Workers' compensation information system (WCIS)

Medical Bill Reporting

The Workers’ Compensation System (WCIS) was mandated by statute in 1993. Its primary objective is to provide State policy makers with reliable, independent information regarding the performance of the California’s workers’ compensation system. California Labor Code §138.6 mandates the data to be collected via electronic data interchange (EDI) according to the EDI standards developed by the International Association of Industrial Accident Boards and Commissions (IAIABC).

The WCIS has been electronically collecting medical bill data since September 2006. Data collected has information regarding medical diagnoses, treatments, providers and payments. Medical bill data is sent to WCIS in X12 837 files via electronic data interchange (EDI). Prior to April 6, 2016, the WCIS used (IAIABC) EDI Medical Release 1.1 standard for data collection based on the X12 4010 standard. Beginning April 6, 2016 the WCIS used (IAIABC) EDI Medical Release 2.0 based on the X12 5010 standard. The data fields currently collected by WCIS can be seen in California EDI Implementation Guide for Medical Bill Payment Records Version 2.0.

The WCIS uses the Jurisdiction Claim Number (JCN), Insurer Federal Employer Identification Number (FEIN) and Claims Administrator Claim Number to match medical bills with FROI/SROI claims. Data presented in these tables are for claims matched with a FROI/SROI claim. It does not include unmatched data. The bills submitted on X12 4010 and 5010 formats were consolidated in these tables.

March 2021