Top News. Medical Data Call Medical Data Call Research NCCI Adds Electronic POC Service for Hawaii IAIABC POC Release 3.0 Format

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1 July 2013 Table of Contents 1 Top News 11TH EDITION Top News Medical Data Call Medical Data Call Research NCCI Adds Electronic POC Service for Hawaii IAIABC POC Release 3.0 Format Research in Full Swing NCCI recently published a report called Medical 3 Data Quality Update Services for Claims 20 Edit Changes Data Providers Make the Grade Medical Incentive Program (MIP) or More Years Old. This study which uses Medical Call Data evaluates the 4 Data Communications age and gender of claimants 5 Data Reporting Outlook for workers compensation Financial Call Reporting 2013 Season Results Record Crowd at 2013 Data Education Program 5 Data Education Data Reporting Education Opportunities 6 Data Tips Medical Data Call Reporting Paid and Secondary Procedure Codes Tools and Resources Guides Catastrophe Numbers 7 Did You Know? Our Brand Data Extraction Electronic Transmission User s Guide Contact Us Your feedback is important to us. If you have any comments or suggestions on this or future editions of The Data Connection, please us at thedataconnection@ncci.com. receiving medical services claims at least 20 years after the injury. The study also focuses on which drugs were prescribed, the types of injuries that were treated, and where these services were rendered (doctor s office, hospital, home, etc.). The key findings include: Patients are predominantly male, more so than can be explained by historical gender differences in the workforce Claimants younger than age 60 cost more per year, per claimant, to treat than those older than age 60 indicating that advancing age does not drive higher costs These older claims had significantly greater claim costs for prescriptions, supplies, home health services, and the maintenance of implants, orthotics, and prosthetics The full report is available on ncci.com, under Research and Outlook.

2 THE DATA CONNECTION Just For Fun Do You Know NCCI? 1. Where was NCCI s first headquarters? 2. In what year did NCCI start operating? 3. How was data originally submitted to NCCI? For answers, see the last page. Aloha! NCCI Adds Electronic POC Service for Hawaii As of October 1, 2013, Hawaii will begin receiving Proof of Coverage (POC) data electronically. Hawaii will receive POC data files in the IAIABC Release 3.0 format on a daily basis. This change will allow carriers to eliminate hard copy Proof of Coverage processing for the Hawaii Department of Labor and Industrial Relations. With the addition of Hawaii, POC service will now be provided electronically to all NCCI states. For more information, see Circular POC-HI on ncci.com. Please refer to the POC Compliance Guide on ncci.com for all of the filing requirements for these jurisdictions. NCCI Set to Deliver IAIABC POC Release 3.0 Format This August, NCCI will start delivering Proof of Coverage (POC) data in the new IAIABC POC Release 3.0 format. This new layout provides processing improvements and is designed to meet the changing needs of the jurisdictions. Idaho, Utah, and Hawaii are the first states implementing this new format in NCCI partnered with IAIABC to provide industry training on the new format, which will increase the quality of data reported by carriers and data delivered to the jurisdictions. Page 2

3 JULY 2013 Data Quality Update What s Coming Down the Pike for Edit Changes NCCI applies edits to all data types to help ensure that quality data is used in our products and services. We maintain an ongoing process to review and implement edit changes as needed. The Future Edit Matrix helps you stay up to date by providing a summary of edits scheduled for future implementation. For your planning purposes, this matrix provides advance industry lead time and projected implementation dates for upcoming changes. The matrix includes information about how the edit will perform, the error severity, and the edit description. Here s a sample of a future unit edit: Edit Data Data Error Edit Expected Number Field Grade Message Description Implementation Time Frame Class 4 CLASS CODE Class Code 3rd Qtr 2013 Code 9077 MUST 9077 must be BE REPORTED reported with WITH EXPOSURE Exposure COVERAGE ACT Coverage Act CODE 02 Code 02. Lead Time Extended for Medical Incentive Program (MIP) As originally communicated in April 2013, NCCI extended the lead time for the implementation of the MIP. The MIP components include Completeness, Quality, and Insufficient Data. The Completeness and Insufficient Data components, initially slated for implementation beginning with 1st Quarter 2013 data, will be implemented as follows: Implementation Plan Lead-Time Period Initial Evaluation Quarter for Monetary Assessments Initial Assessment Billing During the lead-time period, MIP assessment information is displayed on the Incentive Results screen, located in the Medical Data Collection tool. This will include any assessments that would have applied for a given quarter, as if the lead-time period were over. Completeness, Quality, and Insufficient Data 1st Quarter 2012 through 4th Quarter st Quarter 2014 (due by June 30, 2014) August 2014 The Future Edit Matrices, along with the Production Matrices, are located in the data guidebooks in ncci.com s Manuals Library. The Medical Incentive Program is available from the Data Quality Web Page (Compliance Programs) on ncci.com. Data Providers Continue to Make the Grade In February, NCCI distributed its Carrier Data Quality Report (Report Card) to the industry. The Report Card includes overall reporting performance by data type, based on data received or due in The industry as a whole had excellent results, with the most passing grades to date! This year s Report Card included DCI informational only results for data that was due in These results show that the industry has responded positively to the introduction of DCI data into the Report Card. This is a favorable outlook for formal grading of DCI data, which begins in The industry as a whole had excellent results, with the most passing grades to date! Page 3

4 THE DATA CONNECTION Data Communications The following are key communications that NCCI released so far in They are available on ncci.com: State-Specific Medical Data Collection Discontinued (FYI-MED-TN and FYI-MED-KS ) Announces the elimination of Tennessee and Kansas Medical Data collection efforts. Proof of Coverage Transition to IAIABC EDI POC Release 3.0 (POC-ID and POC-UT ) Announces the Idaho and Utah transition from IAIABC EDI POC Release 2.1 to Release 3.0. Policy Data Proof of Coverage (POC) Notice/Binder Data Reporting Instructions (POLS ) Includes data reporting instructions for new batch transaction Proof of Coverage (POC) Notice/Binder (Transaction 16). Arizona Employee Leasing Policy Data Reporting Requirements (POLS-AZ ) Announces reporting instructions for policies covering employers or leased and nonleased employees in Arizona. Policy Data Addition of Supporting POC Data Elements to Policy Reporting (FYI-POLS ) Features policy data reporting changes to support implementation of IAIABC EDI POC Release 3.0. Units Unit Statistical Loss Reporting (UNIT ) Provides instructions for unit statistical loss reporting, specific claim conditions, and national and state programs that affect loss reporting and experience rating. Page 4

5 JULY 2013 Data Reporting Outlook Financial Call Reporting 2013 Season Results Early results are in, and NCCI has received 100% of expected Call data for the 2013 season! These results, representing more than $22 billion in premium, were accomplished by data providers working in partnership with NCCI to provide timely, accurate, and complete data. Record Crowd at 2013 Data Educational Program NCCI held its annual Data Educational Program from January 28 through February 1 at the Palm Beach County Convention Center, with the biggest attendance ever 310 customers. The program s theme for 2013 was Your Journey Toward Workers Compensation Data Knowledge. Data reported in the 2013 Financial Call reporting season is utilized in the state rate and loss cost filings made throughout 2013 and into early Attendees received basic and detailed training on the reporting of Proof of Coverage data, Policy data, Unit Statistical data, Financial Calls, Detailed Claim Information, and the Medical Data Call. Hands-on classes about NCCI s data tools were also included. WHAT ARE OUR CUSTOMERS SAYING? Every class was valuable, and I learned something from every speaker. I really enjoyed it. I m new to the insurance business, and the online and basic classes were very informative. As a reporter working for a small insurance company and wearing multiple hats, I found the conference extremely helpful. Data Education Watch for Data Reporting Education Opportunities Webinars on Demand are online modules available on ncci.com that allow customers to view and listen to valuable training at their convenience right from their desktops. Here s the tentative 2013 schedule: 2013 Webinars on Demand Available 2013 Financial Data Reporting Season Available Item Filing U-1398 Revisions to NCCI s Statistical Plan Manual Available Data Quality Incentive Program for Detailed Claim Information Available Policy, Unit, DCI, Financial, and Medical Data Tools and Resources Guide 4th Qtr Updated Data Quality Incentive Program DCI 4th Qtr Basics of Financial Data Reporting TBD Unit Statistical Loss Reporting TBD Claim Reporting Across Data Types Schedule is subject to change. Page 5

6 THE DATA CONNECTION Data Tips Medical Data Call Reporting Paid and Secondary Procedure Codes The Medical Data Call includes the reporting of the Paid and Secondary Procedure Codes. The Paid Procedure Code should always reflect the code used to determine the reimbursement, which may not always be the same code indicated on the bill. Tools and Resources Guides More Than a Pretty Face! Our Tools and Resources Guides for each data type just got a makeover. What hasn t changed is that they are useful resources, providing high-level views of the data tools available from NCCI. Read them to learn all about reporting and correcting your data and monitoring your overall reporting performance. You can also find out about the manuals, communications, and training resources available by data type. You can access these guides on ncci.com under the Education section. What s Extraordinary About Catastrophe Numbers? The Catastrophe Number is reported on Unit Statistical losses. It identifies two different types of workers compensation (WC) loss events Non-Extraordinary and Extraordinary. For example, an ambulatory surgery center bills for a facility fee using a CPT code. However, the reimbursement is determined based on an APC code. The codes must be reported as follows: The APC code is reported as the Paid Procedure Code, and The CPT code is reported as the Secondary Procedure Code The Medical Data Call Reporting Guidebook provides the rules for reporting the Paid and Secondary Procedure Codes. Refer to the Medical Data Reporting Web page on ncci.com for Paid and Secondary Procedure Code examples. This chart highlights the differences among these Catastrophe Numbers: Non-Extraordinary Loss Event WC loss for one employer One accident involving two or more reportable claims Catastrophe Codes 01 to 10 are assigned by the data providers, which they code to these claims Subject to loss limitation rules Catastrophe Number Comparison Extraordinary Loss Event (ELE) WC loss that may affect multiple employers A significant loss event that may involve many claims A unique Catastrophe Code (11 to 99) is assigned by the WC bureau, which is coded by data providers to each claim involved in the event Reviewed on a case-by-case basis to determine whether losses should be excluded from experience ratings and state loss cost/rates NCCI maintains the complete listing of ELE codes on the Data Quality Web page on ncci.com. Page 6

7 JULY 2013 Did You Know? Putting Our Best Brand Forward Since the beginning of this year, our publications have a Got ETUG? Electronic Transmission User s Guide, That Is! fresh new look. NCCI constantly looks for ways of keeping ETUG provides the our corporate image relevant and authentic. As part of our necessary guidelines branding initiative, we have updated the look and feel of for you to prepare our graphic image. and submit test and production files. This helpful manual can be found on ncci.com in the Manuals Library/ Data Manuals section. ETUG provides information on electronic transmission options and testing requirements. So if you re implementing a new system, making changes to a current system, or trying to implement a new data type, ETUG can give you the information you need on the certification You may have noticed the changes in our brochures, process and file naming conventions. circulars, and manuals. Also, our data reporting tools now have a new logo, and the format of our signatures has been made consistent. Whether it s online or printed, publication, tool, or logo you ll see NCCI s fresh, uniform look. Data Extraction at Your Fingertips Did you know that you can get an electronic copy of the Unit NCCI Facts Answers 1. NCCI s first headquarters was in New York City we moved our offices to South Florida in the 1980s. 2. NCCI became operational in Statistical data that s stored on NCCI s database? The Extract Production Data function within DCA Access Online provides you with the data for your company s use. Examples include creating corrections and subsequent reports, archiving, and researching. If you have access to the Unit Pre-Edit Tool, you will automatically have access to this feature. If you do not have access, please check with your company administrator, or contact NCCI s Customer Service Center at 800-NCCI Data was originally submitted using punch cards. Page 7

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