WCSTAT (Unit) Data File Submission and Processing

Transcription

1 WCSTAT (Unit) Data File Submission and 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 WCSTAT (Unit) Data File Submission and Processing Presented by: Bob Vaughan and Lisa Combes Objectives Provide an understanding of the electronic reporting process from building the file through updating your data. Data Excellence! 2 1

4 Agenda Submission and Editing Overview Electronic Submission Requirements Submission Methods Submission Editing Data Quality Editing Reporting and Updating Unit Data Unit Data Collection Tool 3 Submission and Editing Overview 2

5 Submission and Editing Flow Identify expected unit reports (1st and subsequent reports) Review URC Expected Reports and Unit Data Collection Carrier Create unit reports Update source system Pre edit the data Are corrections needed? Yes No Submit unit reports 5 Recommended Unit Data Reporting Workflow Edit the reports Update source system Did the unit reports reject? Yes NCCI No Unit reports are accepted and loaded to database Are corrections needed? Yes No Data is available for use 6 3

6 Electronic Submission Requirements Manuals Unit Reporting Rules Electronic Reporting Requirements Statistical Plan Manual Electronic Transmission User s Guide Unit Statistical Reporting Guidebook WCIO Workers Compensation Data Specifications Manual 8 4

7 Electronic Unit Statistical Data Data Elements Items of data that convey information about the policy, exposures, and losses. This data may be submitted as codes and values. Records Collec on of related data elements Unit Report Composed of a record or series of records 9 Record Types 1 Header 2 Name 3 Address 4 Exposure 5 Loss 6 Total 9 File Control 10 5

8 WCIO Overview Workers Compensation Insurance Organizations (WCIO) WCIO Workers Compensation Data Specifications Manual provides standards for data reporting Defines Field Formatting Applicable Data Collection Organizations (DCOs) Record Layout With Data Element Definitions WCSTAT for Unit Statistical data 11 WCIO Specifications Layout Example of different types of field requirements from WCIO manual: WCPOLS 12 6

9 Statistical Plan 13 WCIO Specifications Layout 14 7

10 WCIO Specifications Layout 15 Numeric Fields 16 8

11 Reporting Fields With Assumed Decimals Exposure Amount Decimal between Positions 75 and Manual Rate Decimal between Positions 89 and 90 Experience Mod Factor Decimal between Positions 51 and Link Data and Key Fields Links individual records within a unit report Coverage Provider ID (NCCI Carrier Code) Policy Number Policy Effective Date Exposure State Key Fields Link Data Report Number Correction Sequence Number 18 9

12 Unit Report Control (URC) 1st Report Open Policy Unit Report Control (URC) 2nd Report Closed 3rd Report Not Expected 19 Original Reports Requirements Unit Report Type Header Record (1) Name Record (2) Address Record (3) Exposure Record (4) Loss Record (5) Total Record (6) Original Reports: 1st Reports Must have only 1 Must have only 1 Optional Must have at least 1 Required when there is a loss(es) Optional 1st Replacement Reports Must have only 1 Must have only 1 Optional Must have at least 1 Required when there is a loss(es) Optional Subsequent Reports Must have only 1 Must have only 1 Optional None allowed Must have at least 1 Optional Unit Statistical Reporting Guidebook: Part 1 B

13 Submission Methods Submission Methods Electronic File Unit Data Collection Unit Submission 22 11

14 Electronic File Submissions Data Transfer via the Internet (DTVI) (Secure Mailbox) Web based tool for reporting data Receive your submission results reports and data files notification is sent to submitter when data is received Files retained for eight calendar days Electronic Transmission User s Guide:Part 2 23 Electronic File Submissions Secure FTP (File Transfer Protocol) Automates your file transmissions Define directories to retrieve and store files Set up a transmission schedule Electronic Transmission User s Guide:Part

15 Electronic Certification Testing What does the certification process test? Ensures all connections, files, and systems are functioning and processing correctly Who has to get certified? All new data providers Data providers who changed their data reporting system For general certification requirements, refer to the Electronic Transmission User s Guide Electronic Transmission User s Guide: Part 4 F 5 25 File Naming Conventions Inbound File Type Naming Convention Production File unit25e*.txt Certification File unit25e*.tst *Accommodates up to 30 additional characters 26 13

16 DTVI File Names Inbound Files Unique date and time stamp before the file extension in the stored file name yyyymmdd_hhmmssnnn Inbound File Name unit25e*.txt Stored File Name unit25e*_ _ txt 27 Submission Editing 14

17 Pre Editing In House Pre Edit Service Pre Edit Tool 29 Pre Edit Tool/Service Pre Edit Tool Submit data via ncci.com Online correction of unit data prior to submitting to production Receive Pre Edit Submission Results Report Pre Edit Service Submit data via ncci.com Receive Pre Edit Submission Results Report 30 15

18 File Naming Conventions Inbound File Type Naming Convention Pre Edit Service File unitpru**.txt Pre Edit Tool pred250e.**.txt **Accommodates up to 18 additional characters 31 Submission Edits Invalid File Name Unauthorized User File does not follow standard naming convention 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 80% Duplicate Units Invalid Encryption Key 80% or more of the units match data already on NCCI s database PGP encryption key does not match NCCI key 32 16

19 Data Quality Editing Unit Statistical Editing Front end quality checks Validity Accuracy Completeness Two different versions of the matrix are found in the Unit Statistical Reporting Guidebook All Edits in Production Future Enhancements 34 17

20 Unit Edit Matrix 35 Description Provides results of individual file submissions and displays units that were rejected or accepted with errors. Description Includes information on all unit reports that were submitted the prior day and remain rejected or in error. Unit reports with rejects and/or errors that were corrected are not included on this report. Data Reports Unit Submission Results Report Frequency/Naming Convention Upon Submission UnitSubmissionResultsReport_xxxxxxx.cvs Unit Daily Submission Results Report Frequency/Naming Convention Daily UnitDailySubmissionResultsReport_xxxxxxx.cvs 36 18

21 Data Reports Feature 37 File Tracking Feature Unit Data Collection

22 Reporting and Updating Unit Data Reporting Unit Data Correction Reports Updating Header Record Update Type Code Updating Exposure Record Updating Loss Record 40 20

23 Correction Reports Requirements Unit Report Type Correction Reports: Header Record (Correction Type H) Exposure Record (Correction Type E) Loss Record (Correction Type L) Multiple Record (Correction Type M) Total Record (Correction Type T) Loss Record Corrections Due to Aggravated Inequity (Correction Type A) (FL Only) Header Record (1) Must have only 1 Must have only 1 Must have only 1 Must have only 1 Must have only 1 Must have only 1 Name Record (2) Optional Must have only 1 Must have only 1 Must have only 1 Must have only 1 Must have only 1 41 Address Record (3) None Allowed None Allowed None Allowed None Allowed None Allowed None Allowed Exposure Record (4) None Allowed Required None Allowed Required when correcting exposure(s) None Allowed None Allowed Loss Record (5) None Allowed None Allowed Required Required when correcting loss(es) None Allowed Required Total Record (6) None Allowed Optional Optional Optional Must have only 1 Optional Unit Statistical Reporting Guidebook: Part 1 B 2 Correction Sequence Number Number of Corrections Field Value First 9 sequential correction reports 1 through 9 Next 26 sequential correction reports A through Z Beyond 35 sequential correction reports Z Unit Statistical Reporting Guidebook: Part 1 C

24 Updating Unit Data Correction Reports Header Record Update Type Code Exposure Record Loss Record 43 Header Corrections 1st reports only Use Correction Type Code H or M Report all Header Record fields Updateable key fields Carrier Code, Policy Number, Policy Effective Date Use Previously Reported fields to correct key fields Exposure State is not updateable need to report a new unit Other link data fields are not updateable (Report Number, Correction Sequence Number) Contact NCCI Customer Service if you need to change 44 22

25 Header Correction for Key Fields Example Updating Policy Number Unit Statistical Reporting Guidebook Example: Part 3 B 45 Header Correction for Key Fields Example Updating Policy Number Pol Nbr WC Carrier Cd Pol Eff Dt 01/01/07 Corr Seq Nbr 1 Corr Type Cd H Prev Pol Nbr WC12345 Prev Carrier Cd Prev Pol Eff Dt Unit Statistical Reporting Guidebook Example: Part 3 B 46 23

26 Updating Unit Data Correction Reports Updating Header Record Update Type Code Updating Exposure Record Updating Loss Record 47 Update Type Code Identifies how each Exposure and Loss Record will be processed Two methods: Previous and Revised (P and R) Add, Change, and Delete (A, C, D) Statistical Plan: Part 6 Unit Statistical Reporting Guidebook: Part 1 E 48 24

27 Update Type Code R or A P and R or D and A P or D C Update Type Code Reporting Original 1st Reports Adding Exposure Class Code Adding Claims One record is required Records Required Updating or Correcting Exposure and/or Loss Information One record for the previous data (P or D) Must match previously submitted data (including matching fields) One record for the changed and unchanged data (R or A) Deleting Exposure and/or Loss Information One record is required Matching data elements must match previously submitted data To delete an entire report all records get P s or D s Correcting Exposure/Loss Information (cannot be used to update matching fields) One record is required Updated information including the same matching fields 49 Updating Unit Data Correction Reports Updating Header Record Update Type Code Updating Exposure Record Updating Loss Record 50 25

28 1st Reports Only Exposure Corrections Use Correction Type Code E or M Report Correction Sequence Number 51 Exposure Matching Fields Match Exposure Corrections to 1st Report Prevent Duplicate Exposure Records Class Code or Statistical Code Exposure Act/Exposure Coverage Code Experience Modification Effective Date Rate Effective Date 52 26

29 Unmatched Exposure Records Exposure Record on correction report: Exposure Record ( P, C, or D ) does not have a corresponding Exposure Record ( A, C, or R on the database) Based on the exposure matching fields Unit report will reject 53 Unmatched Exposure Corrective Actions When the correction rejects due to unmatched Exposure Records, then correct the invalid matching data: On the correction report or On the original 1st unit report 54 27

30 Unmatched Exposure Corrections Example Original 1st Report Pol Nbr: WC12345 Carrier Cd: Pol Eff Dt: 01/01/15 Rpt Nbr: 1 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 09 Update Type Exp Act Class Cd Exposure Amt Rate Premium Amt Experience Mod Mod Eff Dt Rate Eff Dt R , , /01/15 01/01/15 0 Split Period 55 Unmatched Exposure Corrections Example Original 1st Report Pol Nbr: Rpt WC12345 Nbr: 1 Carrier Corr Cd: Seq Nbr: 0 Pol Eff Dt: 01/01/15 Rpt Nbr: 1 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 09 Update Exp Class Exp Exposure Class Premium Mod Eff Rate Eff Split Type Act Cd Amt Rate Amt Experience Mod Mod Eff Dt Dt Rate Dt Eff Period Dt Type Act Cd R R , ,630 01/01/ /01/15 01/01/

31 Unmatched Exposure Corrections Example Exposure Correction Report Updating Exposure Classification Code Pol Nbr: WC12345 Carrier Cd: Pol Eff Dt: 01/01/15 Rpt Nbr: 1 Corr Seq Nbr: 1 Corr Type Cd: E Exp St: 09 Update Type Exp Act Class Cd Exposure Amt Rate Premium Amt Experience Mod Mod Eff Dt Rate Eff Dt P , , /01/15 01/01/15 0 R , , /01/15 01/01/15 0 Split Period Class code on previous record does not match 1st report. 57 Unmatched Exposure Corrections Example Exposure Correction Report Updating Exposure Classification Code Rpt Nbr: 1 Corr Seq Nbr: 1 Pol Nbr: WC12345 Carrier Cd: Pol Eff Dt: 01/01/15 Rpt Update Nbr: 1 Exp Corr Seq Nbr: Class 1 Corr Type Cd: E Exp St: 09 Type Update P Type Exp Act Class Cd Act 01 Exposure Amt Cd 8742 Rate Mod Eff Dt Premium 01/01/15 Mod Eff Amt Experience Mod Dt Corr Type Cd: E Rate Eff Dt 01/01/15 Rate Eff Dt Split Period P Exp 100, Class 1, /01/15 01/01/15 0 Update Type R Act 01 Cd 8742 Mod Eff Dt Rate Eff Dt 01/01/15 R , ,630 01/01/ /01/15 01/01/15 0 Class code on previous record does not match 1st report

32 Unmatched Exposure Corrections Example Exposure Correction Report Updating Exposure Classification Code Pol Nbr: WC12345 Carrier Cd: Pol Eff Dt: 01/01/15 Rpt Nbr: 1 Corr Seq Nbr: 1 Corr Type Cd: E Exp St: 09 Update Type Exp Act Class Cd Exposure Amt Rate Premium Amt Experience Mod Mod Eff Dt Rate Eff Dt Split Period P , , /01/15 01/01/15 0 R , , /01/15 01/01/ Unmatched Exposure Corrections Example Exposure Correction Report Updating Exposure Classification Code Rpt Nbr: 1 Corr Seq Nbr: 1 Corr Type Cd: E Pol Nbr: WC12345 Carrier Cd: Pol Eff Dt: 01/01/15 Rpt Update Nbr: 1 Exp Corr Seq Nbr: Class 1 Corr Type Cd: E Exp St: 09 Update Exp Class Exposure Premium Mod Eff Mod Dt Eff Rate Eff Eff Split Dt Type Act Cd Act Amt Rate Cd Amt Experience Mod Dt Dt Period P , ,630 01/01/ /01/15 01/01/15 0 R P , , /01/15 01/01/15 0 Update Type R Exp Act 01 Class Cd 8742 Mod Eff Dt 01/01/15 Rate Eff Dt 01/01/

33 Updating Unit Data Correction Reports Updating Header Record Update Type Code Updating Exposure Record Updating Loss Record 61 Loss Corrections Use Correction Type Code L All report levels A for Aggravated Inequity Claims (Florida only) Use Correction Type Code M 1st reports only Report Correction Sequence Number 62 31

34 Loss Matching Fields Match losses on subsequent and correction reports to losses on prior reports Claim Number Accident Date 63 Duplicate Loss Records Loss Record on subsequent or correction report: Loss Record ( R or A ) does not have a corresponding Loss Record ( P or D ) and Has the same matching fields on another Loss Record in the same correction report or previously submitted unit report Unit report will reject 64 32

35 Duplicate Loss Corrective Actions When the correction report rejects due to duplicate Loss Records: Correct the invalid matching data on the correction record or previously reported data or Add a Previous Record to match the previously reported data 65 Loss Example Original 1st Report Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 1 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Type Claim Nbr Accident Dt Nbr of Claims Class Code Injury Type Claim Status Cat Nbr Jurisdiction St R /11/ Indemnity Paid Indemnity Medical Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 15,000 25,000 20, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N

36 Loss Example Original 1st Report Rpt Nbr: 1 Corr Seq Nbr: 0 Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 1 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Nbr of Class Injury Claim Type Update Claim Nbr Accident Dt Claims Code Type Status Cat Nbr Jurisdiction St R Claim 07/11/08Nbr Accident 09 0 Dt 0 10 Type R /11/08 Indemnity Paid Indemnity Medical Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 15,000 25,000 20, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N Loss Example Subsequent Report Updating Claim Information Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 2 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Type Claim Nbr Accident Dt Nbr of Claims Class Code Injury Type Claim Status Cat Nbr Jurisdiction St R /11/ Indemnity Paid Indemnity Medical Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 25,000 40,000 25, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N 00 Missing previous record on subsequent report

37 Rpt Nbr: 2 Loss Example Subsequent Report Updating Claim Information Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 2 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Nbr of Class Injury Claim Type Claim Nbr Accident Dt Claims Code Type Status Cat Nbr Jurisdiction St Update R /11/ Type Claim Nbr Corr Seq Nbr: 0 Accident Dt 07/11/08 Paid Paid Paid Deductible Emp Attny Fees Clmt Attny Fees Indemnity Indemnity Medical Medical ALAE Reimbursement R 35,000 25,000 40,000 25, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N 00 Missing previous record on subsequent report. 69 Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 2 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Type Claim Nbr Accident Dt Nbr of Claims Class Code Injury Type Claim Status Cat Nbr Jurisdiction St P /11/ Indemnity Paid Indemnity Medical Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 15,000 25,000 20, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N 00 Update Type Claim Nbr Accident Dt Nbr of Claims Class Code Injury Type Claim Status Cat Nbr Jurisdiction St R /11/ Indemnity Paid Indemnity Medical Loss Example Subsequent Report Updating Claim Information Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 25,000 40,000 25, Injury Description Loss Conditions Code (type of): Code: Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Lump- Sum Fraud Claim N N

38 Pol Nbr: W Carrier Cd: Pol Eff Dt: 01/01/08 Rpt Nbr: 2 Corr Seq Nbr: 0 Corr Type Cd: Exp St: 10 Update Rpt Nbr: 2 Corr Nbr of Seq Class Nbr: Injury 0Claim Type Claim Nbr Accident Dt Claims Code Type Status Cat Nbr Jurisdiction St P /11/ Indemnity Paid Indemnity Update Medical Paid Medical Paid ALAE Deductible Reimbursement Emp Attny Fees Clmt Attny Fees 35,000 15,000 25,000 20, Injury Description Loss Conditions Code (type of): Code: Type Lump- Act Loss Recovery Claim Settlement Part Nature 07/11/08 Cause Voc Rehab Sum Fraud Claim N N 00 P Update Type Claim Nbr Accident Dt Update Loss Example Subsequent Report Updating Claim Information Claim Nbr Nbr of Claims Class Code Accident Dt Injury Type Claim Status Cat Nbr Jurisdiction St R /11/ Claim Nbr Accident Date Paid Paid Paid Deductible Emp Attny Fees Clmt Attny Fees Indemnity Indemnity Medical Medical ALAE Reimbursement 35,000 Type25,000 40,000 25, Injury Description 07/11/08 Loss Conditions Code (type of): Code: R Lump- Act Loss Recovery Claim Settlement Part Nature Cause Voc Rehab Sum Fraud Claim N N Unit Data Collection Tool 36

39 Unit Data Collection All unit report types can be entered and submitted through Unit Data Collection Update Type Code A/C/D Changes made online should be made in the carrier s system to ensure synchronization of data between NCCI and the carrier Units submitted through Unit Data Collection generate a WCSTAT data file that is sent to the carrier via Data Transfer via the Internet Return file name = udcunit_ txt Extract Data feature can be used to create subsequent reports

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41 Supplemental Information

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43 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. Lisa Combes has worked at NCCI for 15 years and is a senior data analyst in the Data Services Department in the Data Resources Division. Lisa supports NCCI s data providers by developing industry communications, data reporting manuals, and customer training materials. She is also responsible for researching and resolving escalated customer inquiries. Lisa s prior positions at NCCI include systems support manager for Residual Markets; underwriting analyst, quality technical analyst, and senior business analyst in the Assigned Risk Department; and senior technical business analyst in Residual Market Plan Administration. Lisa has 31 years of experience in the insurance industry, including personal lines and as a general liability underwriter. She is a graduate of Gateway Technical Institute.