WCIS eNews No. 124
March 21, 2016

Countdown to California Medical Version 2.0

The WCIS is two weeks away from transitioning to California Medical Version 2.0. This new version updates reporting requirements for trading partners to report workers’ compensation medical bill payments to WCIS and enables the Department of Industrial Relations to collect data that will be used to identify emerging workers’ compensation medical trends, including the large and fast growing pharmaceutical benefit area.

On April 6, 2016, the WCIS will start receiving 837 files based on the California Medical Version 2.0 standard. There will be no parallel reporting in Version 1.1 and Version 2.0. Beginning March 23, 2016, the WCIS will discontinue receiving medical bill data according to the California Medical Version 1.1 standard. Between March 23 and April 5, the WCIS will only be sending out 997 and 824 acknowledgements for all 837 files received prior to March 23, 2016. During the time between March 23 and April 5, WCIS will continue testing with Trading Partners for California Medical Version 2.0.

Trading Partners sending their own data should make sure they are compliant on April 6, 2016 by completing testing as soon as possible. The testing steps can be found in Section IV of California EDI Implementation Guide for Medical Bill Payment Records, Version 2.0, April 6, 2016.  To start testing, contact your WCIS contact provided below. Trading Partners using a vendor to transmit their data should contact their vendor and ensure compliance by April 6, 2016. Trading Partners not in compliance with the mandatory reporting requirements are subject to a target audit by the Division’s Audit Unit (California Code of Regulations, title 8, section 10106.1(c)(5)(C)).   

The California Medical Version 2.0 FAQ is posted to the DWC website.

The WCIS medical data validation logic is posted on the WCIS website.

WCIS trading partner contacts:

Johnny Lee
email: jblee@dir.ca.gov
phone: 510-286-6772
Trading partner letters A, C, G, I-L, S-V, Z

Elisema Cantu
email: ecantu@dir.ca.gov
phone: 510-286-6763
Trading partner letters B, D-F, H, M-R, W-Y

Antoinette Esqueda
email: aesqueda@dir.ca.gov
phone: 510-286-6773
Medical reports technical contact

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.dwc.ca.gov/wcis.htm.

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