WCIS e.News
#5    August 9, 2000

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Occasional announcements and technical updates regarding
California's Workers' Compensation Information System (WCIS),
from the California Division of Workers' Compensation
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Planned Amendments to WCIS Regulations

The California Division of Workers’ Compensation (DWC) is considering a number of possible amendments to its existing WCIS regulations, California Code of Regulations sections 9700-9704. These planned amendments were presented and discussed at the most recent meeting of the WCIS Advisory Committee on May 2, 2000. Although the drafting of proposed amendments is far from complete, the following summary is provided as a courtesy to our trading partners.

Please be advised that DWC is providing this summary of planned WCIS amendments in order to keep our Trading Partners well informed of possible technical changes to the WCIS system. This summary is not, and should not be construed as, a substitute for the extensive procedures set forth in the Administrative Procedures Act (APA) that are required for DWC or other state agencies to adopt or amend regulations. All Trading Partners will receive a "Notice of Proposed Rulemaking" when DWC initiates the formal APA procedures, and will have an opportunity to file formal comments on the proposed amendments. The final regulations may differ from the initial proposal, in response to public comment.

DWC's working outline for proposed amendments includes the following:

Penalties for Non-Compliance

No amendment is planned at this time. The need for a formal penalty structure will be re-evaluated after all variances have expired and overall compliance has been monitored for several months.

Delay Mandatory Transition to Release 2 Reporting

Delay until July 1, 2001 any required use of IAIABC Release 2 data formats, by changing the footnoting in subsection 9702(b) and (d) to indicate that the Release 2 only data elements are optional until July 1, 2001.

Re-Introduce Medical Data Elements

Re-introduce Medical Bill/Payment Report requirements as in the proposed regulations dated May 1999. Require reporting for all claims, instead of the sample defined in the May 1999 proposal. Require reporting for claims with date of injury on or after October 1, 2001. Require reporting within 10 days of payment or denial of each medical bill. For denied bills, require only bill-level data — not line-item data — until such time as payments are made. Require separate reporting of lien payments. Add several data elements to those proposed in May 1999, including Bill Submission Reason Code (DN508), Bill Adjustment Group Code (DN543), Bill Adjustment Reason Code (DN544), Service Adjustment Group Code (DN731), Service Adjustment Reason Code (DN732), HCPCS Line Procedure Billed Code (DN714), Jurisdiction Procedure Billed Code (DN715), Total Charge Per Bill (DN501), Total Charge Per Line (DN552), Date Insurer Received Bill (DN511), Date Insurer Paid Bill (DN512), and Unique Bill ID Number (DN500).

Reporting of ICD-9 CM Diagnosis Code

Require submission of Diagnosis Code only when other medical data is submitted. (This will involve no change in paper filing of Doctor's First Reports of Occupational Injury or Illness. DWC will work with the Division of Labor Statistics and Research to eliminate paper filing of Doctor's First Reports of Injury, only for those claims on which the First Report of Injury and the Diagnosis Code are submitted electronically within 5 days after the Doctor's First Report is received by the claims administrator.)

Eliminate Reporting of Some Current Data Elements

Eliminate required reporting of the following data elements:

Initial Date Last Day Worked (DN65)
Benefit Adjustment Code (DN92)
Benefit Adjustment Weekly Amount (DN93)
Benefit Adjustment Start Date (DN94)
Benefit Adjustment Through Date (DN125)
Benefit Credit Code (DN126)
Benefit Credit Start Date (DN127)
Benefit Credit End Date (DN128)
Benefit Credit Weekly Amount (DN129)
Current Date Last Day Worked (DN145)

Introduce Additional First and Subsequent Report Data Elements

Require reporting of Benefit Type Claim Weeks (DN90), Benefit Type Claim Days (DN91), and Non-Consecutive Period Indicator (DN212). Require reporting of Net Weekly Amount (DN87) only for claims administrators who remain in Release 1 beyond January 1, 2001.

Eliminate Duplicative Reporting

Eliminate "Annual Report of Inventory" requirements beginning January 2002, for organizations that submit complete, valid, accurate data to WCIS for the applicable period.

Jurisdiction Claim Number

Amend footnoting in subsection 9702(c) to indicate that the Jurisdiction Claim Number (DN5) is required only in specified circumstances, such as when changing a Claim Administrator Claim Number or Claim Administrator FEIN.

Modify Start-Up for Annual Reports

Amend subsection 9702(f) to require Annual Reports only for claims with date of injury on or after July 1, 2000, rather than March 1, 2000.

Add Benefit Period Dates for Annual Reports

Amend subsection 9702(f) to require submission of Benefit Period Start Date (DN88) and Benefit Period Through Date (DN89) on all Annual Reports.

Modify Permanent Disability Codes Accepted

Amend the footnote in subsection 9702(d) to indicate that rating for Whole Body (code 99) is required, and ratings for individual body parts are optional.

Clarify Requirements for Closed Claims

Define "closed" claim, and amend subsections 9702(d) and (f) to clarify that final reports (MTC=FN) are required only for indemnity claims. For medical-only claims, a sufficient final report would be the annual report (MTC=AN) with Claim Status = "closed".

<End of this WCIS e.News>
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Contents of this bulletin do not change existing regulatory requirements; they provide additional or revised detail about the technical implementation of those requirements. All technical changes will subsequently be reflected in other WCIS documentation. Any bulletin can be forwarded as needed, but should be forwarded in its entirety and without modification. If you have received a forwarded copy of this bulletin and are concerned about its authenticity, you can view this and previous bulletins on our WCIS web site: www.dir.ca.gov/dwc/wcis.htm.

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