Pennsylvania Bureau of Workers' Compensation (BWC) Electronic Data Interchange (EDI) State Workers' Insurance Fund (SWIF) Special Terms and Conditions

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1 Pennsylvania Bureau of Workers' Compensation (BWC) Electronic Data Interchange (EDI) State Workers' Insurance Fund (SWIF) Special Terms and Conditions SWIF is seeking a transaction partner to assist it in complying with the Bureau of Workers Compensation s (BWC s) electronic data interchange (EDI) requirements. SWIF needs to meet the requirements detailed in the BWC EDI Claims Implementation Guide published by BWC, including any updated versions issued by the BWC (BWC EDI Claims Implementation Guide) (attached hereto as Appendix A). Because SWIF has been identified as a testing partner by BWC, it will need to meet the requirements in the BWC EDI Claims Implementation Guide by March GENERAL The transaction partner will be responsible for ensuring the Trading Partner has completed the EDI Trading Partner Agreements before sending Trading Partner s EDI transactions to BWC, as specified in the BWC EDI Claims Implementation Guide. DATA PROCESSING The transaction partner must process data, as outlined in the IAIABC Guide (Claims Release 3.0), and specific to Pennsylvania, as described in the BWC EDI Claims Implementation Guide. The transaction partner will be responsible for the electronic filing of data to the BWC and receipt of acknowledgement reports, as well as errors for missing and/or invalid information, and rejected files. SERVICE LEVEL AGREEMENTS (SLAs) The transaction partner must adhere to: 1. Proper filing of LIBC forms as listed in Appendix C of the Workers Compensation Act and in accordance with the BWC EDI Claims Implementation Guide. 2. Compliance with any enhancements, updates, and/or changes of the BWC EDI requirements with notice to SWIF within 5 business days. 3. EDI filing by 8 p.m. on the same day as the receipt of the SWIF data file, if SWIF transmits the file by 5 p.m. If the file is transmitted by SWIF after 5 p.m., the transaction partner must transmit the data to BWC by 8 p.m. next business day. 4. Receipt of the acknowledgement reports by SWIF, as defined in section 4.4 of the BWC EDI Claims Implementation Guide, by 5 p.m. on the same business day as received by the transaction partner from BWC. The selected transaction partner and SWIF agree that if a service level is not met, the failure will interfere with the operation of SWIF s program. Where that damage is not otherwise clearly 1

2 calculable (as in the overpayment of a claim) and able to be reimbursed as a direct or consequential damage, it is otherwise impractical and extremely difficult to fix the actual damage sustained. SWIF and the selected transaction partner therefore presume in the event of any failure to meet a service level, the amount of damage which will be sustained from the failure will be the amount listed as liquidated damages under Chart 1 below, and that the selected transaction partner shall pay such amount as liquidated damages and not as a penalty. Payment of such liquidated damages by transaction partner shall be the exclusive remedy of SWIF for failure of transaction partner to meet these servicing standards. SWIF, at its option, for amounts due SWIF as service-level damages, may deduct the amounts from any money payable to the selected transaction partner, or may bill the selected transaction partner as a separate item. SWIF shall notify the selected transaction partner in writing before deducting such sums from money payable to the selected transaction partner. In addition to any liquidated damages due, failure to adhere to the set minimum service levels will constitute cause for progressive action toward termination, or termination, at SWIF s discretion. Performance Metric Description Frequency of Review Liquidated Damages Compliance with any enhancements updates and/or changes of the BWC EDI requirements with notice to SWIF within 5 days. Proper notification to SWIF of BWC enhancements, updates and/or changes Ongoing $1, per business day of non notification of BWC enhancement updates and/or changes to SWIF after 5 business days, up until and including day of notice of non compliance notification from BWC. 2

3 EDI filing by 8 p.m. on the same day as the receipt of SWIF data, if SWIF transmits file by 5 p.m. If file is transmitted by SWIF after 5 p.m., the transaction partner must transmit the data to BWC by 8 p.m. next business day. Receipt of the acknowledgement reports by SWIF, as defined in section 4.4 of the BWC EDI Claims Implementation Guide, by 5 p.m. on the same business day as received by the transaction partner from BWC. EDI filing from SWIF to BWC by transaction partner Receipt of the acknowledgement reports by transaction partner to SWIF Daily Daily 10% of the monthly charges for the 1 st failure to comply. If non compliant 2 or more times within the same monthly billing cycle. The penalty increases to 25% of the monthly amount payable by SWIF for EDI reporting services. TESTING The transaction partner must support and assist SWIF with the testing efforts for the project, including but not limited to system integration testing between the transaction partner and SWIF prior to testing with BWC. Testing with SWIF will occur prior to the scheduled start date assigned to SWIF in the BWC test schedule; please refer to the BWC EDI Claims Implementation Guide. The testing procedure with BWC is outlined in the BWC EDI Claims Implementation Guide. Data Quality requirements thresholds for SWIF and the transaction partner will be aligned with BWC s, as outlined in the BWC EDI Claims Implementation Guide (section 5.3). TECHNICAL REQUIREMENTS L&I s OIT will provide a secured FTP site for the transaction partner to transmit and/or receive data. 3

4 The awarded transaction partner will provide all services, using secured technologies and techniques in accordance with industry best practices and the Commonwealth s security policies, procedures, and requirements. All responses must be submitted on the basis that all applicable IT Terms and Conditions, as issued by the PA Department of General Services, can and will be adhered to. The IT Terms and Conditions are located at: ORDER OF PRECEDENCE These Special Contract Terms and Conditions supplement the IT Terms and Conditions. To the extent that these Special Contract Terms and Conditions conflict with the IT Terms and Conditions, these Special Contract Terms and Conditions shall prevail. TERM OF CONTRACT The Contract shall commence on the Effective Date (as defined herein) and expire two (2) years from the effective date of the contract. The Effective Date shall be fixed by the Issuing Officer after the Contract has been fully executed by the bidder and all approvals required by Commonwealth contracting procedures have been obtained. Once the contracts are approved, a purchase order will be issued to bidder for actual dates to begin service. OPTION TO RENEW This Contract may be renewed for three (3) additional one (1) year terms at the sole option of the Commonwealth. If the Contract is renewed, the same terms and conditions shall apply. If the Commonwealth exercises the option to renew, the supplier may request an increase in the per transaction price, up to 5% of the per transaction price, which the Commonwealth may grant in its sole discretion. OPTION TO EXTEND The Commonwealth reserves the right, upon notice to the bidder, to extend the Contract or any part of the Contract for up to three (3) months upon the same terms and conditions. This will be utilized to prevent a lapse in Contract coverage and only for the time necessary, up to three (3) months, to enter into a new contract. BIDDER PRICING Contractor must bid cost on a per transaction price to be billed monthly. 4

5 *SWIF s annual estimated transactions 24,648. These transactions represent the number of FROI and SROI reports. This number is considered to be only an estimate, based on past experience, and is subject to change. CONFIDENTIALITY The Contractor shall not publish or otherwise disclose, except to the Commonwealth and except matters of public record, any information or data obtained hereunder from private individuals, organizations, or public agencies, in a publication whereby the information or data furnished by or about any particular person or establishment can be identified, except with the consent of such person or establishment. The parties shall not use or disclose any information about a recipient receiving services from, or otherwise enrolled in, a Commonwealth program affected by or benefiting from services under this Contract for any purpose not connected with the parties Contract responsibilities except with the written consent of such recipient, recipient s attorney, or recipient s parent or guardian pursuant to applicable state and federal law and regulations. REFERENCE MATERIAL Commonwealth of Pennsylvania Bureau of Workers Compensation Website: -compensation/10386 WCAIS Project Website: IAIABC Website: EXHIBITS BWC EDI Claims Implementation Guide. (Appendix A) GLOSSARY BWC Commonwealth of Pennsylvania Bureau of Workers' Compensation (BWC) SWIF State Workers' Insurance Fund IAIABC International Association of Industrial Accident Boards and Commissions is a notfor-profit trade organization comprised of jurisdictions, insurance carriers, and vendors who are involved in workers compensation. WCAIS Workers Compensation Automation and Integration System EDI Electronic Data Interchange Trading Partner An entity that has entered into an agreement with another entity to exchange data electronically. For the purpose of this document they refer to the Claim Administrators who will be sending EDI Claims transactions to BWC. 5

6 Trading Partner Agreement An agreement that describes the expectations between two entities exchanging data electronically. These expectations include, but are not limited to, what transactions to send, what format to use, what data elements to include, when and where data elements are to be sent, and testing to be performed. Transaction Partner Organizations that were selected by BWC to accept EDI Claims transactions from Trading Partners. Transaction The communication of data that represents a single business event. A transaction consists of one or more records. FROI First Reports of Injury SROI Subsequent Reports of Injury 6