Division of Workers’ Compensation

E.D.I. Rule 69L-56

Linda Yon, EDI Coordinator

E-mail: yonl@dfs.state.fl.us Phone: 850-413-1702

Draft Rule proposals

69L-56

Florida Administrative Code

A Draft of the EDI Rule 69L-56 F.A.C. is currently available on the Division’s

Website.

www.fldfs.com/wc/

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 webwww.fldfs.com/wc/

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-6.008 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

Overview of proposed changes to 69L-56 Proof of Coverage Changes

Effective 7-1-2004, 627.4133(4) F.S. was amended to read "Notwithstanding the

provisions of s. 440.42(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-6.014 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

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 insurer’s behalf, or uses a third party vendor’s

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: 1-1-2005

First Group Must Begin Testing: 7-1-2005

First Group Must Be In Production: 10-1-2005

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 insurer’s 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 IAIABC’s website in the near future. This guide contains the transaction record layouts, data dictionary,

scenarios, trading partner requirements, etc.

www.iaiabc.org

Then click on “Implementation Guides”

Florida’s Workers’ Compensation EDI Implementation Manuals are

available under the Electronic Data (EDI) link on the Division’s 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.

www.fldfs.com/WC/

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

Repor

t

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

Division’s 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 DWCLinda Yon

EDI Coordinator 850-413-1702 yonl@dfs.state.fl.us

Karen Kubie

Claims EDI 850-413-1703 kubiek@dfs.state.fl.us

Tonya Granger

POC EDI 850-413-1709 grangert@dfs.state.fl.us