WCIS e.News
#32    April 17, 2003

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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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The Upon Request (UR) option now available

Upcoming Annual WCIS Advisory Committee Meeting

The Annual WCIS Advisory Committee Meeting will be held on Wednesday, May 28, 2003 in the Hiram Johnson State Building at 455 Golden Gate Ave., San Francisco. Within the next few days, we will provide a detailed agenda and other information in an upcoming ENews and Email message. We will also make this information available on our Website at: http://www.dir.ca.gov/DWC/WCIS.htm

UR Option:

At last year’s WCIS Advisory Committee meeting, held on May 21, 2002, and in ENews #26, the WCIS presented the option of accepting "Upon Request " (UR) MTC transactions from Trading Partners (TPs) in lieu of transactions not yet sent or acknowledged for each and every Indemnity activity on a claim.

As reported in the minutes from the meeting,

"Bill Kahley reported that the system improvement gained in the last few months now indicates that it is time to set up an agreed-upon system for the collection of backlogged SROI data. He presented two options for capturing backlogged data.

The first option is to continue to send data as prescribed in the California Implementation Guide–that is, send SROI transactions every time a benefit is opened, closed, changed, updated, etc.

The second option is to send all FROI data as usual, and report SROI backlog data via the UR Maintenance Type Code (MTC). This latter option would entail a two-step process.

First, all backlogged SROI data would be sent on a UR–that is, TPs would provide a current snapshot of the cumulative payments on each type of benefit paid on the claim. Then, for claims that do not have Initial Payment (IP) date yet posted in the WCIS database (determined by EDI staff via a query of the WCIS database), TPs would be asked to return the date of the IP maintenance type code to WCIS via flat file."

We are pleased to announce that the second option, as outlined above, is now available to all TPs for a limited time period. The UR procedure is to be used to catch-up on older claims for which SROI transactions have not been transmitted regularly. Once the Claims are up to date or when WCIS discontinues the UR option, Trading Partners should send all SROIs as per the California Implementation Guide.

Trading Partners that elect to exercise this option may now send UR transactions on claims for which:

  1. a FROI was submitted and accepted
  2. the SROI Date of Injury is on or after July 1, 2000
  3. Indemnity payments were made
  4. the Trading Partner has a backlog of SROI transactions to report

The information in each UR transaction must include a sweep of information for all benefits. Each benefit must include a "start date", the latest "through date" and the current cumulative amount paid. The UR will be validated according to the logic detailed in ENews #8 (November 8, 2000). To assist TPs in this effort , the validation logic as originally reported in Enews #8 is reproduced below.:

  1. On all claims for which the UR option will be used, the TP has already submitted the corresponding FROI data.
  2. When reporting SROI data using the UR transaction, TPs do not need to report the stops and starts of each benefit period. Instead TPs should send just one SROI transaction reporting the most recent Benefit period information (if possible, using the earliest start date for each BTC) for each Benefit Type paid and the cumulative amount paid for that benefit. The Maintenance Type Code to be used is UR (Upon Request). It follows the same data requirements as IP transactions. Below is an example of how URs are processed:
  3. Sequence of events

    Date of Injury

    07/01/2001

    TD (Temporary Disability) paid

    07/03/2001-07/31/2001

    Employee returned to work: TD benefit suspended

    08/01/2001

    TD resumed and paid

    08/15/2001-09/30/2001

    PD (Permanent Disability): Benefit changed from TD to PD

    10/01/2001- Still being paid at end of variance

    The table below shows how to report the above benefit sequence using one MTC = UR transaction with two benefit blocks:

    MTC Date is 12/31/2001

    MTC

    BTC

    Start Date

    Thru Date

    Cumulative Benefit Amt Paid

    UR

    050

    20010815

    20010930

    2000

    030

    20011001

    20011231

    3600

     

  4. WCIS will use the MTC Date and Benefit Period Through Date to interpret whether a benefit period is open or closed. This is done in the following manner. If the Benefit Period Through Date for the particular Benefit Type Code is the same as the MTC Date then WCIS will consider that benefit type as "open" (benefits are still being paid). On the other hand, if the Benefit Period Through Date is prior to the MTC Date, WCIS will interpret this as a closed benefit period. In the above example Benefit Type 030 (PD) is considered an open benefit period, and Benefit Type 050 (TD) is considered a closed benefit period. The interpretation of MTC= UR is important in order to avoid benefit sequencing problems later. The Maintenance Type Code Date and the Benefit Period Through Date together act as a sort of "flag" to identify benefit periods as open or closed.

Please note that this usage of the "UR" transaction is provided as a convenience for the regulated community in transmitting historic data that is due to WCIS. TPs who do not wish to utilize this mechanism are welcome to submit instead the complete series of benefit starts and stops that occurred for this claim.

The following process will occur after receipt of a UR:

On claims without an existing Initial Payment (IP) transaction, the UR will update the claim according to the process described in ENews #8. A spreadsheet listing all of these claims will be sent to the TP who will need to fill in the IP date (MTC date of the original Initial Payment transaction) and send it back to WCIS. WCIS will update the claims with the information in the spreadsheet.

On claims with an existing IP transaction, the UR will also update the Claim according to the above process, except that no additional information from the Trading Partner will be necessary.

PLEASE NOTE: Be sure to provide the cumulative amount paid for each benefit type for which a benefit was paid on a claim. This option is available only for a limited time period for past-unreported SROI data. All TPs must report SROI data on all new indemnity claims as instructed in the CA Implementation Guide.

Please be sure to contact your Trading Partner contact if you have any questions regarding this process. We will do our best to respond to your questions and concerns. We appreciate your cooperation and support.

Change in Trading Partner Contacts:

Due to her unique skills and knowledge, Alice Cantu will be temporarily reassigned to a special project with a different department. We expect her back in six months. In the meantime, her Trading Partners will be split between the remaining Contacts as follows (Letters underlined are Alice’s):

 

Trading Partner Contacts:


Damon Chen, Trading Partners — B, C, D, E, F, G-H, M, P-R
e-mail:
dcchen@dir.ca.gov

Tel. 415.703-4413 Fax: 415.703.5911

Johnny Lee, Trading Partners - A, I-L, N, O, S, U-V, W, X, Y, Z
e-mail:
jblee@dir.ca.gov
Tel: 415.703.4427 Fax: 415.703.5911

<End of this WCIS e.News>
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