Introduction to Detailed Claim Information Reporting. Lesson 4: Resources and Tools

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1 Introduction to Detailed Claim Information Reporting Lesson 4: Resources and Tools 1

2 LESSON 4 OBJECTIVES Learn which DCI reporting resources and tools you need and which tools can assist you in the DCI reporting process Recognize the importance of using the Call for Detailed Claim Information Instruction Manual Understand the benefits of using DCA Access Online for viewing, correcting, and submitting DCI Gain a basic knowledge of the DCI submission methods Know where to access the resources and tools online 2

3 Resource List NCCI provides a comprehensive package of Detailed Claim Information (DCI) resources and tools for data providers to help them efficiently report timely and quality DCI to NCCI. Resources In addition to this module, we recommend that data providers begin with the following resources that provide the rules, requirements, and other information to help data providers report DCI: Call for Detailed Claim Information Instruction Manual* The Texas Department of Insurance s Texas Detailed Claim Information Statistical Plan Electronic Transmission User s Guide* Workers Compensation Insurance Organization s (WCIO) Workers Compensation Data Specifications Manual* Circulars and FYI Plus Releases* Data Reporting DCI Web Section* Annual Data Reporting Workshop Data Tools The following tools are designed to help data providers report, view, edit, and submit DCI: DCA Access Online* Data Transfer via the Internet* Hard Copy Tracking and Image Retrieval (System Image Retrieval)* * The referenced resources and data tools can be accessed online at ncci.com. 3

4 Resources Call for Detailed Claim Information Instruction Manual NCCI s Call for Detailed Claim Information Instruction Manual provides comprehensive DCI reporting requirements information. This manual provides the necessary requirements and instructions for data providers to report DCI accurately. This manual is available online at ncci.com and includes the following information: General information that includes the purpose and scope of DCI Rules and requirements for reporting DCI Editing requirements as displayed in the DCI Edit Matrix DCI forms and instructions Sampling process and procedures with examples DCI participation process and eligibility requirements Data quality details on the Workers Compensation Data Monitoring System Texas Detailed Claim Information Statistical Plan Because Texas reporting requirements differ from other states, the Texas Department of Insurance s Texas Detailed Claim Information Statistical Plan must be adhered to when reporting DCI claims for Texas. 4

5 Resources (continued) Electronic Transmission User s Guide NCCI s reporting requirements for submitting DCI electronically are detailed in the Electronic Transmission User s Guide. It contains the requirements for data providers to prepare and submit test and production files to ensure that all connections and systems are processing correctly. This manual also helps data providers prepare for the electronic certification testing process. Workers Compensation Insurance Organization s (WCIO) Workers Compensation Data Specifications Manual The WCIO Workers Compensation Data Specifications Manual contains specifications for submitting electronic DCI in the required WCCDCI file format. It also provides the specifications and record layouts, as well as information on the fields, such as positions, number of bytes, type of characters, and if these fields are required or optional. This manual contains industry electronic and hard copy reporting specifications that provide standard formats for exchanging other types of data, in addition to DCI, with all the data collection organizations and their members. It is intended for use by all rating organizations. Therefore, certain data elements and requirements do not apply to NCCI, or they may be optional. 5

6 Resources (continued) Circulars and FYI Plus Releases NCCI s circulars and FYI Plus releases are mailed to subscribers regarding DCI reporting topics that may require action, are time-sensitive, and/or announce important information necessary for reporting timely and quality data. Annual Data Reporting Workshop NCCI conducts an annual Data Reporting Workshop that educates data providers on the fundamentals of DCI Reporting and the use of DCA Access Online. 6

7 Resources (continued) Data providers should regularly access the Data Reporting DCI Web Section at ncci.com for information and tools necessary to report timely and accurate DCI. The DCI Web section includes links to the following: Data Manuals Data Tools Circulars and FYI Plus Releases Articles and Guides Training Data providers can stay up to date on important DCI reporting information by setting their Data Web Preferences at ncci.com. An notification and/or a home page alert regarding new DCI information will be automatically sent as soon as it is released. 7

8 Data Tools DCA Access Online NCCI s DCA Access Online is a Web-based application that allows data providers to search, view, enter, and correct DCI online, in addition to other NCCI data types. NCCI recommends that data providers use this tool to assist in achieving data reporting compliance and to streamline research and reporting activities. This tool is free of charge through ncci.com. DCA Access Online offers the following functions: View detailed claim information for both the 85- and 86-element formats View and correct claims that contain errors or have been rejected by NCCI Add a claim, including original and all subsequent reports, as well as corrections View hard copy and electronic DCI submissions previously sent to NCCI or processed through DCA Access Online View, add, or update sample control information online View the history of when reports have been received by NCCI for a particular claim and when additional reports are expected Create customized (ad hoc) DCI Reject and Error, Expected, or Overdue reports to be available via NCCI s Data Transfer via the Internet in a print image format Receive a WCCDCI file containing DCI claim or sample control transactions entered via DCA Access Online Generate a print view of DCI claim forms in pdf format 8

9 Data Tools DCA Access Online (continued) The following DCA Access Online screen shows the 86-element format. DCI 1 st Report (Report Type 1) claims may be submitted or corrected through DCA Access Online using this format. 9

Data Tools DCA Access Online (continued) The DCI Submission Tracking option through DCA Access Online allows data providers to track and monitor electronic and hard copy DCI submissions sent to NCCI

10 Data Tools DCA Access Online (continued) The DCI Submission Tracking option through DCA Access Online allows data providers to track and monitor electronic and hard copy DCI submissions sent to NCCI or processed through DCA Access Online. Data providers can also verify that the amount of records submitted equal the amount of records processed. The following DCA Access Online screen displays the submissions for a specified time period and coverage provider ID. Click to enlarge 10

11 Data Tools- DCA Access Online (continued) A variety of searches can be performed with DCA Access Online s DCI Search function. The following DCA Access Online screen displays how a search can be performed by entering the Claim Number and clicking Show Historical Transactions. This search will allow data providers to view all report levels for a particular claim, including original, revision, and correction transactions. Click to enlarge 11

12 Data Tools Data Transfer via the Internet NCCI s Data Transfer via the Internet offers a cost-effective, faster, and easier way to exchange DCI with NCCI, in addition to other NCCI data types. This tool is used to submit data files online, or receive NCCI reports or data files online. This eliminates manual processes associated with hard copy, magnetic tapes, or cartridges. Reject and error information, as well as Expected and Overdue reports, can also be retrieved and downloaded from a designated Secure Browser Mailbox or Secure Software file transmission procedure. Data Transfer via the Internet offers the following features: Secure transmission notification File transfer tracking eight-day retention Less expensive than hard copy submission User-friendly navigation and documentation 12

13 Data Tools Hard Copy Tracking and Image Retrieval The Hard Copy Tracking and Image Retrieval (System Image Retrieval) allows data providers to retrieve hard copy documents and submission tracking reports online that have been scanned by NCCI s keying vendor. Retrieving hard copy documents online helps data providers conduct research and resolve keying and submission issues associated with hard copy data. This tool is free of charge through ncci.com. Data providers can perform the following activities: Track hard copy submissions as they are received and processed through NCCI s keying vendor View data submitted on hard copy after the keying vendor receives them Retrieve documents shortly after they are keyed 13

14 Submission Methods Electronic and Hard Copy Electronic Submissions NCCI allows data to be submitted electronically or on hard copy. However, NCCI encourages data providers to submit data electronically in order to maintain accuracy and to be able to take advantage of our online data tools and efficient data reporting processes. Manual keying costs, and additional delays are associated with hard copy keying; reporting electronically allows data providers more flexibility and is the most effective method of reporting to achieve accurate and timely data submissions. Data providers have convenient electronic options for accessing, viewing, updating, verifying, and transmitting data quickly. NCCI tools that can be used to submit DCI include the following: DCA Access Online NCCI s online tool for viewing, submitting and correcting DCI Data Transfer via the Internet NCCI s data tool that enables the exchange of DCI online To submit data electronically via Data Transfer via the Internet or other electronic media, specific formatting and reporting requirements are detailed in the Electronic Transmission User s Guide. This publication also includes information on the electronic certification testing process. For electronic reporting, each data element must be reported in the specific record layout in accordance with the WCCDCI file format located in the WCIO Workers Compensation Data Specifications Manual. This WCCDCI file format defines the attributes for each data element contained in the record. 14

15 Submission Methods Electronic and Hard Copy (continued) Electronic Certification To submit data electronically to NCCI, the data provider must submit a Letter of Authority that contains specific user information and authorization from the company to report data electronically. The data provider must also complete the electronic certification testing process, which involves preparing and submitting test and production files to NCCI to ensure that all data files, connections, and systems are functioning and processing correctly. NCCI s media support team works directly with data providers through a step-by-step process until certification and all electronic reporting preparation requirements are met. Hard Copy Submissions Hard copy data is reported on DCI forms found in the Call for Detailed Claim Information Manual and submitted to NCCI s keying vendor. Hard copy data is keyed by the vendor and converted into the WCCDCI electronic standard format. NCCI then processes and edits the data in NCCI s DCI database. Hard copy reporting requirements are contained in NCCI s Call for Detailed Claim Information Manual and WCIO Workers Compensation Data Specifications Manual. 15

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