EDI Newsletter. Hello!

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1 Department of Financial Services Division of Worker s Compensation Bureau of Data Quality and Collection March 2017 Volume 1, Issue 2 EDI Newsletter Hello! Welcome to issue two of the EDI Newsletter. In this issue we discuss some upcoming projects and issues for all three sections, as well as the answer key to last months puzzles. Sorry to all that we missed February! - Victoria LaPonzina Inside this issue January Puzzle Answer Keys...2 DAN Request Information...3 Triage is Traveling!...3 Calculation Tips...3 Crossword...4 Technical Tip...5 Medical EDI updates...6 Claims EDI RNR...6 SSN Redaction Request...6 Medical EDI Word Search...7 FAQ...8 Contact Information...8 Special points of interest Happy St. Patrick s Day!. VL Triage Team traveling dates have been finalized! See page 3!

2 January Answer Keys 2

3 DAN Requests If you do not have access to an IWs Social Security Number, you can request a Division Assigned Number for the IW in order to file the claim with the Division. These requests can be made by ing DWCAssigneNumber@myflorida cfo.com ~~ We ask that when you make these request that you specify the First, Middle, and Last names, as well as make the requests with the MO/DAY/ YEAR format for the dates. This will prevent additional clarify questions prior to you receiving your DAN request. ~~ It is important that your DAN request is spelled and hyphenated as you plan on reporting it to the Division. If your DAN request has the Last Name hyphenated but your submission does not, this could cause a rejection. Please be thorough and clear when submitting DAN requests. Triage Team Travel Update As mentioned in the previous issue, the Triage team will be traveling to Sarasota, St. Petersburg, and Tampa in the month of April. If the Triage Team is traveling to your city and you would like to set up a meeting, please contact Tonya Granger tonya.granger@myfloridacfo.com, You do not need to be actively involved with the Triage Team, you can use this time for additional one-on-one training. Calculation Tips Margaret and Peggy will be in the following cities during these times: Sarasota April 3rd and 4th St. Petersburg April 5th Tampa April 6th and 7th Again, you do not need to be working with the Triage team to take advantage of this one-on-one training opportunity! 2 DAYS 3 DAYS 4 DAYS When calculating for 1 DY = DY = DY = 0.25 benefits, the 2-7 DYs = 1 2 DYs = DYs = 0.50 amount of days a WK 3-7 DYs = 1 WK 3DYs = 0.75 week the IW worked 4-8 DYs = 1 WK is important as it determines how to calculate the days 5 DAYS 6 DAYS 7 DAYS 1 DY = DY = DY = reported for the 2 DYs = DYs = DYs = benefit. The 3 DYs = DYs = DYs = majority of the IWs 4 DYs = DYs = DYs = are reported as DYs = 1 5 DYs = DYs = day a week workers, WK 6-7DYs = 1 WK 6 DYs = and many calculate 7 DYs = 1 WK all benefits at a 5 day a week worker rate this causes TA-FL errors if the IW has not been reported as a 5 day a week worker. Example: A 4 day a week worker is due 1 week and 3 days of BTC 050 at a $ GWA: 3 If it is calculated as a 5 day/wk worker, the amount paid would be $ ($ x 1.6) this would result in an underpayment TA-FL error because we would expect $ ($ x 1.75) to be paid. Provided above is a quick and easy breakdown of days.

4 EDI Puzzler Across 5. The IW's pre-injury wage 7. Claim that has been taken over by a new claim administrator 9. Subsequent Report Down 1. A transaction filed when a specific benefit is being denied 2. First Report 3. This benefit is paid when the claimant is unable to perform any work for pay due to their injury, which they are expected to recover fully from 4. The code that identifies the type of payment being made 6. Full Denial Reason Code for No Coverage due to No Employee/Employer Relationship 8. Late Reason Code due to Late Notification, Jurisdiction Transfer 9. Type of Suspension filed when the IW has died 4

5 Technical Tip MTC SAs are due for every open claim every six months from the Date of Injury until the claim is closed (except in a few instances please see below excerpt from the Event Table for these exceptions). There have been a few instances when we receive s regarding claims on a trading partners Missing MTC SA list, however the claim is closed in their system. If a MTC FN is not received by the Division (or it was rejected), then the claim is not closed and a MTC SA is still due and expected by the Division. You can view your Missing MTC SA list by logging into the Warehouse and selecting Search for Proprietary Claims EDI Reports from the Main Menu. From there, you select Missing MTC SA Reports from the drop down option under Report Type and then click Search. Then the lists will be generated from most recent to earliest. Please review the most current and if you have any questions you can the Claims EDI Team at claims.edi@myfloridacfo.com The most common reason for a MTC SA to reject is due to the number of benefits that are reported on the MTC SA is greater than what was previously reported. Please be sure to verify what you have already reported to the Division prior to submitting the MTC SA. This way you can ensure that you are not submitting additional benefits or verify if you need to send a transaction prior to submitting the MTC SA. 5

6 Claims EDI RNR List Claims EDI also has a RNR list. This list is generated every Saturday and can be found in the Warehouse (first log into the Warehouse, click Search for Claims EDI Filings, and under the last drop down option Notification Listings select Rejected but not Resubmitted Listing (Updated Every Saturday). The Claims EDI team can remove transactions from your RNR list if the transaction was sent in error and is not expected to be sent again. SSN Notice If you are ing either the Claims EDI Team, the Medical EDI Team, or the Triage Team, please be sure to redact any Social Security Numbers that may be on the or included in any of the attached paper work. Medical EDI Outstanding RNR List by Justin Hale Medical EDI can be overwhelming and there are times when the number of rejected bills can be overwhelming and tough to chart or correct. However, twice a month the Division provides batch submitters with a record of the Outstanding Rejected Not Resubmitted bills. The Outstanding Rejected Not Resubmitted list is generated through an internal database and is provided to all contacts in the Division s database that wishes to receive the monthly notifications. If bills are originally rejected and resubmitted to the Division under a new control number, you may send a withdrawal to remove the older bill from the system. The bill submission reason code for this scenario is 01. We ve received feedback from some who say they can t reach the old bill due to system changes and updates. In the event a bill can t be withdrawn you may reach out to the Division for assistance. Please provide us with the initial control number along with the control number that served as a replacement, so we can review the bill for possible manual withdrawal. If the bills need to be resubmitted, please resubmit them to the Division with the corresponding reason code - in this case 02. Additionally, if you have questions about any penalties or fines as a result of rejected bills, please reach out to the CPS liaison for your company or, if you do not know who your CPS Liaison is, please contact: ssmedformat@myfloridacfo.com 6

7 Medical EDI Puzzler E T A C I L P U D L C R Y Z O H P S L C G O N H O M E L H U X W D I G V T E N Z R C R Z S X N N B L D R T C E G O R X U A L S M V T A J V D Y R W R T Z N H H A C N I I B N D L E J G S K U T F S E P C H F N D P L L S L J I M I I F F L Q A O V P I Q O B I C B L D A L E P U S J N U S S D K Q C G K H P T T F H I I S G G O P X B L Z W M R E L L I F E C A P S L H O V A U F V O N E N L E U I H N Q J R F Q N R C G T T Y B W P R E P A Y M E N T O T F M U Word Bank BILLHEADER PREPAYMENT DUPLICATE NDC SPACEFILLER RECORDFLAG REVISIONF CONTACTLIST TRANSMISSION CLIENTLIST 7

8 Frequently Asked Questions Q: I have a medical only settlement, do I need to report it to the Division? Why did my MTC PY reject for reporting BTC 501? A: Medical only settlements are not required to be reported to the Division. It would only be reportable if BTC 500 or BTC 524 is being reported as well, or has already been reported. Q: We received a fine that we do not believe we should have received. A: Please contact your designated CPS Liaison (if you do not know who is your CPS Liaison, please ssmedformat@myfloridacfo.com). We Would Appreciate Your Feedback! EDI is tricky, but we are here to help in any way that we can. How can we better assist you? What topics would you like to see in future issues? Please contact us! You can reach the EDI team by ing us at claims.edi@myfloridacfo.com You can reach the Medical EDI team by ing us at MedicalDataManagementTeam@myfloridacfo.com If you feel as though you could use additional Training Assistance with the Triage Team, please contact the Triage Claims EDI Contact Tonya Granger at tonya.granger@myfloridacfo.com or