of the contract.HEADER:FIELDLENGTHExample ValueRecord Type6 Characters“HEADER” Constant valueCreate Date8 Characters“07012007” (MMDDYYYY)Create Time6 Characters“013000” (HHMMSS)As of Date8 Characters“07012007” (MMDDYYYY)Contact Person Name40 Characters“John Smith”Telephone Number10 Characters“7177059295”Email Address25 Characters“jsmith@state.pa.us”File Name40 Characters“INTF_nnnn.BUS.PARTNER.OUT.DAT” Where nnnn is 4 char DFS FLOW object ID number, followed by a unique name(s), and extension OUT.DAT separated by dots.Record Count8 Characters“00000230”(count = all data records + header record)OUTPUT:SAP R/3 Field NameTableTypeLengthSAP Field Name DescriptionComments/RulesPositionSUBTYP0082CHAR4Subtype (Coverage Code)1RDATEP0082DATS8Report on5PERNRP0000NUMC8Personnel no13IDATEP0082DATS8Date of Illness21Calculate:Use function module ZHR_GET_SAL_RATESQ0008 P0008CURR13Biweekly Salary at InjuryRight justify with 2 decimal places implied. Pad with leading zeroes. (do not include or default zeros) Per Diem wage type 1250.As of injury date29NACHINP0002CHAR40Last name42VORNAP0002CHAR40First name82MIDNMP0002CHAR 40Mid. Name122NAMZUP0002CHAR15Suffix162PERIDQ0002CHAR20SSNLeft justify177STRASP0006CHAR60Address line 1Residence address197ORT01P0006CHAR40City/countyResidence address257STATEP0006CHAR3StateResidence address297PSTLZP0006CHAR10Zip codeResidence address300ZZ_COUNCP0006CHAR2Residence CountyResidence address310AREACQ0006NUMC3Telephone number (area code) Personal numberIf blank will send 9’s in same format as area code312TELNRQ0006CHAR14Telephone number (Personal number)Left justifyIf blank will send 9’s in same format as telephone number315GBDATP0002DATS8Birth date329GESCHP0002CHAR1GenderU = UnknownM = MaleF = Female337RCD05P00082CHAR2Marital status338RCD04P00082CHAR2Dependents340DAT01P0041DATS8Z1 (Current Svc Date)Find the date value for the corresponding Z1 date type.As of injury date342PERSKP0001CHAR2EE SubgroupAs of injury dateFT = Full timePT = Part timeVO = U9ZZ = all others350WERKSP0001CHAR4Personnel area (Dept/Agency)As of injury date352STELLP0001NUMC8Job KeyAs of injury date356T513S-STLTXT513SCHAR25Job key (text)364ORGEHP0001NUMC8Organization unitAs of injury date389T527X-ORGTXT527XCHAR25Organization unit (text)397P0006-STRASInfotype 6 subtype 10CHAR30House no/street (Work Location)As of injury date422P0006-LOCATInfotype 6 subtype 10CHAR35House no/street (Work Location)As of injury date452P0006-ORT01Infotype 6 subtype 10CHAR20City (Work Location)As of injury date487P0006-STATEInfotype 6 subtype 10CHAR3Region (State) Work LocationAs of injury date507P0006-PSTLZInfotype 6 subtype 10CHAR10Post code (Zip) Work LocationAs of injury date510Q0006-AREACInfotype 6 subtype 10NUMC3Area Code (Work Location)As of injury dateIf blank will send 9’s in same format as area code520Q0006-TELNRInfotype 6 subtype 10CHAR22Telephone no. (Work location)Left justifyAs of injury dateIf blank will send 9’s in same format as telephone number523CONTYV_T5UTZCHAR25County (Work County)As of injury date545ITIMEP0082TIMS6Illness time570OTM05P0082TIMS6Shift Start Time576P1001STEXTQ1001CHAR40Name (of Supervisor)As of injury date582AEDTMP0082DATS8Last Changed On (Flag)This field is used by SAP for created and changed records.622Text - T01250All equipment….using when accident occurred630Text - T02250How injury occurred880Text - T03250If not on premises, address of accidentSeparate fields for Address line 1, city, county, state, zip code (see bottom of list PAD_STRAS, PAD_ORT01, REGIO, PSTLZ_HR, COUNC)1130Text - T04250Medical Provider Info1380Text - T05250Additional Comments1630Average Weekly WageP0082-AVGSNUMC7AWWRight justify with 2 decimal places implied. Pad with leading zeroes.1880RCD01PA0082CHAR2Y0 - Type of Claim1887ODT02PA0082DATS8Y1 - Date of Death1889ODT03PA0082DATS8Y2 - Date Employer Knew1897ODT04PA0082DATS8Y3 - Date of Illness1905ODT05PA0082DATS8Y4 - Last Day Worked/Paid1913JNF05PA0082CHAR1Y4 – Last Day Worked/Paid (yes/no)Y=Yes/N=No19211VDT06PA0082DATS8Y5 - Date Returned Work/Same Wage1922JNF06PA0082CHAR1Y5 - Date Return Work/Same WageY=Yes/N=No1930JNF07PA0082CHAR1Y6 - Injury on Premises/StateY=Yes/N=No1931REM07PA0082CHAR20Y6 - Injury on Premises /State1932JNF08PA0082CHAR1YA - Occur During OT?Y=Yes/N=No1952RCD09PA0082CHAR2Z0 - Injury Type Code1953RCD10PA0082CHAR2Z1 - Body Part Code1955RCD11PA0082CHAR2Z2 - Cause Code1957REM12PA0082CHAR20Z3 – Injury Type Info1959REM13PA0082CHAR20Z4 – Body Part Info1979REM14PA0082CHAR20Z5 – Cause Info1999RCD15PA0082CHAR2Z6 - Injury Type Code 22019RCD16PA0082CHAR2Z7 - Body Part Code 22021JNF17PA0082CHAR1ZA - Equipment Guards Provided?Y=Yes/N=No2023JNF18PA0082CHAR1ZB - Equipment Guards Used?Y=Yes/N=No2024JNF19PA0082CHAR1ZC - Tools Involved?Y=Yes/N=No2025JNF20PA0082CHAR1ZD – Mechanical Defect?Y=Yes/N=No2026JNF21PA0082CHAR1ZE - Unsafe Act?Y=Yes/N=No2027JNF22PA0082CHAR1ZF - Unsafe Condition?Y=Yes/N=No2028JNF23PA0082CHAR1ZG – Amputation?Y=Yes/N=No2029JNF24PA0082CHAR1ZH – Vehicle Accident?Y=Yes/N=No2030JNF25PA0082CHAR1ZI – Panel?/Init TreatmentY=Yes/N=No2031RCD25PA0082CHAR2ZI - Covered by Panel/treatment2032PAD_STRASPA0082CHAR60Street Address PAD_ORT01 PA0082CHAR40CityREGIO PA0082CHAR3StatePSTLZ_HR PA0082CHAR10Zip CodeCOUNC PA0082CHAR3County CodeIf out of state – display County of (state) ................
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