Florida Division of Workers’ Compensation Claims EDI Missing SA 2013.

Florida Division of Florida Division of Workers’ Workers’

Compensation Compensation Claims EDI Claims EDI

Missing SA Missing SA 20132013

22

Presenter:Presenter:

Tonya GrangerTonya GrangerAdministrator, Claims & POC Administrator, Claims & POC

EDI TeamEDI Team

Bureau of Data Quality and Bureau of Data Quality and CollectionCollection

FL Division of Workers’ FL Division of Workers’ CompensationCompensation

Florida Statute Florida Statute 440.51(7) mandates 440.51(7) mandates that: “The department that: “The department shall keep shall keep accumulated cost accumulated cost recordsrecords of all injuries of all injuries occurring within the occurring within the state coming within state coming within the purview of this the purview of this chapter….”chapter….”

Missing SA ReportMissing SA Report

MTC SAMTC SA is the is the transaction used to report transaction used to report accumulated cost records accumulated cost records for an injury, while the for an injury, while the claim is still open, and is claim is still open, and is due every 6 months from due every 6 months from DOI.DOI.

MTC FNMTC FN is the is the transactiontransaction used when the used when the claim is now closed.claim is now closed.


Rule Excerpts for Rule Excerpts for MTC SA & MTC SA &

FN FilingsFN Filings

The claim administrator shall The claim administrator shall send Electronic Periodic Claim send Electronic Periodic Claim Cost Reports (MTC SA or FN) to Cost Reports (MTC SA or FN) to the Division for the following the Division for the following cases: cases:

““Lost Time/Indemnity Case”; Lost Time/Indemnity Case”; ““Medical Only to Lost Time Medical Only to Lost Time Case; Case; ““Denied Case” for which any Denied Case” for which any indemnity benefit was paid prior indemnity benefit was paid prior to or after the denial. to or after the denial.

Rule 69L-56.3013

The first MTC SA will be The first MTC SA will be considered timely filed with the considered timely filed with the Division if it is received by the Division if it is received by the Division and is assigned an Division and is assigned an Application Acknowledgement Application Acknowledgement Code of “TA” (Transaction Code of “TA” (Transaction Accepted) Accepted) within 30 days after within 30 days after six (6) months from the date of six (6) months from the date of injury.injury. All subsequent SA’s shall All subsequent SA’s shall be sent to the Division every six be sent to the Division every six (6) months thereafter. (6) months thereafter.

Rule 69L-56.3013

A subsequent SA will be A subsequent SA will be considered timely filed with the considered timely filed with the Division if it is received and Division if it is received and assigned a “TA” (Transaction assigned a “TA” (Transaction Accepted) Accepted) within 30 days of the within 30 days of the due date as due date as determined by the determined by the following: A subsequent MTC SA following: A subsequent MTC SA due date will be determined by due date will be determined by adding six month intervals to the adding six month intervals to the month of injury (e.g. Date of month of injury (e.g. Date of Injury (DOI) = 3/15/06, MTC SA Injury (DOI) = 3/15/06, MTC SA due 9/15/06, next MTC SA due due 9/15/06, next MTC SA due 3/15/07). 3/15/07).

Rule 69L-56.3013

If the resulting MTC SA due date If the resulting MTC SA due date is not a valid calendar date, the is not a valid calendar date, the due date for that MTC SA will due date for that MTC SA will default to last day of the default to last day of the calculated month calculated month first day of the first day of the next monthnext month (e.g. DOI = 8/30/06, (e.g. DOI = 8/30/06, MTC SA due 2/28/07 MTC SA due 2/28/07 3/01/073/01/07, , next MTC SA due 8/30/07). next MTC SA due 8/30/07).

Rule 69L-56.3013

The first MTC SA The first MTC SA shall not be sent shall not be sent to the Division earlier than six to the Division earlier than six months after the date of injurymonths after the date of injury. . However, if the claim However, if the claim administrator closed the case administrator closed the case prior to 6 months after the date prior to 6 months after the date of injury, the first Electronic of injury, the first Electronic Claim Cost Report may be sent Claim Cost Report may be sent prior to six (6) months after the prior to six (6) months after the date of injury if it is sent as an date of injury if it is sent as an MTC FN.MTC FN.

Rule 69L-56.3013

If the claim did not become a If the claim did not become a “Lost Time/Indemnity Case” until “Lost Time/Indemnity Case” until more than six (6) months after more than six (6) months after the date of injury, the date of injury, the first MTC the first MTC SA shall be filed when the next SA shall be filed when the next “6 month”“6 month” SROI MTC SA SROI MTC SA becomes due becomes due (e.g., disability (e.g., disability began 9 months after the DOI, 1st began 9 months after the DOI, 1st MTC SA due 12 months after DOI; MTC SA due 12 months after DOI;

disability began 13 months after disability began 13 months after DOI, 1st MTC SA due 18 DOI, 1st MTC SA due 18 months after DOI).months after DOI).

Rule 69L-56.3013

Subsequent MTC SA’s Subsequent MTC SA’s sentsent more than 7 more than 7 days prior to the days prior to the required six (6) month filing required six (6) month filing interval will be processed as an interval will be processed as an amendment to the previous SA amendment to the previous SA and will and will notnot fulfill the fulfill the filing requirement for the next filing requirement for the next required MTC SA. required MTC SA. **Many are appearing on **Many are appearing on the Missing SA report because the Missing SA report because they are being filed too early, and they are being filed too early, and are not counting for the required are not counting for the required SA filing.SA filing.

Rule 69L-56.3013

Final (FN): Final (FN): The claim The claim administrator shall report the administrator shall report the SROI MTC FN (Final) for all cases SROI MTC FN (Final) for all cases closed since the last required closed since the last required filing of a periodic report. The filing of a periodic report. The FN will be considered timely FN will be considered timely filed with the Division if it is filed with the Division if it is received by the Division and is received by the Division and is assigned a “TA” (Transaction assigned a “TA” (Transaction Accepted) on or before 30 days Accepted) on or before 30 days after the due date of the sub-after the due date of the sub-annual. annual.

Rule 69L-56.3013

The Final (FN) may be sent prior The Final (FN) may be sent prior to the due date of the sub-to the due date of the sub-annual if the claim administrator annual if the claim administrator closes the case and will not be closes the case and will not be paying any further medical or paying any further medical or indemnity benefits. indemnity benefits.

Rule 69L-56.3013

If the claim administrator issues If the claim administrator issues payment or changes the amount payment or changes the amount paid for any Benefit Type Code paid for any Benefit Type Code or Other Benefit Code identified or Other Benefit Code identified in subsections 69L-56.3013(1) in subsections 69L-56.3013(1) and (2), F.A.C., since the filing and (2), F.A.C., since the filing of the previous Final (FN), the of the previous Final (FN), the claim administrator shall send claim administrator shall send an an FN on or before 30 days after FN on or before 30 days after the due date of the sub-annualthe due date of the sub-annual to summarize benefits paid to summarize benefits paid since the last FN filed with the since the last FN filed with the Division.Division.

Rule 69L-56.3013 (FN after FN)

If the claim administrator is re-If the claim administrator is re-opening the claim to pay on-opening the claim to pay on-going indemnity benefits, an going indemnity benefits, an Sub-Annual (SA) Sub-Annual (SA) should be sent should be sent on or before 30 dayson or before 30 days after the after the due date of the Sub-Annual. due date of the Sub-Annual.

Rule 69L-56.3013

The claim administrator shall The claim administrator shall file file another Final (FN) another Final (FN) if it has if it has paid paid additional amounts additional amounts for one for one or more of the following Other or more of the following Other Benefit Type Codes: Benefit Type Codes: OBT Code 370 (Total Other OBT Code 370 (Total Other Medical), OBT Code 380 (Total Medical), OBT Code 380 (Total Voc Rehab Eval), OBT Code 390 Voc Rehab Eval), OBT Code 390 (Total Voc Rehab Educ), OBT (Total Voc Rehab Educ), OBT Code 400 (Total Other Voc Code 400 (Total Other Voc Rehab ), or OBT Code 475 (Total Rehab ), or OBT Code 475 (Total Medical Travel Expenses). Medical Travel Expenses).

Rule 69L-56.3013

Any insurer failing to timely Any insurer failing to timely send an Sub-Annual (SA) or send an Sub-Annual (SA) or Final (FN) in accordance with Final (FN) in accordance with the filing time periods the filing time periods prescribed in this subsection prescribed in this subsection shall be subject to shall be subject to administrative penalties administrative penalties assessable by the Division in assessable by the Division in accordance with the provisions accordance with the provisions of Rule 69L-24.021, F.A.C. and of Rule 69L-24.021, F.A.C. and Section 440.525(4), F.S. Section 440.525(4), F.S.

Rule 69L-56.3013

In the event claims are acquired In the event claims are acquired from another claim from another claim administrator, the insurer shall administrator, the insurer shall ensure that its former claim ensure that its former claim administrator provides the administrator provides the acquiring claim administrator acquiring claim administrator with the total amounts paid for with the total amounts paid for indemnity benefits paid prior to indemnity benefits paid prior to the acquisition of the claim by the acquisition of the claim by the new claim administrator. the new claim administrator.

Rule 69L-56.3013

Notwithstanding the provision Notwithstanding the provision of particular amounts paid by of particular amounts paid by the former claim the former claim administrator(s) for each administrator(s) for each indemnity benefit type, the indemnity benefit type, the acquiring claim administrator acquiring claim administrator shall report on the next required shall report on the next required SA or FN, cumulative totals for SA or FN, cumulative totals for all indemnity benefits paid by all indemnity benefits paid by the former claim the former claim administrator(s) on a administrator(s) on a transferred case as follows: …transferred case as follows: …

Rule 69L-56.3013

…Cumulative totals for indemnity costs paid by the former claim administrator(s) shall be reported under Other Benefit Type Code 430 (Total Unallocated Prior Indemnity Benefits). The acquiring claim administrator shall report any particular costs paid by them for each applicable Benefit Type Code (indemnity benefits) and Other Benefit Type Code, in addition to the unallocated indemnity amount paid by the former claim administrator(s).

Rule 69L-56.3013

What claims are What claims are found on the found on the Missing SA Missing SA

Report?Report?


The The Missing SA ReportMissing SA Report identifies:identifies:

• Claims that are due an Claims that are due an SA SA transaction, and transaction, and • Claims for which no SA Claims for which no SA or FN or FN has been filed with has been filed with DWC. DWC.


TheThe Missing SA ReportMissing SA Report includes:includes:

• OPEN, LOST TIME Claims OPEN, LOST TIME Claims for which for which a DWC-1 or DWC-13 a DWC-1 or DWC-13 (paper or (paper or EDI)EDI) is is ‘on file’ and ...,‘on file’ and ...,


……• DOI DOI > > 1/1/2005; or1/1/2005; or

• EDI R1/R3 accepted (any DOI) (excludes EDI R1/R3 accepted (any DOI) (excludes unrescinded FROI 04); orunrescinded FROI 04); or

• PT/PT Supp $ paid (any DOI); orPT/PT Supp $ paid (any DOI); or

• Recent DWC Form (1, 4, 12, or 13) rec’d Recent DWC Form (1, 4, 12, or 13) rec’d on/after 1/1/2008 (regardless of DOI).on/after 1/1/2008 (regardless of DOI).

• Any of the above with Full Denial Any of the above with Full Denial rescinded but no payment made by 12 rescinded but no payment made by 12 months from DOI. months from DOI.


The Missing SA report The Missing SA report will not will not include cancelled include cancelled claims or Full Denials claims or Full Denials (un-rescinded) where no (un-rescinded) where no indemnity has been indemnity has been paid).paid).


Due to a decline in the Due to a decline in the proper filing of Claim Cost proper filing of Claim Cost reports, DWC instituted the reports, DWC instituted the “Missing SA Report” “Missing SA Report” in in 2009. 2009.

• Posted in Data Posted in Data Warehouse under Warehouse under ‘Proprietary Claims EDI ‘Proprietary Claims EDI Reports’.Reports’.


Claim Claim Administrator Administrator ExpectationsExpectations


Missing SA ReportMissing SA Report• Claim Administrators are Claim Administrators are expected expected to reconcile to reconcile each month’s each month’s Missing Missing SA SA reportreport. . • An email advisory will be An email advisory will be sent when sent when each Missing SA each Missing SA Report is posted Report is posted in the in the warehouse. warehouse. • The report includes the The report includes the EE’s EE’s

Name and Date of Birth Name and Date of Birth (SSN has (SSN has been removed.)been removed.)


……If the case was If the case was really a Medical Only really a Medical Only claim and should claim and should never have been never have been filed with the filed with the Division, an MTC 01 Division, an MTC 01 ‘Cancel’ should be ‘Cancel’ should be filed. filed.

Missing SA ReportMissing SA Report……If the file has been acquired If the file has been acquired by another claim admin, advise by another claim admin, advise the Division that this claim has the Division that this claim has been acquired, and provide the been acquired, and provide the name of the new Claim Admin name of the new Claim Admin (if known).(if known).FYI…FYI…When a Claim Administrator When a Claim Administrator acquires acquires any open lost time any open lost time claim claim and any lost time claim and any lost time claim closed closed within five years within five years prior to the date prior to the date of acquisition, an MTC AQ must be of acquisition, an MTC AQ must be filed to report a change in claims filed to report a change in claims administration.administration.

To assist claim To assist claim administrators with this administrators with this Missing SA requirement, Missing SA requirement, the Division has agreed to the Division has agreed to accept a Paper DWC-13 accept a Paper DWC-13 form for any ‘form for any ‘legacy claimlegacy claim’ ’ (Date Claim Admin’s Knowledge of (Date Claim Admin’s Knowledge of Injury was prior to Claim Admin’s Injury was prior to Claim Admin’s R3 Imp Date)R3 Imp Date) IFIF the claim is the claim is now closed, and the filing is now closed, and the filing is a a FINALFINAL. .


Missing SA ReportMissing SA ReportThe The FINALFINAL legacy legacy paper 13 paper 13 must be complete and must be complete and accurate. accurate. Medical, Hospital Medical, Hospital and Drugs/Suppliesand Drugs/Supplies will not will not be required. All other be required. All other indemnity and medical info indemnity and medical info must be greater or equal to must be greater or equal to the previous the previous DWC-13 filed. DWC-13 filed.

Hot Hot TopicTopic

FL no longer requires the FL no longer requires the reporting of:reporting of:Physician (Medical)Physician (Medical)Hospital Hospital Pharmacy/Durable Medical Pharmacy/Durable Medical Paid To Date Paid To Date on the on the EDI Claim Cost EDI Claim Cost “Periodic” report.“Periodic” report.

Other Benefit Type Other Benefit Type Codes Codes (not required by (not required by

FL)FL)

If you are currently reporting If you are currently reporting this information under OBT this information under OBT 370, it should be corrected 370, it should be corrected using one of the following:using one of the following:

SROI 02 SROI 02

SA (amended) SA (amended)

FN (amended)FN (amended)

The Bureau of Monitoring The Bureau of Monitoring and Audit sent a notification and Audit sent a notification email to all CPS contacts email to all CPS contacts advising that the Missing SA advising that the Missing SA Report must be rectified by Report must be rectified by 1/31/11. Failure to comply 1/31/11. Failure to comply may result in a non-willful or may result in a non-willful or willful penalty in accordance willful penalty in accordance with s.440.525 F.S. and Rule with s.440.525 F.S. and Rule 69L-24 F.A.C.69L-24 F.A.C.


SROI SROI SCENARIOSCENARIOMTC “SA”MTC “SA”(Periodic Sub-(Periodic Sub-Annual Report)Annual Report)

Rule 69L-56.3013(4)(a), Rule 69L-56.3013(4)(a), F.A.CF.A.C..

Electronic Claim Cost Report: Electronic Claim Cost Report: SUB-ANNUAL SUB-ANNUAL

Claim is Open andClaim is Open and

Electronic Electronic SUB-SUB-ANNUAL ANNUAL Claim Cost Claim Cost Report is dueReport is due

Send: Send: SROI SASROI SA

Due: Due: DOI + 6 Months (+30 DOI + 6 Months (+30 Days) Or, Days) Or, DOI + 12 DOI + 12 months (+30 Days) if months (+30 Days) if LT LT occurs > 6 Months from DOIoccurs > 6 Months from DOI

NoteNote: The : The firstfirst Electronic Claim Electronic Claim Cost Report must not be sent Cost Report must not be sent earlier than 6 months after the earlier than 6 months after the Date of Injury, unless being Date of Injury, unless being reported as a Final (SROI MTC reported as a Final (SROI MTC FN).FN).


Claim is still Open/Re-Claim is still Open/Re-opened to pay ongoing opened to pay ongoing indemnity or medical indemnity or medical benefits andbenefits and

Subsequent Electronic Subsequent Electronic SUB-ANNUAL Claim Cost SUB-ANNUAL Claim Cost Report is dueReport is dueDue: Due: At 6 month intervals At 6 month intervals from DOI from DOI (+ 30 Days) until (+ 30 Days) until Final is filed.Final is filed.


The first Sub-Annual must The first Sub-Annual must not be sent prior to the not be sent prior to the end of six (6) months from end of six (6) months from the date of injury, or the the date of injury, or the transaction will reject. transaction will reject.

Sequencing Rule for Sequencing Rule for SA’sSA’s

If MTC SA is sent more than If MTC SA is sent more than 7 days prior to the date it 7 days prior to the date it is due, it will be considered is due, it will be considered an amendment an amendment to the to the previously accepted MTC previously accepted MTC SA, rather than the next SA, rather than the next required MTC SA.required MTC SA.

Duplicate Processing Note Duplicate Processing Note for SA’sfor SA’s

Example: DOI = 9-1-06Example: DOI = 9-1-0611stst SA filed no earlier than SA filed no earlier than 3-1-07 3-1-07 (not always exact 180 days-use (not always exact 180 days-use

calendar months)calendar months) and no later and no later than 3-31-07than 3-31-07

22ndnd SA must receive a TA SA must receive a TA no earlier than 7 days no earlier than 7 days prior to 9-1-07 and no prior to 9-1-07 and no later than 30 days after 9-later than 30 days after 9-1-07 (10-1-07) to fulfill the 1-07 (10-1-07) to fulfill the 22ndnd SA filing requirement. SA filing requirement.


Another Example: DOI = 8-31-Another Example: DOI = 8-31-060611stst SA filed no earlier than 3- SA filed no earlier than 3-1-07 and no later than 3-31-1-07 and no later than 3-31-07.07. (if 6 month (if 6 month interval results in an invalid interval results in an invalid

date, use 1st day of next month)date, use 1st day of next month)

22ndnd SA must receive a TA no SA must receive a TA no earlier than 7 days prior to 8-earlier than 7 days prior to 8-31-07 and no later than 30 31-07 and no later than 30 days after 8-31-07 (9-30-07) to days after 8-31-07 (9-30-07) to fulfill the 2fulfill the 2ndnd SA filing SA filing requirement.requirement.


SROI “SA”SROI “SA”

Florida requires the periodic Florida requires the periodic filings filings on a sub-annual basis to on a sub-annual basis to report the total paid report the total paid amounts paid in indemnity amounts paid in indemnity and certain medical costs and certain medical costs for all for all open cases.open cases.

SROI “SA”SROI “SA”The claim administrator has paid The claim administrator has paid TTD Benefits and some TTD Benefits and some miscellaneous medical and miscellaneous medical and mileage reimbursement costsmileage reimbursement costs..

For Electronic Claim For Electronic Claim Cost Reports, FL does not require Cost Reports, FL does not require the reporting of physician, the reporting of physician, hospital, pharmacy and physical hospital, pharmacy and physical therapy costs.therapy costs.

SROI MTC “SA”SROI MTC “SA”(Periodic Sub-Annual Report)(Periodic Sub-Annual Report)

The claim administrator submits The claim administrator submits the sub-annual report on the sub-annual report on 12/21/2007, six months after the 12/21/2007, six months after the accident.accident...

““SA” ScenarioSA” Scenario(only pertinent DN’s displayed)(only pertinent DN’s displayed)

One Benefit type has been One Benefit type has been paid on the claimpaid on the claimand two Other Benefit and two Other Benefit typestypes

SROI “SA” SROI “SA” ScenarioScenarioTemporary Total benefits Temporary Total benefits

were paid through December were paid through December 14, 2007.14, 2007.

““SA” ScenarioSA” ScenarioTwo OBT’s were paidTwo OBT’s were paid

•370 - Total Other Medical370 - Total Other Medical•475 – Total Medical 475 – Total Medical Travel ExpensesTravel Expenses

SROI SROI SCENARIOSCENARIOMTC “FN”MTC “FN”(Final Report)(Final Report)

Rule 69L-56.3013(4)(b), Rule 69L-56.3013(4)(b), F.A.CF.A.C..

Electronic Claim Cost Electronic Claim Cost Report: Report:

FINAL “FN”FINAL “FN”Claim is Closed and Claim is Closed and

Electronic FINAL Electronic FINAL Claim Claim Cost Report is Cost Report is duedue

Send: Send: SROI FNSROI FN

Due: Due: On or before 30 days On or before 30 days after the due date of the next after the due date of the next SA, or Upon Closure of Claim SA, or Upon Closure of Claim by Claim Administrator, or by Claim Administrator, or final payment of indemnity final payment of indemnity and medical benefits)and medical benefits)

“ “FN” may be sent prior to FN” may be sent prior to the due date of the next SA if the the due date of the next SA if the case is closed and no further case is closed and no further indemnity or medical benefits will be indemnity or medical benefits will be paid. paid.

Electronic Claim Cost Electronic Claim Cost Report: Report:

FINAL “FN”FINAL “FN”

SROI “FN”SROI “FN”

Previously Submitted Reports:Previously Submitted Reports:

1.1. MTC FROI 00-Original MTC FROI 00-Original First First

Report with MTC SROI IP-Report with MTC SROI IP-Initial PaymentInitial Payment

2.2. SROI MTC SA-Sub-Annual SROI MTC SA-Sub-Annual

Periodic Claim Cost Periodic Claim Cost ReportReport

SROI “FN” SROI “FN” ScenarioScenario

(only pertinent DN’s displayed)(only pertinent DN’s displayed)A Final report is sent on A Final report is sent on 1/16/08.1/16/08.


(only pertinent DN’s (only pertinent DN’s displayed)displayed)

Injured worker received a 15% Injured worker received a 15% Permanent Impairment RatingPermanent Impairment Rating

SROI “FN” SROI “FN” ScenarioScenarioThree Benefit Types have Three Benefit Types have

been paid on the claim.been paid on the claim.

SROI “FN” SROI “FN” ScenarioScenarioBenefit Type Code 500 – Benefit Type Code 500 –

Unspecified Lump Sum Unspecified Lump Sum Payment/SettlementPayment/Settlement


Benefit Type Code 030 – Benefit Type Code 030 – Impairment Income Benefits were Impairment Income Benefits were previously paid.previously paid.


Benefit Type Code 050 – Benefit Type Code 050 – Temporary Total Benefits were Temporary Total Benefits were previously paid.previously paid.

What are the 10 What are the 10 most common most common errors on a SA errors on a SA Report?Report?

10.10. Other Ben Type Previously Other Ben Type Previously RPTD RPTD not sent not sent on SROI on SROI (0282-059)(0282-059)

9.9. CLM ADM Zip CLM ADM Zip must be must be changed changed via 02, AQ or via 02, AQ or AU/SROI AU/SROI (0014-117)(0014-117)

8.8. Benefit type code Benefit type code previously reported previously reported not not sent sent on SROI.on SROI.

(0288-059)(0288-059)

Top 10 errors on an SATop 10 errors on an SA

7. 7. Insurer FEIN Insurer FEIN must be must be changed changed via 02, via 02, AQ or AQ or AU/SROI.AU/SROI. (0006-117)(0006-117) 6. 6. AVG Wage AVG Wage must be changed must be changed via MTC via MTC 02, CB, CA, AP or RB.02, CB, CA, AP or RB. (0286-059)(0286-059)

5. WKLY Comp Amt WKLY Comp Amt must must change on change on MTC CB, CA, 02, MTC CB, CA, 02, AP or RB.AP or RB.

(0134-059)(0134-059)


4. 4. Thru Date Thru Date must not be >must not be > Prev Thru Prev Thru Date.Date. (0089-059)(0089-059)

3. 3. Reduced Benefit Amount Reduced Benefit Amount Code Code MissingMissing (0202-001)(0202-001)

2. 2. Benefit Type Amount Paid Benefit Type Amount Paid < < PreviouslyPreviously Reported Reported (0086-059)(0086-059)


And the # 1 error on And the # 1 error on an an

SA is…?SA is…?

1. The number of benefits should not be > than what is on file. (0288-044)(0288-044)

Top 10 errors on an SA Top 10 errors on an SA ReportReport

RememberRemember……

Sequencing edits Sequencing edits may be may be preventing preventing your SA or FN from your SA or FN from accepting. accepting. New Benefit types can not New Benefit types can not appear for the first time on appear for the first time on an SA, they must be sent on an SA, they must be sent on a CB (or other applicable a CB (or other applicable MTC) prior to the SA.MTC) prior to the SA.

In addition to the Top 10 In addition to the Top 10 errors for SA’s, these errors for SA’s, these additional errors are additional errors are prevalent on FN’s (Finals). prevalent on FN’s (Finals).

Additional errors on an FN Additional errors on an FN ReportReport

3. Ben Type Code Previously Ben Type Code Previously RPTD RPTD not not sentsent on SROI on SROI (0288-(0288-059)059)

2. The number of benefitsThe number of benefits should notshould not be be > than what > than what is on file. is on file. (0288-044)(0288-044)

And the # 1 error on And the # 1 error on an an

FN is…?FN is…?

In addition to the Top 10 In addition to the Top 10 errors for SA’s, these errors for SA’s, these additional errors are additional errors are prevalent on FN’s (Finals). prevalent on FN’s (Finals).

Additional errors on an FN Additional errors on an FN ReportReport

1.. NO SROI S1-7, 04, CD, VE, NO SROI S1-7, 04, CD, VE, PY OR PY OR PD PD ON FILE ON FILE (0002-063)(0002-063)

FN’s (Finals) will FN’s (Finals) will notnot accept accept until ongoing indemnity until ongoing indemnity benefits have been benefits have been suspended, denied or suspended, denied or settled.settled.This is one of the industry’s This is one of the industry’s top 5 FN rejections.top 5 FN rejections.

How to find the How to find the Missing SA Missing SA

Report?Report?


Accessing the Missing SA Reports go Accessing the Missing SA Reports go to… to… DWC Claims EDI Warehouse DWC Claims EDI Warehouse (Production) (Production)

…then open the “Report Type” drop box and select “Missing MTC SA Reports” to search.

From this list you may view the information provided in the Missing SA Report.

If you have edit errors that If you have edit errors that are preventing your SA or are preventing your SA or FN transaction from FN transaction from accepting, and you are accepting, and you are unsure how to resolve it, unsure how to resolve it, please contact the EDI team please contact the EDI team at at [email protected]

Questions?

Florida Division of Workers’ Compensation Claims EDI Missing SA 2013.

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Transcript of Florida Division of Workers’ Compensation Claims EDI Missing SA 2013.