Unit Editing and Data Validation Concepts · Unit Editing and Data Validation Concepts ... Unit...

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1 1 © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. Unit Editing and Data Validation Concepts Presented by: Bruce Hallman and Hal Dooley 2 © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. Objectives Become familiar with the types of Unit Edits/Validation Tests and how to research and resolve them

Transcript of Unit Editing and Data Validation Concepts · Unit Editing and Data Validation Concepts ... Unit...

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1© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Editing and Data Validation Concepts

Presented by:Bruce Hallman and Hal Dooley

2© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Objectives

Become familiar with the types of Unit Edits/Validation Tests and how

to research and resolve them

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3© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Agenda

Unit Data Editing

• Unit Edit Process• Examples

Unit Data Validation

• Unit Validation Process• Examples

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Unit Data Editing

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Unit Data Editing Topics

• Resources for reporting requirements

• Data grades

• Types of Edits—Field, Logical, Relational, and Net

• Editing path in Data Collection

• Edit matrices

• Edit creation process

6© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Resources for Reporting Requirements

• Statistical Plan• Filed rules

• Unit Statistical Reporting Guidebook• Reporting examples• Edit and Validation Test Matrices

• WCIO Data Specifications Manual• WCSTAT

• Online Tools• DCA Access® Online• Unit Pre-Edit Service/Tool• Data Transfer via the Internet

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Editing Path in Data Collection

Corrections/ReplacementsUpdate source system if using DCA Access® Online

Submission Results/Reports

Net Edits

Data Accepts/Rejects

Front-End Edits

Submit Data for Processing

Pre-Edit

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Pre-Edit Options

Unit Pre‐Edit Service

•Submit electronic files to see errors before submitting to production

Unit Pre‐Edit Tool

•Allows you to update your units online and submit

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Unit Edit Data Grades

Error Class(Data Grade Description)

Data Grade(Level of Severity)

Error-Free 0

Informational 1

Suspect 2

Default 3

Priority Error 4

Priority/Critical Error 5

Reject 9

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Edit Types

Field:Checks field values, e.g., numeric, alphanumeric, and valid codesLogical:Checks that the data reported in a field is valid in relation to:– One or more fields on the record or– Within other records on the unit report

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Edit Types

Relational:Compares data reported in a field:– With other data in the same submission– With data on the databaseNet (Logical and Relational): Uses the current header and latest exposure and loss information at each report level to:– Identify error conditions– Clear errors on corresponding unit reports

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Unit Submission Results Report

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Unit Edit Matrix

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Unit Edit Matrix

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Unit Edit Matrix

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Future Enhancement Unit Edit Matrix

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Edit Creation Process

New Edit Idea (data quality concern or rule requirement)

Internal Review

External Edit Task Group

Future Edit Enhancement Matrix

Production Edit Matrix

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Unit Data Editing Match Game

Questions

Identifies the Severity of an Error

Checks for Numeric/Alpha Values

First Step in Editing Path

Error Free Data

Location of Edit Matrix

Answers

Pre‐Edit

Unit Statistical Reporting Guidebook

Data Grades

Field Edit

Data Grade 0

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Unit Data Edits—Examples

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Before We Begin, a Few Notes …

• The focus should be on reporting accurate data rather than clearing errors

• There can be multiple ways to clear an error depending on what data is in error

• Update source system if using DCA Access®

Online

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Unit Data Edits

Edit Number

Description

0282-14 LOSSES WITHOUT EXPOSURE (Front-End)

0282-18 LOSSES WITHOUT EXPOSURE (Net)

0075-03 EXPERIENCE MODIFICATION FACTOR INCONSISTENT

0282-17 INCONSISTENT CLASS CODE ACROSS REPORT LEVELS

9901-07 OPEN LOSSES NOT UPDATED ON SUBSEQUENT

0286-05 LOSS MATCHING

0286-06 LOSS MATCHING

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Losses Without Exposure

Relational Edit Number: 0282-14Data Grade: 5 (9 for MN and NC)Element: Classification Code (on Loss Record)

Edit Description: The loss class code on the incoming unit must have a corresponding exposure class code with a nonzero exposure amount.

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Losses Without Exposure

Concept: We don’t expect a loss to be paid for a worker that wasn’t covered under the policy.

Example: A loss is reported for a roofing injury under Classification Code 5551, but no roofers are covered on the policy—i.e., there is no exposure record for Code 5551.

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Losses Without Exposure—Set Up

2-1 R–Claim2 5551 $500 5

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810 $1,000 R–Claim1 8810 $250 0

2-0 P–Claim1R–Claim1

88108810

$250$300 0

0282-14

Losses Without Exposure Data Issue

Matching exposure class code is missing

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Losses Without Exposure Correcting—Method 1

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810 $1,000 R–Claim1 8810 $250 0

2-0 P–Claim1R–Claim1

88108810

$250$300 0

2-1 R–Claim2 5551 $500 5

2-2 P–Claim2R–Claim2

55518810

$500$500 0

Based on research, it is determined that the class code on the loss is incorrect.

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Losses Without Exposure Correcting—Method 1

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The current data grade for this claim is 5.

For additional priority errors, you can check here.

Losses Without Exposure Correcting—Method 1

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Losses Without Exposure Correcting—Method 1

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The report level data grade is now zero.

Losses without Exposure Correcting—Method 1

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The report level data grade is now zero. The current data

grade for this

claim is now zero.

For further confirmation,you can check here.

Losses without Exposure Correcting—Method 1

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Losses Without Exposure Correcting—Method 2

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810 $1,000 R–Claim1 8810 $250 0

2-0 P–Claim1R–Claim1

88108810

$250$300 0

2-1 R–Claim2 5551 $500 5

Based on research, it is determined that the class code on the loss is correct.

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Losses Without Exposure Correcting—Method 2

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810 $1,000 R–Claim1 8810 $250 0

2-0 P–Claim1R–Claim1

88108810

$250$300 0

2-1 R–Claim2 5551 $500 5

1-1 R–5551 $1,500 0

0

Based on research, it is determined that the class code on the loss is correct.

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Net Edits

• Compare reported values on incoming units with data on NCCI’s database

• Apply to the newly reported or previously submitted data

• Corrections must be submitted in sequential report level order, starting with the earliest report level that the error occurred

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Front-End vs. Net

Aspect Front-End Net

Field Yes No

Logical Yes Yes

Relational Yes Yes

Aspect Front-End Net

Field Yes No

Logical Yes Yes

Relational Yes Yes

Unit Pre-Edit Tool/Service

Yes No

Aspect Front-End Net

Field Yes No

Logical Yes Yes

Relational Yes Yes

Unit Pre-Edit Tool/Service

Yes No

Rejected Units Yes No

Aspect Front-End Net

Field Yes No

Logical Yes Yes

Relational Yes Yes

Unit Pre-Edit Tool/Service

Yes No

Rejected Units Yes No

Edit Operation Edits operate on submitted records

All edits operate when any unit is received

Applying Edits Incoming Unit Incoming Unit and unit(s) on database

Clearing Errors Yes, by replacing the record

Yes, even to records previously submitted

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Losses Without Exposure Net

Net Edit Number: 0282-18Data Grade: 5Element: Classification Code (on Loss Record)

Edit Description: The loss class code on a previously reported unit must have a corresponding exposure class code with a non-zero exposure amount.

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1-1 P–8810 $1,000 0

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810R–8742

$1,000$750

R–Claim3 8810 $250 0

2-0 P–Claim3R–Claim3

88108810

$250$300 0

Losses Without Exposure Net—Set Up

5

5

Net 0282-18

Losses Without Exposure Net—Data Issue

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Losses Without Exposure NetCorrecting—Method 1

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810R–8742

$1,000$750

R–Claim3 8810 $250 5

2-0 P–Claim3R–Claim3

88108810

$250$300 5

1-1 P–8810 $1,000 0

Based on research, it is determined that the class code on Claim3 is correct and the removal of exposure Class Code 8810 was incorrect.

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Losses Without Exposure NetCorrecting—Method 1

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810R–8742

$1,000$750

R–Claim3 8810 $250 5

2-0 P–Claim3R–Claim3

88108810

$250$300 50

1-1 P–8810 $1,000 0

1-2 R–8810 $1,500 0

0

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Based on research, it is determined that the class code on the claims is incorrect and the removal of exposure Class Code 8810 was correct.

Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810R–8742

$1,000$750

R–Claim3 8810 $250 5

2-0 P–Claim3R–Claim3

88108810

$250$300 5

1-1 P–8810 $1,000 0

Losses Without Exposure NetCorrecting—Method 2

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Report # and Seq. #

Exposure Class Code Exposure

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R–8810R–8742

$1,000$750

R–Claim3 8810 $250 5

2-0 P–Claim3R–Claim3

88108810

$250$300 5

1-1 P–8810 $1,000 0

1-2 P–Claim3R–Claim3

88108742

$250$250 0

2-1 P–Claim3R–Claim3

88108742

$300$300 0

Losses Without Exposure NetCorrecting—Method 2

0

0

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Match Game

Questions

Two Types of Errors

Highest “Current” Data Grade

Pre‐Edit Applies To

View Data Grade 4 and 5 Errors

Possible Corrective Actions

Answers

Front‐End Edit

Update Exposure or Loss Classification

Front‐End and Net

Report Level 

Outstanding Priority Errors

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Experience Modification FactorInconsistent

Relational Edit Number: 0075-03Net Edit Number: 0075-07Relational Edit Data Grade: 4 (9 for MN and NC)Net Edit Data Grade: 4Element: Experience Modification Factor

Edit Description: The Experience Modification Factor on the incoming unit must be the same for all class codes with the same Experience Modification Effective Date.

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Experience Modification FactorInconsistent

Concept: We expect the Experience Modification Factor to be the same for all class codes subject to experience rating that share the same Experience Modification Effective Date.

Example: Class Code 8742 with a 1/1/09 Experience Modification Effective Date has an Experience Modification Factor of 0.79. Class Code 8810 has 0.82 for the same Experience Modification Effective Date.

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1-1 P – 8742R – 8742R – 8810

1/1/091/1/091/1/09

$250,000$275,000$475,000

0.790.820.79

44

Experience Modification Factor Inconsistent

Report # and Seq. #

Exposure Class Code

Exp Mod Eff Date Exposure

Experience Mod

Data Grade

1-0 R - 8742 1/1/09 $250,000 0.79 0

0075-03Inconsistent Modification Factors

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1-1 P – 8742R – 8742R – 8810

1/1/091/1/091/1/09

$250,000$275,000$475,000

0.790.820.79

44

Experience Modification Factor Inconsistent

Report # and Seq. #

Exposure Class Code

Exp Mod Eff Date Exposure

Experience Mod

Data Grade

1-0 R - 8742 1/1/09 $250,000 0.79 0

0075-03 Errors are cleared

1-2 P – 8742R – 8742

1/1/091/1/09

$275,000$275,000

0.820.79 0

Based on research, it is determined that the Experience Mod should not have changed.

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Experience Modification FactorInconsistent

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Experience Modification FactorInconsistent

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Experience Modification FactorInconsistent

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Experience Modification FactorInconsistent

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Inconsistent Class Code AcrossReport Levels

Relational Edit Number: 0282-17Net Edit Number: 0282-20Data Grade: 9 (Relational)/5 (Net)Element: Classification Code (on Loss Record)

Edit Description: The class code must be reported consistently across all report levels for this loss.

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Inconsistent Class Code AcrossReport Levels

Concept: The reported class code of the injured worker is not expected to change over the life of the loss.

Example: A claim is reported under Classification Code 8810 (office and clerical) on the first report. Then on the second report, the class is reported as Code 8742 (Salesperson).

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3-0 P – Claim4R – Claim4

88108742

$300$350 9

Inconsistent Class Code Across Report Levels—Data Issue

Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

UnitRejected

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Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

3-0 P – Claim4R – Claim4

88108742

$300$350 9

Inconsistent Class Code Across Report Levels Correcting—Method 1

Unit Rejected

Based on research, it is determined that the class code on the 3-0 is incorrect.

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Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

3-0 P – Claim4R – Claim4

88108742

$300$350 9

Inconsistent Class Code Across Report Levels Correcting—Method 1

Unit Rejected

3-0 P – Claim4R – Claim4

88108810

$300$350 0

Correct Data and Resubmit Unit

Based on research, it is determined that the class code on the 3-0 is incorrect.

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Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

3-0 P – Claim4R – Claim4

88108742

$300$350 9

UnitRejected

Based on research, it is determined that the class code on the 3-0 is correct.

Inconsistent Class Code Across Report Levels Correcting—Method 2

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Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

3-0 P – Claim4R – Claim4

88108742

$300$350 9

1-1 P – Claim4R – Claim4

88108742

$250$250 05

5

UnitRejected

Based on research, it is determined that the class code on the 3-0 is correct.

Inconsistent Class Code Across Report Levels Correcting—Method 2

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Report # and Seq. #

Claim Number

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim4 8810 $250 0

2-0 P – Claim4R – Claim4

88108810

$250$300 0

3-0 P – Claim4R – Claim4

88108742

$300$350 9

1-1 P – Claim4R – Claim4

88108742

$250$250 0

2-1 P – Claim4R – Claim4

88108742

$300$300 0

UnitRejected

3-0 P – Claim4R – Claim4

87428742

$300$350 0

Resubmit Rejected 3-0 Unit

Based on research, it is determined that the class code on the 3-0 is correct.

Inconsistent Class Code Across Report Levels Correcting—Method 2

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Open Losses Not Updatedon Subsequent

Relational Edit Number: 9901-07Data Grade: 5 (NC and WI are not included)Element: Miscellaneous edit (on Header Record)

Edit Description: The incoming unit does not contain updates for all open claims that exist at the previous report level.

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Open Losses Not Updatedon Subsequent

Concept: All open losses must be reported on subsequent units.

Example: If a loss is open at the 1st report, the loss must be updated and reported on the 2nd report.

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Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR – Claim6R - Claim7

O – OpenO – Open

88108810

$250$125

00

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

00

Open Claims Not Updated on a Subsequent Report Level—Data Issue

Since Claim6 was open at the 1st report level and not updated at the 2nd report, the header record for the 2-0 receives a 9901-07 DG 5 error.

Then the header record of the 1-0 receives a 9901-26 Net DG 5 error.

500

Edit 9901-07

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

00

500

Edit 9901-26Writes the Error

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After carrier research, it is determined that Claim6 was still open at the 1st report and requires an update.

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

Open Losses Not Updated on a Subsequent Report Level—Correction Method 1

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Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR – Claim6R - Claim7

O - OpenO - Open

88108810

$250$125

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

2-1 HeaderP - Claim6R - Claim6

O - OpenC - Closed

88108810

$125$175

000

No Error

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

000

9901-26Clears the Error

Open Losses Not Updated on a Subsequent Report Level—Correction Method 1

These edits write to the header record. When the 2-1 arrived, it became the latest header at the 2nd report and it has no errors. The DG 5 on the 2-0 is just historical.

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Open Claims Not Updated on a Subsequent Report Level—Correction Method 2

After carrier research, it is determined that Claim6 should have been closed at the 1st report.

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

64© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$250$125

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

1-1 HeaderP - Claim6R - Claim6

O - OpenC - Closed

88108810

$125$125

000

Open Claims Not Updated on a Subsequent Report Level—Correction Method 2

Submitting a 1-1 loss correction that closes Claim6 will clear the 1st report error by replacing the current header.

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

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Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$250$125

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

1-1 HeaderP - Claim6R - Claim6

O - OpenC - Closed

88108810

$125$125

000

Open Claims Not Updated on a Subsequent Report Level—Correction Method 2

Report # and Seq. #

Claim Number

ClaimStatus

Loss Class Code

Loss Amount

Data Grade

1-0 HeaderR - Claim6R - Claim7

O - OpenO - Open

88108810

$125$250

500

2-0 HeaderP - Claim7R - Claim7

O - OpenC - Closed

88108810

$250$300

500

Next, Net edit 9901-26 will operate to physically clear the error on the 2-0.

000

9901-26 Clears the Error

66© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Loss Matching

Relational Edit Number: 0286-05Data Grade: 9Element: Update Type Code

Edit Description: If the reported Update Type is P, C, or D, a previously reported R, A, or C Update Type must be found on the database for that claim.

Matching fields used to identify previously reported loss records are: Claim Number and Accident Date.

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Loss Matching

Relational Edit Number: 0286-06Data Grade: 9Element: Update Type Code

Edit Description: If the reported Update Type is A or R without a corresponding D or P on the same unit, the claim must not already exist on the database.

Matching fields used to identify previously reported loss records are: Claim Number and Accident Date.

68© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Loss Matching

Concept: If a loss is being updated, it must have the same claim number and accident date as the loss on our database. If a new loss is being added, it must not match a claim that already exists on our database.

Maintaining the Claim Number and Accident Date for the life of the loss is very important because these fields uniquely identify the claim.

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Loss Matching FieldsStates Loss Fields

All States Except MD and VAClaim NumberAccident DateTX—Policies Effective 01/01/15

and Subsequent

TX—Policies Effective 10/01/08 Through12/31/14

Claim NumberAccident DateLoss Condition Code: ActLoss Condition Code: Type of Claim

MD and VA Only—Policies Effective10/01/08 and Subsequent

Claim NumberAccident DateLoss Condition Code: Type of Claim

MD, TX, and VA—Policies Effective Priorto 10/01/08

Claim NumberAccident DateLoss Condition Code: ActLoss Condition Code: Type of LossLoss Condition Code: Type of RecoveryLoss Condition Code: Type of ClaimVocational Rehabilitation IndicatorJurisdiction State Code

Part 5—Unit Statistical Reporting Guidebook

70© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Report # and Seq. #

Claim Number

Accident Date

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim8 4/1/06 8810 $250 0

Loss Matching—Data Issue

• Previous (P) record rejected for 0286-05 (matching)• Revised (R) record rejected for 0286-06 (duplicate)

Report # and Seq. #

Claim Number

Accident Date

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim8 4/1/06 8810 $250 0

2-0 P – Claim8R – Claim8

4/2/064/1/06

88108810

$250$300

99

Unit Rejected

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Report # and Seq. #

Claim Number

Accident Date

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim8 4/1/06 8810 $250 0

2-0 P – Claim8R – Claim8

4/2/064/1/06

88108810

$250$300

99

Loss Matching—Correcting

Based on research, it is determined that the date on the previous record of the 2-0 should have been 4/1/06.

72© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Report # and Seq. #

Claim Number

Accident Date

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim8 4/1/06 8810 $250 0

2-0 P – Claim8R – Claim8

4/2/064/1/06

88108810

$250$300

99

Loss Matching—Correcting

Now the previous (P) record for the loss on the 2-0 correctly matches the revised (R) record for the loss on the 1-0 and the unit loads to the database.

Report # and Seq. #

Claim Number

Accident Date

Loss Class Code

Loss Amount

Data Grade

1-0 R – Claim8 4/1/06 8810 $250 0

2-0 P – Claim8R – Claim8

4/1/064/1/06

88108810

$250$300

99

Correct Data and Resubmit Unit

00

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73© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

New Unit Edits

Edit Number Description

0055‐130055‐14

Ensure that the correct Deductible Reimbursement Amount is being applied based on date. (Colorado only)

0095‐02 Ensures that the Incurred Claimant Attorney Fee Amount does not exceed the incurred amount of the claim. (Florida only)

0116‐050116‐06

Identifies lump‐sum or closed claims that have an increase in Paid Indemnity that isn’t identified as having a settlement.

9905‐12 Identifies suspect claims that have not been deleted at every report level.

74© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Match Game

Questions

Loss Classification Code

Experience Modification Factor Must Be Consistent

Open Claims

Loss Matching Fields

Proper Reporting of Deleted Claims

Answers 

Must Be Reported at Next Report Level

New Unit Edits

Should Never Change

Same Experience Modification Effective Date 

Claim Number and Accident Date

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75© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Data Validation

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Unit Data Validation Tests

Quality checks after the data is loaded

Verify the completeness, validity, accuracy, and reasonability of the data

Identify patterns and data anomalies over a specified time

Check for reasonability against countrywide or state norms

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Unit Data Validation Tests

Apply to data effective 2000 and subsequent

Performed prior to the state rate filings

Responses are required within a predetermined time frame

Results and responses via Notifications in DCA Access® Online

78© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Countrywide Tests

Countrywide Tests

Identify suspect patterns across states

Impact ratemaking and experience rating

Identify aggregate data issues

Review of historical data before implementation of an edit

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State-Based Tests

Note: Similar issues may occur in numerous states.

State Tests

Identify suspect patterns within a state

Detect unusual year-to-year changes

Have shorter validation periods

80© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Validation Process

Data Provider Research

Outbound Results via DCA Access® Online

Run Validation Tests

NCCI Database

Take Appropriate Action Correction

DetailedExplanation

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Unit Validation Tests Matrix

• Details on All Validation Tests• Assists with working notifications

• Unit Statistical Validation Matrices:• All Validation Tests in production • Future Validation Test Enhancements

Part 12—Unit Statistical Reporting Guidebook

82© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Statistical Validation Test Matrix

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Unit Statistical Validation Test Matrix

84© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Statistical Validation Test Matrix

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Unit ValidationMatch Game

Questions

Identifies Data Anomalies

Countrywide and State Validation Tests

View and Respond to Validation Tests

Identifies State Reporting Patterns

Resource for Working Notifications

Answers 

Notifications via DCA Access® Online

Validation Test Matrix

Validation Tests

The Two Types of Validation Tests

State‐Based Tests

86© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Validation Tests

Validation Type Code Validation Description

C821 Suspect Exposure/Claims Distribution

E133 Duplicate Exposure for Uneven Split Periods

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Validation Tests

Validation Type Code Validation Description

L246 Claims With No Recovery

L501 Deleted Claims on Subsequent Report Level

L303 Suspect Permanent Total Claims

88© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Validation Tests

Validation Type Code Validation Description

L256 (New) Catastrophe Number Greater Than 10

L741 (New) Increased Paid Indemnity With Lump Sum and No Settlement

L742 (New)Increased Paid Indemnity With Closed Claim and No Settlement

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Suspect Exposure/Claims Distribution

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

C821

SUSPECT EXPOSURE/ CLAIMS DISTRIBUTION

CLAIM DISTRIBUTION

SUSPECT COMPARED

TO EXPOSURE

Unusually low claim counts compared to high exposure/premium or unusually high claim counts compared to low exposure/premium in a given class.

The inaccurate distribution of exposure and claims across states or within a state may result in overstated and/or understated loss costs/rates.

90© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Notifications via DCA Access® Online

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Unit Notifications via DCA Access® Online

92© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Notifications via DCA Access® Online

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Unit Notifications via DCA Access® Online

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Claim counts are high or low for policy period

Payroll increases with decrease in claim count

Payroll decreases with increase in claim count

Suspect Exposure/Claims Distribution

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Suspect Exposure/Claims Distribution—Example

StatePolicy Number

Class Code Exposure

Indemnity Claims

Medical‐Only Claims

01 WC1111 9015 575,675 22 0

01 WC1111 9061 8,975,464 1 1

01 WC1111 8810 45,964 0 1

96© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Verify Class Code (Exposure and Loss)

Confirm Exposure Amount

Submit Correction or Detailed Explanation

Suspect Exposure/Claims Distribution

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Duplicate Exposure—Uneven SplitValidation

Type Code

ValidationType

ValidationDescription

ValidationSummary

E133

SUSPECT DUPLICATES RECON-CILIATION

DUPLICATE EXPOSURE IS REPORTED IN UNEVEN EXPERIENCE MODIFICATION AND/OR RATE EFFECTIVE PERIODS

The attached grid displays exposure records on the same policy containing identical class code and payroll amount in unevenly divided experience modification and/or rate effective periods.

Please verify the exposure amounts or submit corrections to reconcile the exposure with the duration of the split experience periods by the due date.

98© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Duplicate Exposure—Uneven Split

Identifies exposure records on same policy with the same class code and payroll but 

uneven split periods

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Duplicate Exposure—Uneven Split—Example

State

Policy Eff. Date

Policy Number

Class Code Exposure Rate Premium

Mod Eff. Date

Rate Eff. Date

Split Period

02 1/1/10 WC1111 8742 825,205 1.25 10,315 1/1/10 1/1/10 0

02 1/1/10 WC1111 8742 825,205 1.25 10,315 9/1/10 9/1/10 1

100© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Duplicate Exposure—Uneven Split

Confirm Exposure Amounts

Confirm Split Dates Are Correct

Submit Correction or Detailed Explanation

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Claims With No Recovery

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L246CLAIMS WITH NO

RECOVERY

DECREASING PAID

LOSSES REPORTED

ON CLAIMS WITH NO

RECOVERY

The attached grid displays claims with a total paid amount less than the total paid amount at the prior report level in absence of a recovery.

Please verify the recovery type code and paid amounts at all applicable report levels by the due date.

102© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Claims total paid amount is less than the total paid amount at the prior report level

No Recovery Code

Claims With No Recovery

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Claims With No Recovery—Example

Rpt.#

Policy Eff. Date

Policy Number

Claim Number

Inj.Type

Paid Indemnity Paid Med

Type of Recovery

1 1/1/10 WC1111 WC1234 09 13,553 25,834 01

2 1/1/10 WC1111 WC1234 09 15,648 28,685 01

3 1/1/10 WC1111 WC1234 09 38,159 30,521 01

4 1/1/10 WC1111 WC1234 09 12,526 30,521 01

104© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Verify Paid Loss Amounts

Confirm if a Recovery Was Received

Submit Correction or Detailed Explanation

Claims With No Recovery

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105© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Match Game

Questions

Researching DistributionTest

Paid Loss Decreases With No Recovery

Alternative to Working Grid in DCA Access® Online

Confirm Split Dates

Always Do This

Answers 

Downloadable Spreadsheet

Submit Corrections or Provide Explanations

Verify Both Exposure and Claim Values

Verify Paid Amounts and if There Was a Recovery

Uneven Splits Identified With Duplicate Exposure

106© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Deleted Claims on Subsequent Reports

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L501

DELETED CLAIMS ON SUBSEQUENT REPORTS

CLAIMS HAVE BEEN DELETED IN ERROR ON SUBSEQUENT UNIT REPORTS LEVELS

The attached grid displays claims that have been deleted or reduced to zero at one or more subsequent report levels.

If claims were deleted or reduced to zero in error, please submit corrections to add the necessary claim data at all applicable report levels by the due date. If the removal of a claim is justified at a subsequent report level, submit corrections to remove the claim at prior report levels and/or add the appropriate loss condition coding.

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Deleted Claims on Subsequent Reports

Claim was deleted or had zero‐filled Loss Amounts on a subsequent report level

108© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Deleted Claims on Subsequent Reports—Example

Upt. Type

Policy Eff. Date

Policy Number

Rpt. #

Class Code

Claim Number

Inj.Type

Inc. Indem.

Inc. Med

R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258

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Deleted Claims on Subsequent Reports—Example

Upt. Type

Policy Eff. Date

Policy Number

Rpt. #

Class Code

Claim Number

Inj.Type

Inc. Indem.

Inc. Med

R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258

110© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Deleted Claims on Subsequent Reports—Example

Upt. Type

Policy Eff. Date

Policy Number

Rpt. #

Class Code

Claim Number

Inj.Type

Inc. Indem.

Inc. Med

R 1/1/10 WC1111 1 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

R 1/1/10 WC1111 2 8742 WC1234 05 1,450 1,258

P 1/1/10 WC1111 2‐1 8742 WC1234 05 1,450 1,258

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Deleted Claims on Subsequent Reports

Review claim to determine if reported in error on subsequent report

Determine appropriate corrective action

Submit Correction Report

112© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Suspect Permanent Total Claims

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L303

SUSPECTPERMANENTTOTAL CLAIMS

CLAIMS REPORTED WITH A PERMANENT TOTAL INJURY TYPE BUT HAVE SUSPECT INCURRED INDEMNITY AND/OR MEDICALAMOUNTS

The attached grid identifies claims with a Permanent Total injury type that appear inconsistent with the incurred indemnity and/or medical amount reported. 

Please verify the claim information or submit corrections to reflect the appropriate injury type and incurred amounts at all report levels by the due date.

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Permanent Total injury type inconsistent with incurred indemnity and/or medical amount

Injury usually likely to develop and require more medical expenses and lost time 

Suspect Permanent Total Claims

114© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Suspect Permanent Total Claims—Example

Policy Eff. Date

Policy Number Rpt. #

Claim Number

Inj.Type

Inc. Indem

Inc. Med Part Nature Cause

1/1/10 WC1111 1 WC1234 09 58,200 61,258 35 10 65

1/1/10 WC1111 2 WC1234 09 65,356 62,556 35 10 65

1/1/10 WC1111 3 WC1234 02 72,398 63,672 35 10 65

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Verify the Injury Type Code

Confirm the Indemnity and Medical Amounts

Submit Correction or Detailed Explanation

Suspect Permanent Total Claims

116© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Catastrophe Number Greater Than 10

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L256

CATASTROPHENUMBER GREATERTHAN 10

CLAIMS AREREPORTED WITH A CATASTROPHENUMBER  GREATERTHAN 10 AND ARENOT PART OF ANEXTRAORDINARYLOSS EVENT

The attached grid displays claims reported with a catastrophe number greater than 10, which do not appear to be extraordinary loss events. 

Please submit corrections to reflect the appropriate catastrophe coding at all report levels by the due date.

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Catastrophe Number greater than 10 but not an Extraordinary Loss Event

Catastrophe Number Greater Than 10

118© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Catastrophe Number Greater Than 10—Example

Policy Eff. Date

Policy Number

Rpt. #

Claim Number

Acc.Date

Inc. Indem

Inc. Med Cat. #

1/1/12 WC1111 1 WC1234 10/21/12 58,200 61,258 11

1/1/12 WC1111 1 WC4321 10/21/12 65,356 62,556 11

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Verify ELE Catastrophe Codes

ELE Codes and Descriptions on ncci.com

Submit Correction

Catastrophe Number Greater Than 10

120© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Increased Paid Indemnity WithLump Sum and No Settlement

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L741

LUMP SUM FLAG “Y” AND NO LOSS CONDITIONSETTLEMENTCODE (00) WITHINCREASED PAIDINDEMNITYAMOUNTS

CLAIMS REPORTEDWITH A LOSS CONDITION SETTLEMENT CODEOF 00, A LUMP SUMFLAG OF “Y,” ANDPAID INDEMNITYAMOUNTS THAT HAVE INCREASEDSIGNIFICANTLY

Claims reported with a Lump‐SumFlag of “Y” and a large increase in paid indemnity amount on a subsequent report or is reported for the first time with a large paid indemnity amount. These claims are reported with a Loss Condition Settlement Type Code of 00.

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Lump Sum Indicator = Yes

Loss Condition—Type of Settlement = 00

Significant Increase in Paid Indemnity

Increased Paid Indemnity WithLump Sum and No Settlement

122© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Increased Paid Indemnity WithLump Sum and No Settlement—

Example

Policy Eff. Date Policy Number

Rpt. #

Claim Number

Paid Indem.

Lump Sum

Loss Cond. –Settlement

1/1/10 WC1111 1 WC1234 58,200 N 00

1/1/10 WC1111 2 WC1234 165,356 Y 00

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Verify Paid Indemnity Amount

Check Lump Sum Indicator

Submit Correction or Detailed Explanation

Increased Paid Indemnity WithLump Sum and No Settlement

124© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Increased Paid Indemnity WithClosed Claim and No Settlement

Validation Type Code

ValidationType

ValidationDescription

ValidationSummary

L742

CLOSED CLAIMSINDICATE NO LOSS CONDITIONSETTLEMENTCODE (00) WITH AN INCREASE OR HIGH PAIDINDEMNITYAMOUNT

CLAIMS REPORTEDWITH A LOSS CONDITION SETTLEMENT CODEOF (00), CLOSEDCLAIM STATUS, ANDPAID INDEMNITYAMOUNTS THAT HAVE INCREASEDSIGNIFICANTLY

The attached grid displays closed claims reported with a large increase in paid indemnity amount on a subsequent report or is reported for the first time with a large paid indemnity. These claims are reported with a Loss Condition Settlement Type Code of 00.

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Claim Status = Closed

Loss Condition—Type of Settlement = 00

Significant Increase in Paid Indemnity

Increased Paid Indemnity WithClosed Claim and No Settlement

126© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Increased Paid Indemnity WithClosed Claim and No Settlement—

Example

Policy Eff. Date Policy Number

Rpt. #

Claim Number

Paid Indem.

Claim Status

Loss Cond. –Settlement

1/1/10 WC1111 1 WC1234 68,200 0 00

1/1/10 WC1111 2 WC1234 175,258 1 00

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Verify Paid Indemnity Amount

Check Claim Status

Submit Correction or Detailed Explanation

Increased Paid Indemnity WithClosed Claim and No Settlement

128© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Editing Process Recap

Data provider submits data to 

NCCI

NCCI edits applied

Submission Results report 

issued

Updated/corrected data is submitted

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Validation Process Recap

Data is subject to NCCI validation tests

Verification or correction requested 

via DCA Access® 

Online Unit Notifications

Data provider submits corrections or provides detailed 

explanation

NCCI validates response—closes notification or requests more information

130© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Unit Notifications

Losses Without Exposure

Identifies Suspect Patterns Across States

Clears Errors on NCCI’s Database

Data Grade 9

Nonextraodinary Loss Event

USRG

Hal’s Beverage Choice

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Thank You!

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Supplemental Information

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Presenter Biographies

  

Bruce Hallman, AIDM, has worked in NCCI’s Data Services Department for 18 years. He is a product support manager, subject matter expert, and the data liaison between NCCI and the independent bureaus. Bruce participates in many projects, including enhancements to Unit and Policy edits. He is actively involved in various industry groups, including the Workers Compensation Insurance Organization, Policy Advisory Task Group, and Advisory Statistical Work Group Committees.

Bruce earned the Associate Insurance Data Manager designation from the Insurance Data Management Association (IDMA). Before joining NCCI, he was employed by the Pennsylvania Compensation Rating Bureau.

Hal Dooley, AIDM, works in NCCI’s Data Quality Department as a lead analyst and unit data subject matter expert. He is involved in all aspects of unit data editing and leads unit data projects. During his 23 years at NCCI, Hal has held positions in Customer Service, Experience Rating, and Data Resources.

Hal earned the Associate Insurance Data Manager designation from the Insurance Data Management Association (IDMA). He holds a bachelor of science degree in business management from Nichols College in Massachusetts.