comparison of multiple (cross) data types...comparison of multiple (cross) data types ncci’s 2016...

Comparison of Multiple(Cross) Data Types

NCCI’S 2016 DATA EDUCATIONAL PROGRAM

January 26–29, 2016

Palm Beach County Convention CenterWest Palm Beach, FL

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© Copyright 2016 National Council on Compensation Insurance, Inc. All Rights Reserved.

Comparison of Multiple (Cross) Data Types

Presented by: Julie Gonzalez and Renee Retterath


2016 DATA EDUCATIONAL PROGRAM

Objective

Provide an understanding of the connections between data types and how data is compared for validation and usage.

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Agenda

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Data Types and Uses

Data Relationships

Data Comparison and Reconciliation

Case Study



Data Types and Uses

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Data Type Overview

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Policy

Unit Statistical

DCI

Financial Calls

Medical Data Call



Policy Data

Policy Data—Information obtained from a workers compensation and employers liability policy

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Policy Data—Information obtained from a workers compensation and employers liability policy

11111 Carrier Code

WC12345 Policy Number

3/1/2013 Policy Effective Date

AL—01State Premium Record

ABC AcmePrimary Name

741258963Primary FEIN $.80Rate

$10,000$80

ExposurePremium

8810Class Code

Medical Losses—01

Losses Subject to Deductible

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Unit Statistical Data

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Unit Statistical Data—Audited exposure, premium, and valued loss information reported for all states covered on a policy

11111 Carrier Code



AL—01Exposure State

ABC AcmePrimary Name

741258963Primary FEIN

$.80Rate

$12,500$100

ExposurePremium

8810Class Code

90744Claim #

1/1/2014Accident Date

23 (MS)Jurisdiction

State

Medical Losses—01

Type of Deductible



Detailed Claim Information

WCCDCI Records

WCIO Manual Section

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Detailed Claim Information (DCI)—Data derived from a sampling of indemnity (lost‐time) claims

11111 Carrier Code



90744Claim #


MS—23Jurisdiction

State

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Medical Call Data

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Medical Call Data—Medical bill detail associated with medical services

11111 Carrier Code



90744Claim #


MS—23Jurisdiction

State



Financial Call Data

Financial Call Data—Aggregated premiums, loss data, and expenses submitted annually

11111 Carrier Code

WC12345 Policy Number3/1/2013 Policy Effective Date

90744Claim #1/1/2014Accident Date

AL—01Exposure State

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Data Type and Uses Review

Which Data Type…

Exposure and premium are estimated

Is reported at the bill line detail

Is aggregated premiums, loss data, and expenses

Includes both exposure and jurisdiction states

Sampling of indemnity claims

Answers

Financial Calls

DCI

Policy Data

Medical Data Call

Unit StatisticalData

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Data Relationships

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Data Relationships

Policy

Unit

Policy InformationClass/Statistical CodesExposure

DCI

Policy InformationClaim InformationIndemnity and Medical Amounts

Medical

Policy InformationClaim InformationMedical Amounts

Financial

Policy InformationClaim InformationClass/Statistical CodesLoss Amounts

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Data Relationships—Expected

Unit

PolicyExpected 1st Report

Expected Subsequent

Open ClaimOpen Claim

DCI

UnitExpected 1st Report

Expected Subsequent

Open ClaimOpen Claim

Financial

Expected Financial

NAIC Data

Expected MedicalExpected Medical

Medical

NAIC Data

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Elements That Drive Expected Unit Report Control Identifies expected Unit Statistical data based

on: Policy Effective Date Policy Number Carrier Code Exposure State on State Premium Record

DCI—Death and PT claims and sampling % of unit reports

Financial Calls Expected on Data Manager Dashboard

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Data Type Comparison Overview

Data Type Valuation DueSubsequentReporting

Policy ‐‐‐‐‐Within 30 Days of Policy Effective Date

‐‐‐‐‐

Unit18 Months After

Policy Effective Date20 Months After Policy

Effective DateUp to 10 Report Levels

DCI18 Months After Reported toInsurer Date

21 Months After Reported toInsurer Date

Up to 11 Report Levels

Medical ‐‐‐‐‐By End of Quarter

Following TransactionUp to 30 Years After

Accident Date

FinancialDecember 31

By April 1 of Year Following Valuation

Up to 31 Years (Policy Calls)Up to 30 Years

(Cal‐Accident Calls)

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Claims that close between the date the unit 1st report is due and the due date of the DCI 1st valuation level

Comparative View of DCI and Unit Claims

7/1/2013 Policy Effective Date (PED)

6/30/2014 Policy ExpirationDate

1/2015 unit 1st report valued at 18 months after PED

10/2013 1/2014 4/2014 7/2014 10/2014 1/2015 4/2015 7/2015 10/2015

Open Claim Reported on Unit Is Expected for

DCI

Claim Reported to Insurer (RTI) 4/1/2014

Claim Closes

7/1/2015

Claim Occurs on

3/31/2014

10/2015 DCI 1stvaluation level valued at 18 months after RTI

DCI 1st report expected volumes are developed estimates using Unit Statistical data.

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Comparative View of Financial Call and Unit Statistical Data

7/1/2013 Policy Effective Date (PED)

6/30/2014 Policy ExpirationDate

1/2015 Unit 1st Report valued at 18 months after PED

10/2013 1/2014 4/2014 7/2014 10/2014 1/2015 4/2015 7/2015 10/2015

Open claim reported on unit

Claim Closes 7/1/2015

Financial Call Valued

as of 12/31/2014

Claim occurs on

3/31/2014

Financial Call Valued

as of 12/31/2013

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Data Connections

Data Element/ Data Category Policy Data Unit Data

Policy InformationPolicy Number, Policy Effective Date, Carrier Code,

Primary Name, FEIN

Exposure State State Premium Record Exposure Record

Class/Statistical Codes Initial Final

Exposure/Premium Estimated Audited

Rate Should Be Consistent

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Data Connections

Data Element/ Data Category Unit Data DCI Data

Policy Information Policy Number, Policy Effective Date, Carrier Code

Claim Information Jurisdiction State, Claim Number, Accident Date

Loss Amounts

Incurred and Paid Indemnity and Medical,

Part/Nature/Cause

Incurred Indemnity, Indemnity Benefit Amount by Type, Incurred and Paid

Medical, Part/Nature/Cause

Vocational Rehabilitation

Included in Incurred and Paid Indemnity

Amount by Type of Vocational Rehabilitation

Expense

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Injury Type Versus Benefit Type

Unit Report Injury Type Code Under each jurisdiction’s law corresponding to

carrier’s estimate, as of the valuation date, of the ultimate injury type of the claim

Does not have to correspond to the type of benefit being paid as of the valuation date Example: If temporary total payments have been

made on a claim with permanent partial reserves, report the claim as a permanent partial claim

DCI Benefit Type Code Type of benefits paid to the claimant as of the

valuation date

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Data Connections

Data Element/ Data Category Unit Data Medical Data

Policy Information Policy Number, Policy Effective Date, Carrier Code

Claim Information Jurisdiction State, Claim Number, Accident Date

Medical Loss Amounts Incurred and Paid MedicalPaid Medical at the Bill Line

Detail

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Data Connections

Call 3

(Policy Year)

Call 5

(Calendar/Accident Year)

Call 8 (Reconciliation

Report)

NAIC— (WC)

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Unit Statistical Data



Financial Call and Unit Statistical Data Comparisons

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Comparison to NAIC Annual StatementCall 8 Reconciliation Report

Reconciles calendar year financial data reported to NCCI with data reported on the carrier’s NAIC Annual Statement, Statutory Page 14

Financial data fields compared include: Net earned premium Paid and incurred losses Defense and Cost

Containment Expenses (DCCE) Paid

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Comparison to NAIC Annual StatementExperience excluded from the Financial Calls is reflected as reconciliation items:

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Data Connections

Unit Data

Carrier Code and Exposure

State

Carrier Code and Exposure

State

PED andAccident Date

Policy Year Call

Calendar-Accident Year

Call

Deductible (Small and

Large)

Large Deductible Call

Included or Excluded Experience

Financial Call Data

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Data Connections

Unit Data

ALAE

DCCE

Medical and Indemnity Losses

(Incurred and Paid)

Medical and Indemnity

Losses (Paid and Case Outstanding)

Loss Amount and Catastrophe

Number

Call 31 includes $500,000 or

more loss and ELE catastrophes

Indemnity Claim Counts

Financial Call Data

Class and Statistical

Codes—Premium and Rate

Earned Premium—DSR Level, Company Standard

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Mapping Examples



Consistent Fields

Data TypePolicy Number

Policy Effective Date

Carrier Code

ClaimNumber

Accident Date

Policy

Unit

DCI

Medical

Financial

IMPORTANT: Report each of these fields the same for the life of the policy.

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Examples of Mapping Reconciliation

Classification Code

Carrier

Assigns applicable class code on policy

Assigns applicable class code on loss

Reconciliation from classification assigned on claim to match classification with exposure on unit

Classification Code reported on unit to NCCI

Claims

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Classification/Statistical Codes

Coal Mining Classification Codes

Black Lung Disease Statistical Codes

Supplemental Disease Statistical Codes (Occupational Disease)

F-Classification Codes

Maritime and FELA Classification Codes

Statistical Codes—Net, Company Standard, DSR

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Financial Call Data Unit Statistical Data

Excludes Experience from Calls 3/5 Includes Experience

Large Deductible policies Large Deductible policies

USL&HW, FELA USL&HW, FELA

Underground Coal Mine Underground Coal Mine

Stat Codes—effects of stat code data inpremium calculations vary

Report all applicable stat codes

Not all premium components will have astat code, but may need to be reported

Not all premium components will have astat code

Retrospective Adjustments—report in Net premium only

Repatriation—report in Net premium only

No stat code for Retrospective Adjustments

No stat code for Repatriation

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Examples of Reporting Differences

Not a comprehensive list of Financial Call experience/data inclusions/exclusions. Please refer to the Financial Call Reporting Guidebook for more details.



Examples of Mapping Reconciliation

Incurred Loss

Carrier Claims

Sets reserves Makes a payment

Reconciliation creates Incurred Loss (Paid + Reserve)

Incurred Loss reported on unit to NCCI

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WCIO Data Mapping Example

Carrier Source System

Open

Closed

Reopened—Open

Reopened—Closed

DCI

Open

Closed

Became Medical Only

Unit

Open

Closed

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Reopened



Data Standards—Claim Number ExampleUnmatched Link/Key Data

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Medical Bill Reviewers

Insurer

Pharmacy

ClaimAdministrators Dental

Hospital

Claim # = 031 123456

Claim # = WC12345

Claim # = 12345XYZ

Claim # = 23456XYZ

Claim # = MAL456

NCCI‐ReportedData

Claim # =? TPA Data

Warehouse

Claim # = 123456

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Data Standards—Claim Number ExampleCorrect Link/Key Data

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Medical Bill Reviewers

Insurer

Pharmacy

ClaimAdministrators Dental

Hospital

Claim # = WC12345

Claim # = WC12345

Claim # = WC12345 Claim # =

WC12345

Claim # = WC12345

Claim # = WC12345

NCCI‐ReportedData

Claim # =WC12345 TPA Data

Warehouse



Data Relationships Review

Policy Effective Date is reported consistently across all data types except DCI

Valuation and due dates are the same for all data types

Exposure is reported as estimated for Policy and audited for Unit Statistical

Allocated Loss Adjustment Expense (ALAE) reported in Unit Statistical data correlates to the Defense and Cost Containment Expense (DCCE) reported in the Financial Calls

True or False?

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Thank You

Supplemental Information

Presenter Biographies

Julie Gonzalez, AIDM, has been employed at NCCI since 1992. As a data consultant and project manager in the Data Services Department, her main responsibilities include managing NCCI’s Data Educational Program, overseeing major compliance projects, developing new data reporting requirements, and enhancing NCCI’s external training programs and data tools. In addition, Julie actively participates on industry committees and association forums to forge industry relationships and provide subject matter expertise.

Prior to joining Data Services, Julie was a senior underwriting analyst, responsible for filing workers compensation rules and programs, and managing the appeals board mechanism for several NCCI states.

Julie has earned both her Associate in Commercial Underwriting (AU) and Associate Insurance Data Manager (AIDM) designations.

Renee Retterath has worked at NCCI for 13 years and is a senior data consultant in the Data Quality and Compliance Department. She is responsible for the development, implementation, and monitoring of the various quality assurance programs for the collection and validation of customer data.

Renee has a master of science degree in school psychology from the University of Wisconsin- Stout.

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