Indemnity Data Call Overview Live Webinar

Transcription

1 Indemnity Data Call Overview Live Webinar Presented by: Julie Gonzalez and Kristin Champagne

2 Objective To gain a better understanding of the reporting requirements for the new Indemnity Data Call To assist with your company s preparations in meeting its future reporting requirements

3 Agenda Overview General Reporting Rules Records and Files Tools and Resources

4 Driving Force Legislative Pricing Identified the need for more indemnity data Worked with Actuarial Committee and the Data Collection Procedures subcommittee to develop Indemnity data proposal Presented proposal of Indemnity Data Call (IDC) to NCCI Board Received unanimous Board approval

5 What is the Indemnity Data Call? Indemnity Benefit Payments Incurred and Paid To Loss Information

6 Who s Required to Report? At least 1% IDC Reporter Latest 3 Years

7 Implementation Timeline Approved by NCCI s Board of Directors Data Educational Program to include IDC classes Start of IDC Collection 2Q Release of IDC Imp Guide and Web section Live webinars and updates available on ncci.com Certification begins 1Q20 First IDC Reporting Due 3Q20

8 Who Can Submit? Part 2 General Rules Affiliate Submit Directly Authorize a Vendor Combination of Both

9 Agenda Overview General Reporting Rules Records and Files Tools and Resources

10 What s Included in the Indemnity Data Call? Claims with indemnity incurred greater than zero within applicable jurisdictions from: Direct workers compensation Voluntary Compensation Employers Liability Policies Noncompensable or Fraudulent Claims

11 What s excluded in the Indemnity Data Call? Initial reporting should not include: Claims from non applicable jurisdictions Medical only claims

12 Applicable Jurisdictions Alabama Georgia Louisiana New Hampshire Texas Alaska Hawaii Maine New Mexico Utah Arizona Idaho Maryland Oklahoma Vermont Arkansas Illinois Mississippi Oregon Virginia Colorado Indiana Missouri Rhode Island West Virginia Connecticut Iowa Montana South Carolina Federal Act District of (USL&HW Act, Kansas Nebraska South Dakota Columbia FELA, Jones Act, Admiralty Law, and Florida Kentucky Nevada Tennessee Federal Mine Safety & Health Act)

13 Agenda Overview General Reporting Rules Records and Files Tools and Resources

14 Transactional and Quarterly Data Transactional Data Quarterly Data Provides the details of each indemnity payment transaction (wage loss, disfigurement, claimant attorney fees, etc.) The inception to date reporting of an indemnity claim

15 Transactional and Quarterly File Overview Transactional File File Control Record Transactional Record(s) Quarterly File File Control Record Quarterly Record(s)

16 Transactional Records and Files Each Transactional Record must be reported by the end of the next quarter Quarter Transaction Range Due by 1st 1/1 3/31 6/30 2nd 4/1 6/30 9/30 3rd 7/1 9/30 12/31 4th 10/1 12/31 3/31 (following year) Reporting frequency: Daily, weekly, monthly, or quarterly

17 Transactional Record Reporting Triggers Report a Transactional Record whenever any of the following circumstances occur within a specific quarter based on the transaction date Indemnity payments for claimants, claimant attorneys, vocational rehabilitation and subrogation recoveries Changes that occur to previously reported transactional records

18 Quarterly Records and Files Each Quarterly Record must be reported by the end of the quarter following the valuation date Quarter Claim Valuation Due by 1st 3/31 6/30 2nd 6/30 9/30 3rd 9/30 12/31 4th 12/31 3/31 (following year) Once the valuation date has passed, the Quarterly Records can be submitted all at once in a single file or in multiple files

19 Quarterly Record Reporting Triggers Report a Quarterly Record whenever any of the following circumstances occur during a reporting quarter: A new claim has been reported to the insurer and the incurred indemnity amount > 0 Corresponds to a Transactional Record (Original, Replacement, or Cancellation) for the same claim within a quarter The amounts of the following data elements change from the prior quarter: Indemnity Amount Paid To Incurred Indemnity Amount Medical Amount Paid To Incurred Medical Amount Allocated Loss Adjustment Expense (ALAE) Amount Paid Changes in the Jurisdiction State for a previously reported claim, when the new jurisdiction state is NOT an applicable IDC state

20 Duration of Reporting for the Claim Part 2 General Rules Reporting continues until transactions no longer occur

21 File Control Record 9 Data Elements Every Indemnity data file requires a File Control Record must be the first record in the file Identifies the carrier, the quarter that the data represents, and the number of Transactional or Quarterly Records being submitted. Record Type Submission File Type Carrier Group Reporting Quarter Reporting Year Submission File Identifier Submission Submission Time Record Total

22 Transactional Record 18 Data Elements Record Type Transaction Transaction Transaction Identifier Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Transaction From Transaction To Transaction Amount Benefit Type Lump Sum Indicator Benefit Offset Benefit Offset Amount Weekly Benefit Amount

23 Transactional Record Record Type Transaction Transaction Transaction Identifier Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident 4 Processing Fields Jurisdiction State Transaction From Transaction To Transaction Amount Benefit Type Lump Sum Indicator Benefit Offset Benefit Offset Amount Weekly Benefit Amount

24 Transactional Record Record Type Transaction Transaction Transaction Identifier Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Transaction From Transaction To Transaction Amount 5 Key Fields Benefit Type Lump Sum Indicator Benefit Offset Benefit Offset Amount Weekly Benefit Amount

25 Transactional Record Record Type Transaction Transaction Transaction Identifier 9 Transactional Detail Fields Policy Number Carrier Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Transaction From Transaction To Transaction Amount Benefit Type Lump Sum Indicator Benefit Offset Benefit Offset Amount Weekly Benefit Amount

26 Quarterly Record 37 Data Elements Record Type Transaction Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Claimant Gender Birth Year Hire Employment Status Closing Reopen Maximum Medical Improvement Reported to Insurer Accident State Attorney or Authorized Representative Indicator Method of Determining Pre Injury/Average Weekly Wage Impairment Percentage Basis Impairment Percentage Disability/LOEC Percentage Pre existing Disability Percentage Part of Body Injury Description Nature of Injury Injury Description Cause of Injury Injury Description Act Loss Condition Type of Settlement Loss Condition Medical Extinguishment Indicator Temporary Disability Benefit Extinguishment Indemnity Paid To Medical Paid To Incurred Indemnity Amount Incurred Medical Amount Employer Legal Amount Paid ALAE Paid Pre Injury/Average Weekly Wage Amount

27 Quarterly Record Record Type Transaction Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Claimant Gender Birth Year Hire Employment Status Closing Reopen Maximum Medical Improvement Reported to Insurer 2 Processing Fields Accident State Attorney or Authorized Representative Indicator Method of Determining Pre Injury/Average Weekly Wage Impairment Percentage Basis Impairment Percentage Disability/ LOEC Percentage Pre existing Disability Percentage Part of Body Injury Description Nature of Injury Injury Description Cause of Injury Injury Description Act Loss Condition Type of Settlement Loss Condition Medical Extinguishment Indicator Temporary Disability Benefit Extinguishment Indemnity Paid To Medical Paid To Incurred Indemnity Amount Incurred Medical Amount Employer Legal Amount Paid ALAE Paid Pre Injury/Average Weekly Wage Amount

28 Quarterly Record Contains all indemnity claim activities (new & existing claims) that occur in a specific quarter Record Type Transaction Carrier Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Claimant Gender Birth Year Hire Employment Status Closing Reopen Maximum Medical Improvement 5 Key Fields Reported to Insurer Accident State Attorney or Authorized Representative Indicator Method of Determining Pre Injury/Average Weekly Wage Impairment Percentage Basis Impairment Percentage Disability/ LOEC Percentage Pre existing Disability Percentage Part of Body Injury Description Nature of Injury Injury Description Cause of Injury Injury Description Act Loss Condition Type of Settlement Loss Condition Medical Extinguishment Indicator Temporary Disability Benefit Extinguishment Indemnity Paid To Medical Paid To Incurred Indemnity Amount Incurred Medical Amount Employer Legal Amount Paid ALAE Paid Pre Injury/Average Weekly Wage Amount

29 Quarterly Record Record Type Transaction Carrier 30 Quarterly Indemnity Claim Fields Policy Number Identifier Policy Effective Claim Number Identifier Accident Jurisdiction State Claimant Gender Birth Year Hire Employment Status Closing Reopen Maximum Medical Improvement Reported to Insurer Accident State Attorney or Authorized Representative Indicator Method of Determining Pre Injury/Average Weekly Wage Impairment Percentage Basis Impairment Percentage Disability/ LOEC Percentage Pre existing Disability Percentage Part of Body Injury Description Nature of Injury Injury Description Cause of Injury Injury Description Act Loss Condition Type of Settlement Loss Condition Medical Extinguishment Indicator Temporary Disability Benefit Extinguishment Indemnity Paid To Medical Paid To Incurred Indemnity Amount Incurred Medical Amount Employer Legal Amount Paid ALAE Paid Pre Injury/Average Weekly Wage Amount

30 Key Fields Data Elements Carrier Accident Policy Number Identifier Claim Number Identifier Policy Effective

31 Data Dictionary Located in Part 6 of the Implementation Guide Alphabetical Order Provides Data Elements Coding Values Examples Reporting Requirements

32 Data Elements Considerations Transaction Transactional Record Report the date that the payment (check) was made or the recovery was received. Quarterly Record The date the record was created. The Transaction cannot be prior to the valuation date for the quarter.

33 Data Elements Considerations State Exceptions Florida example: Vocational Rehabilitation Payment NOC Transactional amount paid for vocational rehabilitation services that is not classified as either evaluation, educational, or maintenance costs. FL Includes Medical Care Coordination costs

34 Specific Notes Data Elements Considerations

35 Data Elements Considerations Consistent With Statistical Plan Data

36 Data Elements Considerations Jurisdiction State

37 File Replacement Transactional or Quarterly Files can be replaced by using Submission File Type R for replacement

38 Replacing a File Submitted in Error FCR for Original File: 5,000 Transactional Records Submitted however 3,500 were reported with an incorrect carrier code. To correct submit Replacement file resend file with correct values as a Replacement (R) file. Field Title/Description Original Reported As Replacement Reported As Record Type Submission File Type O (Original) R (Replacement) Carrier Group Reporting Quarter 2 2 Reporting Year Submission File Identifier TRANS TRANS Submission Submission Time (Time file was generated) Record Total Reserved for Future Use

39 Deleting an Entire File FCR for Original File: 200 Transactional Records Submitted; however, these records were test records. Submit Replacement file as follows to correct: Field Title/Description Original Reported As Replacement Reported As Record Type Submission File Type O (Original) R (Replacement) Carrier Group Reporting Quarter 4 4 Reporting Year Submission File Identifier QTR QTR Submission Submission Time Record Total Reserved for Future Use

40 Changes to Transactional Records Option 1 Reporting with the Transaction Identifier (recommended method) Option 2 Reporting without the Transaction Identifier (accounting method)

41 Changes to Quarterly Records Delete previously reported Quarterly records Change previously reported Quarterly records

42 Editing and Validation Flow File and records processed successfully Indemnity Data Provider File and Record Acceptance Record Level Editing Validation File rejected or records returned Aggregate analysis and cross record type comparison

43 Agenda Overview General Reporting Rules Records and Files Tools and Resources

44 Certification Available 1st Quarter 2020 Edits Applied to each certification test file as if it were received in production Meet minimum formatting and quality requirements prior to production reporting Requirements Indemnity data providers are required to pass certification testing for each carrier group

45 ncci.com

46 ncci.com

47 Indemnity Data Call Implementation Guide Part 1 Introduction Part 2 General Rules Part 3 Indemnity Data Call Structure Part 4 Reporting Rules Part 5 Record Layouts Part 6 Data Dictionary Part 7 Certification Process Part 8 File Submission Requirements Part 9 Editing Procedures Part 10 Data Quality Part 11 Forms

48 Contact Us Call Customer Service Center 800 NCCI 123 ( ) We re here to assist you Monday Friday, 8:00 a.m. 8:00 p.m. ET Visit ncci.com and choose Contact Us Customer Service will respond to your request within 24 hours