florida division of workers’ compensation claims edi requirements table training 2013

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Florida Division of Workers’ Florida Division of Workers’ Compensation Compensation

Claims EDI Claims EDI Requirements Requirements Table Table Training 2013Training 2013

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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

FL FL Trading Trading

Partner Partner TablesTables

Requirements and Requirements and Resource Resource

documentsdocuments

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FL EDI Reporting FL EDI Reporting requirements are defined in requirements are defined in the Trading Partner the Trading Partner Tables:Tables:

EditMatrix

Element

TableRequirement

EventTable

1.1.RequiredRequired

Report(sReport(s))

2.2.Data Data needed on needed on the the Report(s)Report(s)

3.3.ApplieAppliedd

EditinEditingg

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The tables are part of the The tables are part of the rule and Trading Partners rule and Trading Partners are responsible for the are responsible for the requirements in those requirements in those tables.tables.

Event Table:Event Table: When each When each transaction is due. transaction is due.

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Element Requirement Table:Element Requirement Table:

Data Elements required Data Elements required for for each transaction each transaction (MTC), and (MTC), and under what under what conditions the data conditions the data elements are required. elements are required.

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Edit Matrix:Edit Matrix:

Edits that are applied to Edits that are applied to the incoming the incoming transactions and will transactions and will reject the record or reject the record or require follow up with an require follow up with an EDI Team Member. EDI Team Member. This table This table includes population includes population restrictions edits, restrictions edits, sequencing, duplicate sequencing, duplicate processing and money processing and money calculations. calculations.

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These very important These very important requirements requirements documents can be documents can be found on the Claims EDI found on the Claims EDI webpage, and webpage, and are your are your resourceresource for determining for determining when a transaction when a transaction should be filed and should be filed and why why it may have erroredit may have errored..

ImportaImporta

nt!nt!

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http://www.myfloridacfo.com/wc/edi_clms.html

These are These are the the RequiremRequirement ent TablesTables

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Bookmark the FL Bookmark the FL Claims EDI Claims EDI Webpage and Webpage and Check It For New Check It For New or Updated or Updated Information Information http://www.myfloridacfo.com/wc/edi_clhttp://www.myfloridacfo.com/wc/edi_clms.htmlms.html

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What is an What is an Event?Event?

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An Event is a business An Event is a business circumstance that occurs in circumstance that occurs in the life of a WC Claim which the life of a WC Claim which requires the reporting of EDI requires the reporting of EDI information to DWC. These information to DWC. These circumstances reflect FL’s circumstances reflect FL’s requirements, including:requirements, including:

First Report of Injury First Report of Injury eventseventsSubsequent Report eventsSubsequent Report eventsPeriodic eventsPeriodic events

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2. Initial 2. Initial PaymentPayment or or EquivalentEquivalent

witwithh

11. Changes11. Changes(Non-(Non-Indemnity)Indemnity)

9. 9. Lump Lump Sum Sum Payment(Payment(s)s)

1. Establish 1. Establish ClaimClaim

4. 4. Suspension Suspension of all of all BenefitsBenefits

3. Changes to 3. Changes to Benefits/AmBenefits/Amntsnts

Benefits

Claim Event FlowClaim Event Flow in FL

Claim Business Claim Business EventsEvents

10.10.Periodic Periodic ReportsReports

12.12.CancelCancel

8. Claim 8. Claim ClosureClosure

Anytime after First Report and before

Final Report

FL identifies all of the FL identifies all of the transactions (MTC’s) transactions (MTC’s) that are required for that are required for reporting business reporting business events on theevents on the Event TableEvent Table

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http://www.myfloridacfo.com/wc/edi_clms.html

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Due to the national Due to the national standard format and standard format and sequencing sequencing requirements, FL requirements, FL requires the reporting requires the reporting of more business of more business events (MTC’s) than events (MTC’s) than were required via were required via paper forms.paper forms.

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Florida’s Event Table Florida’s Event Table describes what and when describes what and when each MTC is due based on each MTC is due based on claim events.claim events.

Event TableEvent TableEventTable

FL Event Table ExampleFL Event Table Example

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In addition to reporting In addition to reporting “typical” business claim “typical” business claim EventsEvents, , FL requires the FL requires the claim administrator to claim administrator to report the “cost status” of report the “cost status” of the claim via the claim via

Periodic (Claim Cost) Periodic (Claim Cost) Reports.Reports.

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Event TableEvent TableEventTable

FLFL PeriodicPeriodic ReportsReports

FN FinalFN Final – Submitted – Submitted when Claim when Claim Administrator Administrator determines no further determines no further benefits will be paid.benefits will be paid.

SA Sub-Annual – SA Sub-Annual – Submitted every 6 Submitted every 6 months after the DOI, months after the DOI, as defined on FL’s as defined on FL’s Event Table. Event Table.

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In addition to the Event In addition to the Event Table, FL describes its Table, FL describes its business events in the business events in the ‘MTC Filing Instructions’. ‘MTC Filing Instructions’. This document is a This document is a quick reference tool quick reference tool displaying what MTC’s to displaying what MTC’s to use in reporting required use in reporting required business events to FL.business events to FL.

EventTable

Event TableEvent Table

MTC FilingInstructions

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Helpful ResourcesHelpful Resources

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FL MTC Filing FL MTC Filing InstructionsInstructions

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FL Trading Partner FL Trading Partner TablesTables

Element

TableRequirement

Data needed Data needed on the on the

Report(s)Report(s)

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Element Element RequirementsRequirementsThe FL The FL Element Element Requirement TableRequirement Table describes the data elements describes the data elements required for each electronic required for each electronic event (MTC) documented on event (MTC) documented on the Event Table.the Event Table.

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Element Element RequirementsRequirements Element

Table

Requirement

Data Element Data Element requirements are defined requirements are defined for each transaction for each transaction (FROI or SROI) at the (FROI or SROI) at the Maintenance Type Code Maintenance Type Code (MTC) level.(MTC) level.

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Table

Requirement

Requirement Codes Requirement Codes express express FL’s requirement severity by FL’s requirement severity by data element and report type data element and report type (FROI or SROI). (FROI or SROI).

The following slides define The following slides define FL’s requirement codes.FL’s requirement codes.

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Table

Requirement

The Element Requirement Table The Element Requirement Table contains contains 6 worksheets:6 worksheets: FROI Element RequirementsFROI Element Requirements FROI Conditions (for MC’s)FROI Conditions (for MC’s) SROI Element RequirementsSROI Element Requirements SROI Conditions (for MC’s)SROI Conditions (for MC’s) Benefit Segment RequirementsBenefit Segment Requirements

Benefit ConditionsBenefit Conditions (for MC’s)(for MC’s)

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Table

Requirement

Fatal.Fatal. The data element The data element is essential to process is essential to process the the transmission/transaction.transmission/transaction.

F F ==

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Table

Requirement

Exclude.Exclude. The data element is The data element is not applicable to the not applicable to the standard standard requirements for requirements for the MTC and may or may not the MTC and may or may not be sent.be sent.

X =X =

Edits will NOT be Edits will NOT be applied, nor applied, nor will the will the

data be loaded for FL.data be loaded for FL.

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Table

Requirement

Mandatory.Mandatory. The data The data element must be element must be present and must pass present and must pass all edits (documented all edits (documented in the Edit Matrix) or in the Edit Matrix) or the transaction will be the transaction will be rejected.rejected.

M =M =

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Table

Requirement

Mandatory/Conditional.Mandatory/Conditional. The data The data element becomes mandatory element becomes mandatory under conditions documented on under conditions documented on the applicable “Conditional the applicable “Conditional Requirements” worksheets.Requirements” worksheets.

MC =MC =

If the defined condition exists, the If the defined condition exists, the data element becomes mandatory data element becomes mandatory and mandatory rules apply.and mandatory rules apply.

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Table

Requirement

Data Elements defined as Data Elements defined as M or MC (and the condition M or MC (and the condition applies) are required fields. applies) are required fields. If they are not present on If they are not present on the transaction, the the transaction, the transaction will receive a transaction will receive a Mandatory Field Not Mandatory Field Not Present error (Error # 001).Present error (Error # 001).

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Table

Requirement

If Applicable/Available.If Applicable/Available. Data should be sent if Data should be sent if available or applicable to available or applicable to the claim.the claim.

IA =IA =

If present, data will be edited If present, data will be edited for valid value and/or format. for valid value and/or format. If the data passes the edits, If the data passes the edits, the data will be loaded. If the the data will be loaded. If the data does not pass the edit, data does not pass the edit, the data will not be loaded, the data will not be loaded, and no error will be returned and no error will be returned by FL.by FL.

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Table

Requirement

Not Applicable.Not Applicable. The data The data element is not applicable to element is not applicable to FL’s requirements for the MTC, FL’s requirements for the MTC, and may or may not be sent. FL and may or may not be sent. FL will not be editing or loading will not be editing or loading these data elements for this these data elements for this MTC.MTC.

NA =NA =

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Table

Requirement

For DN’s that are on both the For DN’s that are on both the FROI and SROI, FL has identified FROI and SROI, FL has identified which transaction (FROI Or SROI, which transaction (FROI Or SROI, or Both) from which it will or Both) from which it will edit/load data, and from which edit/load data, and from which the data will be ignored (N/A). the data will be ignored (N/A).

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Table

Requirement

Interpreting Requirement Tables

FL’s Claim Number is not FL’s Claim Number is not required on a FROI 00, 04, required on a FROI 00, 04, AQ or AU, but is Mandatory AQ or AU, but is Mandatory on a FROI 01 or 02.on a FROI 01 or 02.

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Table

Requirement

FL Conditional Requirements FL Conditional Requirements TableTable Conditional Conditional

Requirement CodeRequirement Code Data Element Number and NameData Element Number and Name Business ConditionsBusiness Conditions

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Table

Requirement

Additional requirement Additional requirement codes were developed for codes were developed for the MTC the MTC 02 (Change)02 (Change) transaction. transaction.

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Table

Requirement

A A BenefitsBenefits segment is segment is expected when indemnity expected when indemnity benefits have been paid on benefits have been paid on the claim, for each the claim, for each applicable Benefit Type applicable Benefit Type Code value indicated in Code value indicated in the Edit Matrix.the Edit Matrix.Only one Only one BenefitsBenefits segment segment can be sent for each can be sent for each Benefit Type Code.Benefit Type Code.

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Table

Requirement

“ “Event” Benefits Event” Benefits Requirements are described on the Requirements are described on the Event Benefits SegmentEvent Benefits Segment Requirement Table.Requirement Table.

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Table

Requirement

Restricted. The data Restricted. The data element value will not element value will not be accepted by FL.be accepted by FL.

R =R =

For example, FL does not For example, FL does not accept Benefit Type Code accept Benefit Type Code 090 (PI) (Permanent 090 (PI) (Permanent Partial Disfigurement) for Partial Disfigurement) for DOI’s < 08/01/79 or > DOI’s < 08/01/79 or > 12/31/9312/31/93

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Table

Requirement

Restricted Benefit Types for Restricted Benefit Types for FLFL

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Table

Requirement

DN’s in the DN’s in the BenefitsBenefits segment segment are required based on the MTC as are required based on the MTC as well as the Benefit Type Code being well as the Benefit Type Code being paid.paid.

Net Weekly Net Weekly AmountAmount

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Table

Requirement

Data defined as N/A on the Data defined as N/A on the Element Requirement Table, or Element Requirement Table, or was not required by the was not required by the “Condition” will not be edited, “Condition” will not be edited, processed or loaded to DWC’s processed or loaded to DWC’s system if sent for that MTC. system if sent for that MTC.

This is commonly This is commonly misunderstood.misunderstood.

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Table

Requirement

Example: Gross/Net Amounts Example: Gross/Net Amounts are not required for MTC SA or are not required for MTC SA or FN. If these data elements are FN. If these data elements are sent incorrectly, they will sent incorrectly, they will NOTNOT be errored.be errored.However, if Gross/Net However, if Gross/Net Amounts are sent wrong on Amounts are sent wrong on the next Event where they the next Event where they AREARE required (CA, CB, etc.) they required (CA, CB, etc.) they WILL be errored. WILL be errored.

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Table

Requirement

Although the same data Although the same data element may be on both the element may be on both the FROI and SROI, the Element FROI and SROI, the Element Requirement Table will depict Requirement Table will depict on which transaction the data on which transaction the data is required. The other is required. The other transaction will list the transaction will list the requirement as N/A, which requirement as N/A, which means it will not be edited, means it will not be edited, processed or loaded to DWC’s processed or loaded to DWC’s system if sent for that MTC. system if sent for that MTC.

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Table

Requirement

Example: Claim Type is not Example: Claim Type is not looked at on the FROI 00, but looked at on the FROI 00, but is required on the is required on the corresponding SROI IP. If it is corresponding SROI IP. If it is only sent on the FROI and not only sent on the FROI and not the SROI, they will both reject.the SROI, they will both reject.

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FL Trading Partner FL Trading Partner TablesTables

EditMatrix

ApplieAppliedd

EditinEditingg

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Edit MatrixEdit MatrixEditMatrix

The Edit The Edit Matrix details Matrix details the edits the edits applied by FL.applied by FL.

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If a Transaction If a Transaction successfully successfully passespasses

all edits, what all edits, what Application Application

Acknowledgement Acknowledgement Code is sent?Code is sent?

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““TA”TA” Transaction Transaction

AcceptedAccepted

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If a Transaction If a Transaction failsfails an edit, what an edit, what Application Application

Acknowledgement Acknowledgement Code is sent?Code is sent?

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““TR”TR” Transaction Transaction

RejectedRejected

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Edit MatrixEdit Matrix

1. 1. DN-Error Message DN-Error Message TableTable

EditMatrix

2. 2. Value TableValue Table

3. 3. Match Data TableMatch Data Table4. Sequencing TableSequencing Table

The FL Edit Matrix consists The FL Edit Matrix consists of of 8 8 worksheets:worksheets:

5. 5. Duplicate Processing Duplicate Processing ((Proprietary)Proprietary)

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EditMatrix

7. 7. FL Min_Max Table (FL Min_Max Table (Proprietary)Proprietary)

8. 8. FL Calculation Table FL Calculation Table (Proprietary)(Proprietary)

Three proprietary Three proprietary worksheets worksheets (5., 7., and 8.) were added (5., 7., and 8.) were added by FL by FL to express additional to express additional editing.editing.


6. 6. Population RestrictionsPopulation Restrictions

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The 1The 1stst Tab Tab

FL DN-Error FL DN-Error Message Message

Table Table (“L” Table)(“L” Table)

EditMatrix

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EditMatrix

FL DN-Error Message FL DN-Error Message TableTableContains “standard” Contains “standard”

logical edits developed logical edits developed for Release 3.for Release 3. Assists the claim Assists the claim administrator in administrator in determining what determining what caused a specific error. caused a specific error.

(FL refers to this as the (FL refers to this as the “L” “L” Table.)Table.)


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FL Value FL Value TableTable

EditMatrix

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EditMatrix

FL FL Value Value TableTable

Conveys the code Conveys the code values that are values that are expected to be expected to be reported to FL and reported to FL and code values that may code values that may be suppressed.be suppressed.


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The The FL FL “Quick”“Quick” Code Code ReferenceReference Guide assists Guide assists in in interpreting interpreting FL’s FL’s Value Value TableTable in thein the

Edit Matrix.Edit Matrix.

EditMatrix

EditMatrix

FL Value TableEdit MatrixEdit Matrix

FL Quick Code

Reference(FL DWC Website)

64

EditMatrix

The Value Table is The Value Table is separated into two sections:separated into two sections:Section 1:Section 1:

If a Data Element If a Data Element is is collectedcollected by FL but a by FL but a certain code value is certain code value is grayed outgrayed out (i.e., Not (i.e., Not Statutorily Valid in FL), Statutorily Valid in FL), the filing will be the filing will be rejectedrejected if that value is sent.if that value is sent.

FL Value TableFL Value TableEdit MatrixEdit Matrix

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EditMatrix

FL Value Table – FL Value Table – Section 1Section 1Reflects the FROI and SROI Reflects the FROI and SROI

Maintenance Type Codes (MTC’s) Maintenance Type Codes (MTC’s) FL will accept.FL will accept.


66

EditMatrix

FL Value Table – FL Value Table – Section 1Section 1FL does not accept FROI FL does not accept FROI

MTC CO or UI, or SROI MTC MTC CO or UI, or SROI MTC CO or RE.CO or RE.


67

EditMatrix

Section 1Section 1 (cont’d): (cont’d):

If a Data Element is If a Data Element is notnot collectedcollected by FL (reflected as by FL (reflected as “N” in “Capture?” column) “N” in “Capture?” column) and code values are and code values are grayedgrayed outout,, a filing will a filing will NOTNOT be be rejectedrejected if sent with those if sent with those values.values.


68

EditMatrix

FL Value Table – FL Value Table – Section 1Section 1Ex: FL does not require or Ex: FL does not require or

process Initial Treatment process Initial Treatment Codes.Codes.


69

EditMatrix

Section 2:Section 2:

If a Data Element is If a Data Element is statutorily valid in FL (e.g., statutorily valid in FL (e.g., physician payments), but physician payments), but not required to be reportednot required to be reported,, the corresponding code the corresponding code value(s) is value(s) is grayed outgrayed out on on the table, and the filing will the table, and the filing will NOTNOT be be rejectedrejected if sent if sent with that value.with that value.


70

EditMatrix

FL Value Table – FL Value Table – Section 2Section 2Section 2:Section 2: FL will FL will NOTNOT

process theprocess thegrayed out values; however, grayed out values; however, they ARE statutorily valid they ARE statutorily valid (e.g. atty fees).(e.g. atty fees).


71

EditMatrix

FL Value Table – FL Value Table – Section 2Section 2Ex:Ex: 330330 (Total Employer’s Legal (Total Employer’s Legal

Expenses)Expenses) Ex:Ex: 340340 (Total Claimant’s Legal (Total Claimant’s Legal Expenses)Expenses)

Clm Admins may suppress these values.Clm Admins may suppress these values.


EditMatrix

FL MatchFL MatchDataDataTableTable

74

EditMatrix

FL Match Data FL Match Data TableTableDescribes the data Describes the data

elements that will be elements that will be used by FL to used by FL to determine if the determine if the transaction will create transaction will create a new claim, or be a new claim, or be associated with an associated with an existing claim in DWC’s existing claim in DWC’s database.database.


75

EditMatrix

FL Match Data FL Match Data TableTableIf you receive Error # If you receive Error # 117, “Match Data Value 117, “Match Data Value Not Consistent With Not Consistent With Value Previously Value Previously Reported,” Reported,” checkcheck this this tabletable to see which data to see which data elements are being used elements are being used as match data.as match data.


76

EditMatrix

FL Match Data FL Match Data TableTableMatch criteria will also Match criteria will also be applied between FROI be applied between FROI and SROI combo filings. and SROI combo filings. If any of the match data If any of the match data is different between the is different between the FROI and SROI, they will FROI and SROI, they will not be paired together not be paired together for processing.for processing.


77

EditMatrix

FL Match Data FL Match Data TableTableAt present, the letter At present, the letter case type must match case type must match between the FROI and between the FROI and SROI, e.g., can’t send all SROI, e.g., can’t send all caps (JOHN SMITH) on caps (JOHN SMITH) on FROI and mixed case on FROI and mixed case on SROI (John Smith). SROI (John Smith).


78

EditMatrix

FL Match Data FL Match Data TableTableFL no longer requires a FL no longer requires a match on Middle match on Middle Name/Initial. If Middle Name/Initial. If Middle Name is on DWC record, Name is on DWC record, but not sent on EDI but not sent on EDI filing, we no longer filing, we no longer reject for no match on reject for no match on this field…this field…


79

EditMatrix

FL Match Data FL Match Data TableTable……However, you will However, you will receive a TA-FL error. If receive a TA-FL error. If you receive a TA-FL and you receive a TA-FL and have a question have a question concerning the “error”, concerning the “error”, you should contact the you should contact the EDI Team @ EDI Team @ [email protected]


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EditMatrix

FL Match Data FL Match Data TableTableDWC has added a DWC has added a column to the Match column to the Match Data table to identify Data table to identify how we are matching a how we are matching a FROI with a FROI with a corresponding SROI’s.corresponding SROI’s.


81

Standard Standard Match Data Match Data Rules are Rules are described in described in Section 4 of Section 4 of the IAIABC R3 the IAIABC R3 ImplementatioImplementation Guide. n Guide.

Match Data RulesMatch Data Rules

EditMatrix

FL FL SequencinSequencin

g Tableg Table

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FL Sequencing TableFL Sequencing Table

The The FL Sequencing FL Sequencing TableTable elaborates on elaborates on standard error standard error messages related to messages related to transaction transaction “sequencing” (“sequencing” (error error # 0002-063# 0002-063).).

85

Standard Standard minimum minimum Transaction Transaction Sequencing Sequencing limitations are limitations are described in described in Section 4 of Section 4 of the IAIABC R3 the IAIABC R3 ImplementatioImplementation Guide. n Guide.

Transaction SequencingTransaction Sequencing

86

TransactionTransaction SequencingSequencing

Understanding Understanding Transaction Transaction SequencingSequencing in in Section 4 of the Section 4 of the IAIABC R3 Imp. IAIABC R3 Imp. Guide is Guide is necessary for necessary for understanding understanding the the FLFL SequencingSequencing TableTable..

EditMatrix

TransactionSequencing

Section 4

87



The The FL Sequencing Table FL Sequencing Table illustrates the sequence in illustrates the sequence in which business events which business events (MTC) typically occur (MTC) typically occur during the life of a claim during the life of a claim and what MTC must have and what MTC must have precededpreceded the subsequent the subsequent MTC. MTC.

88

2. Initial 2. Initial PaymentPayment or or EquivalentEquivalent

witwithh

11. Changes11. Changes(Non-(Non-Indemnity)Indemnity)

9. 9. Lump Lump Sum Sum Payment(Payment(s)s)

1. Establish 1. Establish ClaimClaim

4. 4. Suspension Suspension of all of all BenefitsBenefits

3. Changes to 3. Changes to Benefits/AmBenefits/Amntsnts

Benefits

Claim Event FlowClaim Event Flow in FL

Transaction Transaction SequencingSequencing

10.10.Periodic Periodic ReportsReports

12.12.CancelCancel

8. Claim 8. Claim ClosureClosure

Anytime after First Report and before

Final Report

89


FL Sequencing FL Sequencing TableTable

Now lets try to interpret Now lets try to interpret Edit Matrix Edit Matrix Sequencing Sequencing editsedits.

90



FL accepts FROI 00 (with FL accepts FROI 00 (with SROI) or FROI 04 to establish SROI) or FROI 04 to establish a claim.a claim.No FROI sequencing edits are No FROI sequencing edits are appliedapplied

91

Shows the sequencing edits Shows the sequencing edits that will be applied for an that will be applied for an IPIP



or initial payment equivalent or initial payment equivalent MTC.MTC.

92

Element Error Text (DN0291) is Element Error Text (DN0291) is the FL error message text sent the FL error message text sent on the AKC which clarifies the on the AKC which clarifies the Error Message Code - Error Message Code - 063 063 “Invalid Event Sequence”.“Invalid Event Sequence”.



93

If you do not understand what is If you do not understand what is meant by the 50 byte error text, meant by the 50 byte error text, you should look it up for more you should look it up for more explanation.explanation.



EditMatrix

FL FL Duplicate Duplicate

Processing Processing

96


FL Duplicate ProcessingFL Duplicate Processing

97


FL Duplicate ProcessingFL Duplicate ProcessingIn addition to duplicate In addition to duplicate errors (#057), there are errors (#057), there are sequencing (#063) and sequencing (#063) and matching errors (#117) in matching errors (#117) in this table.this table.

98


FL Duplicate ProcessingFL Duplicate Processing

Although we do not Although we do not accept an 00/IP after a accept an 00/IP after a previous 00/IP, we WILL previous 00/IP, we WILL accept a 00/IP after a accept a 00/IP after a paper DWC-1; however, paper DWC-1; however, we will process this as an we will process this as an “00/IP SROI ONLY” and “00/IP SROI ONLY” and not as a First Report on not as a First Report on your Report your Report Card/Statistics.Card/Statistics.

EditMatrix

FL FL PopulatiPopulati

on on RestrictiRestricti

onsons

100


FL Population RestrictionsFL Population Restrictions

All FL data All FL data element edits are element edits are documented in documented in this worksheet.this worksheet.

102

EachEach Population Restriction Population Restriction contains: contains:


The DN # and Name;The DN # and Name;

Population RestrictionsPopulation Restrictions

103

EditMatrix


The Error # and Error The Error # and Error IAIABC IAIABC Message description;Message description;


104


The specific text The specific text describing the edit; anddescribing the edit; and


If you do not understand the 50 byte If you do not understand the 50 byte error message you received, this is the error message you received, this is the column that explains how the edit was column that explains how the edit was applied.applied.

105


The FL-specific text The FL-specific text clarifying the IAIABC Error clarifying the IAIABC Error Message Text.Message Text.


EditMatrix

FLFL Min_Max Min_Max Table Table

(Proprietar(Proprietary)y)

108

FLFL Min_Max Table Min_Max Table (Proprietary)(Proprietary)

EditMatrix Edit MatrixEdit Matrix

EditMatrix

FLFL Calculation Calculation

Table Table (Proprietary(Proprietary

))

111

FLFL Calculation Table Calculation Table (Proprietary) (Proprietary)


112



This table will be used This table will be used to validate the “to validate the “Gross Gross Weekly Amount”Weekly Amount” (based (based on the Wage sent)on the Wage sent) and and the “the “Benefit Type Benefit Type Amount Paid”Amount Paid” expected expected from the Claim from the Claim Administrator (Administrator (based on based on the weeks/days sent.)the weeks/days sent.)

113



FL bases all financial FL bases all financial calculations on the calculations on the Average Average WageWage sent. This includes sent. This includes calculations of Calculated calculations of Calculated Weekly Comp Amount, Gross Weekly Comp Amount, Gross Weekly Amount, Net Weekly Weekly Amount, Net Weekly Amount and Benefit Type Amount and Benefit Type Amount Paid. Amount Paid.

114



For Example: If the Comp Rate For Example: If the Comp Rate sent is correct for the claim, sent is correct for the claim, but the Average Wage is but the Average Wage is incorrect for the claim, the incorrect for the claim, the transaction will reject (TR), due transaction will reject (TR), due to the fact that the Comp Rate to the fact that the Comp Rate will not equal 66 2/3% of the will not equal 66 2/3% of the Average Wage sent.Average Wage sent.

115



Although you may have paid Although you may have paid benefits at a Gross/Net Weekly benefits at a Gross/Net Weekly rate that is rate that is more or less thanmore or less than 66 66 2/3’s of the AWW, the Weekly 2/3’s of the AWW, the Weekly Compensation Amount, a/k/a Compensation Amount, a/k/a Comp Rate Comp Rate must always equal must always equal 66 2/3’s of the Wage (within 5 66 2/3’s of the Wage (within 5 cents). This ensures the cents). This ensures the validation of Average Wage validation of Average Wage since this DN is used to check since this DN is used to check indemnity payments.indemnity payments.

116



We see a lot of errors We see a lot of errors generated for:generated for:

““Net < FL Calc Gross Amt Net < FL Calc Gross Amt minus Adj/Credit Amts”. minus Adj/Credit Amts”. This typically results when This typically results when the Net (weekly payment the Net (weekly payment rate for the BTC ) is not rate for the BTC ) is not accurate for the Average accurate for the Average Wage sent Wage sent (not because of a (not because of a subtraction error w/offsets.)subtraction error w/offsets.)

117

How do you know which How do you know which Table/Tab to look at to Table/Tab to look at to research an error?...research an error?...

Error 001 – Element Requirement Error 001 – Element Requirement Table Table (including (including Conditions Tab) Error 057 – Edit Conditions Tab) Error 057 – Edit Matrix: Pop Rest and Matrix: Pop Rest and Duplicate Tab Duplicate Tab Error 063 – Edit Matrix: Pop Rest, Error 063 – Edit Matrix: Pop Rest,

Sequencing and Sequencing and Duplicate Tab Error 117 - Edit Duplicate Tab Error 117 - Edit Matrix: Pop Rest and Match Matrix: Pop Rest and Match

Data Tab Data Tab All Other Error #’s: Pop All Other Error #’s: Pop Restrictions TabRestrictions Tab

118

ALL QuestionsALL Questions, either Business , either Business or Technical, should be sent via or Technical, should be sent via

email to email to [email protected]

This email address is copied to This email address is copied to all members of the EDI team. It all members of the EDI team. It

is the quickest and most is the quickest and most efficient way for us to respond efficient way for us to respond

to your concerns. to your concerns.

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Questions?

florida division of workers’ compensation claims edi requirements table training 2013

Documents

fls event table

floridas event table

fl edi reporting requirements

reporting business events

electronic event mtc

fl claims edi webpage

typical business claim

final report fl