WCPOLS (Policy) File Submission Processing

Transcription

1 WCPOLS (Policy) File Submission Processing January 30 February 2, 2018 Palm Beach County Convention Center West Palm Beach, FL The Path to Data Excellence

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3 WCPOLS (Policy) File Submission Processing Presented by: Bob Vaughan and Josie Flores Mmmm, Who Knew? 2 1

4 Objective Provide an understanding of the electronic reporting process from building the file through updating your data. 3 Agenda Resource Overview Submission Process Data Quality Editing Processing Policy Data Policy Transaction Scenario 4 2

5 Resource Overview Manuals The Workers Compensation Insurance Organizations (WCIO) Workers Compensation Data Specifications Manual WCPOLS for Policy data Policy and Proof of Coverage (POC) Reporting Guidebook Electronic Transmission User s Guide 6 3

6 WCIO Data Specifications Manual Overview The WCIO Workers Compensation Data Specifications Manual provides standards for data reporting. Defined field formatting Data Collection Organizations (DCO) applicability Record Layout with data element definitions WCPOLS for Policy data 7 Workers Compensation Insurance Organizations 8 4

7 WCIO Specifications Layout 9 Reporting Fields With Assumed Decimals 10 5

8 Reporting Fields With Assumed Decimals Record 5 Manual Rate Decimal Between Positions 74 and Decimals in Policy Data Collection Tool (PDC) Enter the decimal point No need to zero fill or justify field 12 6

9 Policy and POC Reporting Guidebook This manual provides the policy data reporting rules, requirements, guidelines, and examples. Identifies Proof of Coverage (POC) requirements for states where NCCI provides POC service Summary of data reporting examples and tips Manuals Library 13 Policy and POC Reporting Guidebook 14 7

10 Policy Data Reporting 15 New Policy (01) Header Record (01) Name Record (02) Address Record (03) State Record (04) Premium Record (05) Header Record (01) Policy Expiration Date Prior Policy Number Identifier Legal Nature of Insured Code Name of Producer 16 8

11 WCPOLS Policy Record Types and Codes D. Policy Record Types and Codes Record Type Code Record Type Name Applicable Transaction Codes 01 Header 01, 02, 04, 06, 08, 10, 14, 15, Name 01, 02, 04, 06, 08, 10, 14, 15, Address Insured Mailing Address (Address Type 01) 01, 02, 04, 06, 08, 10, 14, 15, Address Insurer/Carrier Issuing/Servicing Office Address (Address Type 03) 01, 02, 04, 06, 08, 10, 14, 15, State Premium 01, 02, 04, 06, 08, 10, 14, 15, Exposure 01, 02, 04, 06, 08, 10, 14, 15, Endorsement Identification 01, 02, 04, 06, 08, 10, 14, 15, Cancellation/Reinstatement Experience Rating Modification Change Endorsement 01, 02, 03, 04, 06, 08, 10, 14, Policy Period Endorsement 01, 02, 03, 04, 06, 08, 10, 14, Contingent Experience Rating Modification Factor Endorsement 01, 02, 03, 04, 06, 08, 10, 14, Deductible Endorsement 01, 02, 03, 04, 06, 08, 10, 14, 15, Policy Information Page Data Element(s) Change Endorsement 03 Z1 Noncompliance/Compliance File Control Record Required for each file submission Part

12 WCIO Specifications Layout 19 Data Elements by Record State(s) Applicability Required (R), Conditional (C), Optional (O), or Not Applicable (N) Data Element Exception Industry Code C C C C C C C C C C N N Required in AL, CT, FL, KS, KY, ME, MS, MT, NM, OK, OR, and TN. Part

13 E. Header Record Record Type Code 01 Policy Data Dictionary The Header Record provides information that applies to the entire policy (policy level). One Header Record is required for each unique Policy Number/Policy Effective Date/Transaction Code combination with the exception of Transaction Codes 03, 05, and 17, where no Header Record is to be reported. 2. Experience Rating Code Position(s) 48 Class Numeric (N) Bytes 1 Format N 1 Definition: Code describing whether the policy is experience rated (intrastate and/or interstate) or not experience rated. Code Values: Code Description 1 Interstate-Rated Only 2 Interstate- and Intrastate-Rated 3 Intrastate-Rated Only 5 Not Rated Part Electronic Transmission User's Guide (ETUG) Provides the necessary guidelines for you to prepare and submit test and production files. Electronic submission certification process Manuals Library on ncci.com 22 11

14 Submission Process Submission and Editing Process Carrier Source System Data Pre Edited (Recommended) Updates Corrections Data Submitted to Production Data Edited Results Provided via Data Reports, Policy Data Collection Products and Services 24 12

15 Pre Editing NCCI Edits Policy Pre Edit Service In House 25 Policy Pre Edit Service Process Submit Policy data through the editing process prior to submitting into NCCI production database. Rejects or errors are displayed on the Policy Pre Edit Service Submission Results Report PREPOL*.TXT Contact Customer Service for access 26 13

16 Certification Testing This must be completed before productions files are submitted to NCCI by all new data providers. Data providers who changed their data reporting system POLICY*.TST Electronic Transmission User s Guide 27 Submission Methods Policy Data Submission 28 14

17 Production Process POLICY*.TXT Policy Submission Results Report 29 Transmitting Policy Data Files Data Transfer via the Internet (DTVI) (Secure Mailbox) Web based tool for reporting data Receive your submission results reports and data files notification when data is received and processed Files retained for eight calendar days Data Provider Profile Form Request access to submit data electronically 30 15

18 DTVI 31 Transmitting Policy Data Files Secure FTP (File Transfer Protocol) Automates your file transmissions Defines directories to retrieve and store files Sets up a transmission schedule 32 16

19 File Submission Edits Invalid File Name File does not follow standard naming convention Unauthorized User User does not have access to submit the data Invalid Data Data submitted with invalid characters or the file is empty Out of Balance File Control record counts do not match NCCI counts 33 Data Quality Editing 17

20 Edit Types Field Field Logical Relational 35 Policy Edit Matrices Policy Edit Matrix All Edits in Production Policy Edit Matrix Future Enhancements 36 18

21 Policy Edit Matrix Production 37 Correcting Data via DTVI Corrections 38 19

22 NCCI Generated Reports 39 Customer Generated Reports 40 20

23 Data Reports Guide NCCI Data Reports Guide Policy NCCI Generated Reports via the Data Reports feature Report Name Schedule Notification Sent to: Policy Submission Results Report Upon Submission File Submitter Policy Daily Submission Results Report Daily No s distributed Policy Certification Submission Results Report Upon Submission File Submitter Policy Monthly Outstanding Data Grade 7 Report Monthly Policy Main Contact on file Noncompliance/Compliance Reject Report Daily Policy Main Contact on file Monthly Outstanding Noncompliance Report Monthly Policy Main Contact on file Policy Pre Edit Service Submission Results Report Upon Submission File Submitter Customer Generated Reports via the Data Reports feature Report Name Schedule Notification Sent to: Policy Reject & Error Report Upon Request Report Requestor Policy Risk ID Report Upon Request Report Requestor 41 Data Reports Guide 42 21

24 POC Reports 43 File Tracking via Policy Data Collection 44 22

25 File Tracking 45 File Tracking via Policy Data Collection 46 23

26 Policy Transaction Scenario Transaction Types and Codes Proof of Coverage Notice/Binder Transaction Code 16 Establishing Transaction Codes 01, 02, 04 Endorsements Transaction Code 03 Full Policy Replacements Transaction Codes 06, 08, 10, 14, 15 Cancellation/Reinstatement/ Nonrenewal Transaction 05 Noncompliance/Compliance Transaction Code

27 File Sorting/Processing Order Transaction Codes Category 01, 02, 04 Establishing 06 Key Field Change 08, 10, 14, 15 All Other Changes 03 Endorsement 05 Cancellation/Reinstatement 49 Link Data and Key Fields Link Data Elements reported consistently within each record to link all records of a single transaction A subset of link data reported consistently across all transactions 50 25

28 Link Data and Key Fields Links individual records within a unit Coverage Provider ID (NCCI Carrier Code) Policy Number Policy Effective Date Transaction Issue Date Key Fields Link Data Transaction Code 51 WCPOLS New Policy Example Link Data Positions WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS

29 Link Data All Policy Transactions Positions 1 43 Carrier Code Policy Number Pol Eff Date Trans Issue Date Trans Code WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS Record Layout Minimum Records Required for All Full Policy Transactions Trans Codes 01, 02, 04, Link Data State Code Record Type Other Fields Vary by Record LINKDATA 01 (Header) LINKDATA 02 (Name) LINKDATA 03 (Address) LINKDATA 03 (Address) LINKDATA (State Premium) LINKDATA (Exposure) 54 27

30 WCPOLS Record Layout Minimum Records Required for All Full Policy Transactions Trans Codes 01, 02, 04, Link Data State Code Record Type Other Fields Vary by Record LINKDATA 01 (Header) LINKDATA 02 (Name) LINKDATA 03 (Insured Mailing Address) LINKDATA 03 (Carrier Address) LINKDATA (State Premium) LINKDATA (Exposure) 55 Link Data All Policy Transactions Positions 1 43 Carrier Code Policy Number Pol Eff Date Trans Issue Date Trans Code WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS WCPOLS

31 Replacement Transaction Example Link Data State Code Record Type Other Fields Must be the same on all 02 (Additional Name(s)) 03 (Location of Operation) records of the 09 (Florida) 05 (Exposure Record) transaction 57 Miscellaneous Elements Quiz Record Type Header Name Address State Premium Exposure Name Link Identifier Continuation Sequence Number Name of Producer Insured Phone Number State Unemployment Number 58 29

32 Cancellation/Reinstatement Record Data Element Positions Value(s) State Code Record Type Code Cancellation/ Reinstatement ID Code 48 1 Cancellation Cancellation Type Code 49 2 Cancelled Pro Rata Reason for Cancellation Nonpayment of Premium Code Cancellation Mailed to Insured Date Cancellation/ Reinstatement Transaction Sequence Number Cancellation/ Reinstatement Effective Date Cancellation/Reinstatement Record Data Element Positions Value(s) State Code Record Type Code Cancellation/ Reinstatement ID Code 48 2 Reinstatement Reinstatement Type Code 49 2 Reinstatement of Policy Cancelled Mid-Term Reason for Reinstatement Reinstatement Regular Code Corresponding Cancellation Effective Date Cancellation/ Reinstatement Transaction Sequence Number Cancellation/ Reinstatement Effective Date

33 Questions Thank You 31

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35 Supplemental Information

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37 Presenter Biographies Bob Vaughan, AIDM, has worked at NCCI for 20 years. He is a consultant in the Data Services Department in NCCI s Data Resources Division. Bob participates in many projects related to NCCI s data tools and serves as coordinator for the Data Collection Procedures (DCP) Subcommittee. Bob is also responsible for data reporting communications and manuals. He is actively involved in industry committees focused on data reporting. Josie Flores has worked at NCCI since She is a Policy Data Analyst on the Policy/Proof of Coverage (POC) Team in the Data Collection Department. She supports the Policy Data Team and her responsibilities include coordinating outbound communications to carriers for Policy Availability, DTVI Vulnerability, and Policy/POC reporting issues. She is also a tester for system enhancements and support. Josie has a Bachelor of Science in Criminal Justice from Florida Atlantic University.