1 florida division of workers compensation claims edi release 3 technical training 2008

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Florida Division of Workers’ Florida Division of Workers’ Compensation Compensation

Claims EDI Claims EDI Release 3 Release 3 TechnicalTechnical

TrainingTraining 20082008

FL TechnicalFL TechnicalRequirementRequirement

ss

69L-56.310, F.A.C.

FL Technical FL Technical RequirementsRequirements

The FL Technical The FL Technical Requirements can be Requirements can be found in found in 69L-56.310 69L-56.310

F.A.CF.A.C. . The following slides The following slides

highlight highlight somesome of the of the requirements in the requirements in the

rule.rule.

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Transmissions received Transmissions received on or on or beforebefore 9:00 p.m., 9:00 p.m., E.S.T., will be processed E.S.T., will be processed by DWC the same day by DWC the same day the transmission was the transmission was sent.sent.It will be acknowledged It will be acknowledged the next calendar day the next calendar day (morning). (morning).


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Transmissions received Transmissions received afterafter 9:00 p.m. EST will be 9:00 p.m. EST will be processed by DWC the processed by DWC the following calendar day. following calendar day.

It will be acknowledged the It will be acknowledged the day after the transmission day after the transmission is processed.is processed.


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FL processes FL processes transmissions transmissions 7 days a 7 days a week, week, including including holidays.holidays.

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FL Technical FL Technical RequirementsRequirementsIf either the FROI or SROI If either the FROI or SROI (filed to represent the (filed to represent the electronic equivalent of the electronic equivalent of the First Report of Injury or First Report of Injury or Illness) contains an error Illness) contains an error that results in the rejection that results in the rejection of one of the transactions, of one of the transactions, both the FROI and SROI will both the FROI and SROI will be rejected.be rejected.

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FL Technical FL Technical RequirementsRequirementsThe claim admin must The claim admin must re-re-send bothsend both the corrected the corrected FROI and SROIFROI and SROI to the to the Division in order for the Division in order for the two transactions to be two transactions to be processed together. processed together. The The Division will only pair Division will only pair FROI’s and SROI’s that are FROI’s and SROI’s that are received by the Division on received by the Division on the same day.the same day.

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R3 transactions must be R3 transactions must be sent to DWC using only the sent to DWC using only the following transmission following transmission methods:methods:

Advantis Value Added Advantis Value Added NetworkNetwork (VAN), OR (VAN), OR

Secure Socket Layer/File Secure Socket Layer/File Transfer Protocol (SSL/FTP)Transfer Protocol (SSL/FTP) in in accordance with instructions accordance with instructions on on Form DFS-F5-DWC-EDI-4Form DFS-F5-DWC-EDI-4


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Sender ID =Sender ID = Claim Claim Admin’s/Insurer FEIN Admin’s/Insurer FEIN

++ Claim Admin’s/Insurer’s Claim Admin’s/Insurer’s

Postal Code as reported on: Postal Code as reported on:

Form DFS-F5-DWC-EDI-1 & EDI-3Form DFS-F5-DWC-EDI-1 & EDI-3


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NOTE:NOTE: All 9 digits of the All 9 digits of the Trading Partner’s Postal Trading Partner’s Postal Code should be sent in the Code should be sent in the Sender ID. Sender ID. This postal This postal code must match either the code must match either the Physical or Mailing Sender Physical or Mailing Sender Address Postal Code, and Address Postal Code, and should be a valid location should be a valid location for the company.for the company.

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FL Technical FL Technical RequirementsRequirementsThe Sender ID on the The Sender ID on the Header Record shall Header Record shall represent the insurer’s represent the insurer’s or claim administrator’s or claim administrator’s FEIN and Postal Code, FEIN and Postal Code, notnot that of the vendor. that of the vendor.

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FL Technical FL Technical RequirementsRequirementsIf a vendor is submitting If a vendor is submitting files on behalf of more files on behalf of more than one insurer or claim than one insurer or claim administrator, the administrator, the vendor shall send vendor shall send separate header and separate header and trailer records for trailer records for eacheach client.client.

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Receiver FEIN for FL = Receiver FEIN for FL = 596001874596001874

Receiver Postal Code for FL Receiver Postal Code for FL = = 323994226323994226


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File Naming File Naming ConventionsConventions

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There is no standard file There is no standard file name for Trading Partners name for Trading Partners using using Advantis.Advantis.

Each file is simply a Each file is simply a message in the Division’s message in the Division’s mail box. However, the mail box. However, the Trading Partner must Trading Partner must include the include the FROI/SROI FROI/SROI Message ClassMessage Class when they when they transmit a file (see DWC transmit a file (see DWC “Receiver Specifications”.) “Receiver Specifications”.)

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If you do not have a current If you do not have a current FTP account established FTP account established with the Division, you are with the Division, you are required to have one set up required to have one set up prior to sending a prior to sending a transmission.transmission.FTP Filing instructions are FTP Filing instructions are documented in the documented in the DFS-F5-DWC-EDI-4 Form: SSL / FTP Instructions for POC EDI and Claims EDI..

FTP File Naming FTP File Naming ConventionConvention

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If you currently have a If you currently have a Medical (non-claims) FTP Medical (non-claims) FTP account established with the account established with the Division, it is not necessary Division, it is not necessary to set up a separate SSL/FTP to set up a separate SSL/FTP account for your Claims account for your Claims submissions.submissions.

Please contact the Division Please contact the Division about setting up your Claims about setting up your Claims SSL/FTP account at SSL/FTP account at [email protected]

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SSuseriduserid148-CCYYMMDD-148-CCYYMMDD-HHMMSSz.TXT HHMMSSz.TXT SSuseriduseridA49-CCYYMMDD-A49-CCYYMMDD-HHMMSSz.TXTHHMMSSz.TXT

The first letter is fixed and shall = “S”; The first letter is fixed and shall = “S”; ““userid” = Division-assigned userid” = Division-assigned nine digitnine digit TP TP ID. “148”, “A49” refer to the electronic ID. “148”, “A49” refer to the electronic formats in which data are sent.formats in which data are sent.

The CCYYMMDD = date transmission sent.The CCYYMMDD = date transmission sent.HHMMSS =hour, minutes, and seconds, HHMMSS =hour, minutes, and seconds, and and ““z” =file is being sent as test (“T”) or z” =file is being sent as test (“T”) or production (“P”), followed by .TXT.production (“P”), followed by .TXT.


TechnicalTechnicalOverviewOverview

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Release 3 Release 3 RecordsRecords

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Release 3 RecordsRelease 3 Records A A Record Record is a group of related ‘Data is a group of related ‘Data

Elements’ that form a transaction.Elements’ that form a transaction.

In R3, the FROI and SROI In R3, the FROI and SROI are comprised of are comprised of 2 Records2 Records

each: each: 148148 + + R21R21 = = FROI FROI A49A49 + +

R22R22 = SROI = SROI

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Release 3 RecordsRelease 3 Records

Some Release 3 Some Release 3 RecordsRecords are are FixedFixed length and length and some are some are VariableVariable length.length.

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Release 3 RecordsRelease 3 RecordsIdentified by DN0001-Identified by DN0001-Transaction Set IDTransaction Set ID

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Fixed Fixed LengthLength Record Record

The length of a “Fixed The length of a “Fixed Length Record” is Length Record” is consistently the same consistently the same number of data positions number of data positions each time the record is each time the record is assembled. assembled.


The data within the record The data within the record is always in the same is always in the same position within the record, position within the record, based on the individual based on the individual record layout .record layout .

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Variable Length RecordVariable Length Record

The length of a The length of a “Variable Length “Variable Length Record” Record” may varymay vary each time the each time the record is record is assembled. assembled.


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Variable Length RecordVariable Length RecordThe record length is The record length is determined using the determined using the “Variable Segment Counters” “Variable Segment Counters” which are the “ which are the “ Number ofNumber of ” ” fields in the FROI and SROI fields in the FROI and SROI segments. These segments segments. These segments occur zero to many times occur zero to many times based on the allowed number based on the allowed number of occurrences for the of occurrences for the segment.segment.

Note: These fields Note: These fields must must always be always be present.present.


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Although each Although each segment is a fixed segment is a fixed length, the total record length, the total record length will vary length will vary depending on the depending on the number of segments. number of segments.

Variable Length Variable Length RecordRecord

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When a variable length When a variable length record is sent, the entire record is sent, the entire segment should be sent, even segment should be sent, even if there are blanks.if there are blanks.Example: Example:

Benefits segment = 103 charactersBenefits segment = 103 characters

Payments segment = 98 charactersPayments segment = 98 characters

Other Benefits segment = 34 charactersOther Benefits segment = 34 characters

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Release 3 RecordsRelease 3 RecordsVariable Length RecordsVariable Length Records

Let’s see how it works… Let’s see how it works…

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Counters Counters determidetermine the ne the overall overall record record length.length.

Release 3 Variable SegmentsRelease 3 Variable SegmentsPartial display of SROI R22 Partial display of SROI R22 recordrecord

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When When the the transactitransaction on includes includes one one Benefits Benefits segmentsegment, , ((Fixed Fixed length = length = 650)650)


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The The BenefitsBenefits segment segment = 103 = 103 bytes, bytes, the R22 the R22 record record ends at ends at position position 753. 753.


Ben Ben Seg Seg == 103 103

BytesBytes

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Release 3 RecordsRelease 3 RecordsVariable Length RecordVariable Length RecordLet’s try one more…Let’s try one more…

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Counters Counters determine determine the overall the overall record record length.length.

Release 3 Variable SegmentsRelease 3 Variable Segments

Fixed lengthFixed length

= 650= 650

Overall Overall lengthlength

= 803= 803

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The The transactitransaction on includes includes one one Benefits Benefits segment segment and one and one SuspensiSuspension on NarrativeNarrative..


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Suspension Suspension NarrativeNarrative = = 50 bytes.50 bytes.

BenefitsBenefits segment segment = 103 = 103 bytes; bytes;


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The R22 The R22 record record ends ends at at position position 803. 803.


TransactionTransactionss

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Release 3 Release 3 TransactionsTransactions consist of 2 records consist of 2 records toto report a report a claimclaim event event148

A49

R22

R21 FROIFROI

SROISROI

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Transaction ‘KEY’Transaction ‘KEY’The Claim Administrator The Claim Administrator Claim Number (DN0015) is Claim Number (DN0015) is a a MANDATORY MANDATORY “KEY" used “KEY" used to validate:to validate:–148 record relationship to 148 record relationship to R21 companion recordR21 companion record

–A49 record relationship to A49 record relationship to R22 companion recordR22 companion record

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Transaction ‘KEY’Transaction ‘KEY’The Claim Administrator The Claim Administrator Claim Number (DN0015) Claim Number (DN0015) ties the records ties the records together!together!

This ensures proper FROI This ensures proper FROI to SROI combo processing. to SROI combo processing.

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FROI Companion record FROI Companion record relationship is verified by relationship is verified by comparing comparing Claim Administrator Claim Administrator Claim NumberClaim Number (positions 205 (positions 205 to 229 in the 148 record),….to 229 in the 148 record),….

Transaction ‘KEY’ Transaction ‘KEY’ FROIFROI

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……to positions 24 to 48 on the to positions 24 to 48 on the R21 (next record in the batch). R21 (next record in the batch). When a match is found, the When a match is found, the relationship is confirmed.relationship is confirmed.

Transaction ‘KEY’ Transaction ‘KEY’ FROIFROI

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SROI Companion record SROI Companion record relationship is verified by relationship is verified by comparing comparing Claim Claim Administrator Claim NumberAdministrator Claim Number positions 136 to 160 on the positions 136 to 160 on the A49 recordA49 record

Transaction ‘KEY’ Transaction ‘KEY’ SROISROI

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to positions 24 to 48 on the to positions 24 to 48 on the R22 (next record in the R22 (next record in the batch). When a match is batch). When a match is found, the relationship is found, the relationship is confirmed.confirmed.

Transaction ‘KEY’ Transaction ‘KEY’ SROISROI

BatcheBatchess

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BATCH

Trailer

Header

FROITransactions

Header

Trailer

FROI

Transactions

BATCH

FILE: FILE: Consists of 1 Consists of 1 or more or more batches of batches of the same the same type of type of transaction transaction (e.g., FROI) (e.g., FROI)

**A separate SROI A separate SROI file is sent with 1 file is sent with 1 or more SROI or more SROI batches.batches.

F F I I LLEE

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BATCH

BATCH:BATCH: Consists of Consists of 1 Header 1 Header record, one record, one or more or more TransactionTransactions and 1 s and 1 Trailer Trailer record.record.

Note:Note: These These would be sent would be sent in 2 separate in 2 separate files.files.

Trailer

Header

FROITransactions

Header

Trailer

SROI

Transactions

BATCH

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TrailerTrailer

HeaderHeader

FROIFROITransactionsTransactions

BBAATTCCHH

148 Rec 1

148 Rec 3

FROI

FROI

R21 Rec 2

FROIR21 Rec 4

FROIFROI148 Rec 5

FROIFROIR21 Rec 6

Batch of FROI Batch of FROI transactionstransactions 8 records; 4 8 records; 4 transactionstransactions

FROIFROI148 Rec 7

FROIFROIFROIFROIR21 Rec 8

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TrailerTrailer

HeaderHeader

SROISROITransactionsTransactions

BBAATTCCHH

A49 Rec 1

A49 Rec 3

FROI

FROI

R22 Rec 2

FROIR22 Rec 4

FROIFROIA49 Rec 5

FROIFROIR22 Rec 6

Batch of SROI Batch of SROI transactions transactions 8 records; 4 8 records; 4 transactionstransactions

FROIFROIA49 Rec 7

FROIFROIFROIFROIR22 Rec 8

Header Header RecordRecord

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uniquely identifiesuniquely identifies the the sender (Claim sender (Claim Admin/Insurer),Admin/Insurer),

HD1 – Release 3 Header HD1 – Release 3 Header RecordRecord

and date/time batch was prepared.and date/time batch was prepared.the receiver the receiver (FL),(FL),

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Date Transmission Sent Date Transmission Sent MUST be the same day the MUST be the same day the file is actually sent to DWC. file is actually sent to DWC.


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DATE TRANSMISSION SENT – DATE TRANSMISSION SENT – DN0100DN0100DefinitionDefinition: Actual date the : Actual date the batch of data was sent to thebatch of data was sent to the receiverreceiver..

CLAIMS RELEASE 3.0 STANDARDS DATA CLAIMS RELEASE 3.0 STANDARDS DATA DICTIONARYDICTIONARY


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FL ProcessingFL Processing::FL will edit Date Transmission Sent to FL will edit Date Transmission Sent to

ensure that the date is ensure that the date is within 1 daywithin 1 day of of receipt (not edited in R1).receipt (not edited in R1).

Batch processing order will be determined Batch processing order will be determined by Date Transmission Sent and Time by Date Transmission Sent and Time Transmission Sent.Transmission Sent.

Time Transmission Sent for FROI batches Time Transmission Sent for FROI batches must be prior to (at least a fraction of a must be prior to (at least a fraction of a second) the Time Sent for SROI batches, to second) the Time Sent for SROI batches, to ensure proper “combo” processing.ensure proper “combo” processing.

HD1 – HD1 – ReleaseRelease 3 Header 3 Header RecordRecord

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Identifies whether the batch Identifies whether the batch contains test or production contains test or production data and thedata and theInterchange Version ID (e.g. Interchange Version ID (e.g. 14830).14830).

FROI FROI RecordsRecords

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148148 – 913 Byte Fixed Length – 913 Byte Fixed Length RecordRecord

Release 3 FROI recordRelease 3 FROI record

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R21R21– Variable Length Record – Variable Length Record Counters determine record Counters determine record lengthlength

R3 FROI Companion R3 FROI Companion recordrecord

SROI SROI RecordsRecords

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Release 3 SROI recordRelease 3 SROI record..A49A49 – Variable Length Record – Variable Length Record

Counters determine record Counters determine record lengthlength

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R3 SROI Companion R3 SROI Companion recordrecordR22R22 – Variable Length Record – Variable Length Record

Counters determine record Counters determine record lengthlength

Trailer Trailer RecordRecord

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TR2 – Release 3 Trailer TR2 – Release 3 Trailer RecordRecord

designates designates the endthe end of a of a batch of transactionsbatch of transactions

provides provides a counta count of records of records and transactions within a and transactions within a batchbatch is used to ensure that the is used to ensure that the entire batch is entire batch is complete complete and validand valid

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Pop Quiz: Pop Quiz:

If If

the Detail Record the Detail Record Count in the Count in the

Trailer is 6, what Trailer is 6, what would the would the

Transaction Count Transaction Count be?be?

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Pop Quiz Answer: Pop Quiz Answer:

If the Detail If the Detail Record Count in Record Count in the Trailer is 6, the Trailer is 6, the Transaction the Transaction

Count would be Count would be 33..

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Data Data PopulationPopulation

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Prior to populationPrior to population of data of data elements into the record, elements into the record, allall positions are defined as positions are defined as spacesspaces. .

Data PopulationData Population

This indicates absence of This indicates absence of data or no population of data or no population of data in the field.data in the field.

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Data Element Data Element FormatsFormats

The data format The data format becomes becomes applicable only applicable only when the data when the data element is element is populated in populated in the the record.record.

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This means that This means that “numeric” fields “numeric” fields that are not being that are not being populated should populated should be sent as spaces be sent as spaces and not zeros.and not zeros.

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Data Data FormatsFormats

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Data ElementData Element:: A single A single piece of information. piece of information.

Definitions, standard data Definitions, standard data format, valid data values format, valid data values and population rules for and population rules for Release 3 data elements Release 3 data elements are defined in the Data are defined in the Data Dictionary in Section 6 of Dictionary in Section 6 of the Release 3 the Release 3 Implementation Guide.Implementation Guide.

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Data Element Data Element InformationInformation

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Data Element Data Element InformationInformationRelease 3 standard data Release 3 standard data

formats are defined in the formats are defined in the System Rules in Section 2 System Rules in Section 2 of the Release 3 of the Release 3 Implementation Guide.Implementation Guide.Let’s check out Let’s check out the standard datathe standard data formats…formats…

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Dates: Type = DATE Dates: Type = DATE (CCYYMMDD): (CCYYMMDD): Data Data elements that are assigned elements that are assigned the format of DATE should the format of DATE should be populated with only a be populated with only a valid date. valid date. Example: 12/01/2007; Example: 12/01/2007; December 1, 2007, 12-December 1, 2007, 12-1-071-07 would be sent as : would be sent as : 20071201 20071201 (CCYYMMDD)(CCYYMMDD)

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All zeros in a date All zeros in a date field are considered field are considered to be invalid data. to be invalid data.

2007120120071201Dates: Type = DATE:Dates: Type = DATE:

Spaces indicate Spaces indicate absence of data, do absence of data, do not zero fill.not zero fill.

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Time: Type = TIME:Time: Type = TIME: Data Data elements that are assigned elements that are assigned the format of TIME should be the format of TIME should be populated with only a valid 24-populated with only a valid 24-hour military time. hour military time.

11:54 pm

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Time: Type = TIME:Time: Type = TIME: The valid values for The valid values for military time are military time are only only 000000 (midnight) through (midnight) through 235959235959. .

Example: Example: HHMMSS: HHMMSS: 142903142903 = 2:29:03 P.M. = 2:29:03 P.M.

Spaces indicate absence of data.Spaces indicate absence of data.

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Time: Type = TIME:Time: Type = TIME: There is a difference in There is a difference in the length and Valid the length and Valid Values of DN0032 Time Values of DN0032 Time of Injury and the other of Injury and the other time fields (as on the time fields (as on the header).header).

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Numeric: Type = N:Numeric: Type = N: Data Data elements that are assigned elements that are assigned the format of N should be the format of N should be populated with only a valid populated with only a valid numeric. If the data numeric. If the data element is not populated, element is not populated, spaces should be sent.spaces should be sent.

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Numeric: Type = N:Numeric: Type = N:

Example: Example: 3 numeric ‘123’ in 6 byte field 3 numeric ‘123’ in 6 byte field = = 000123 000123

Spaces indicate absence of data.Spaces indicate absence of data.Negative numbers are not valid.Negative numbers are not valid.

Valid values consist of 0 -9 Valid values consist of 0 -9 and are right justified zero and are right justified zero filled to the left.filled to the left.

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Monetary Amounts: Type = $9.2:Monetary Amounts: Type = $9.2: Data Data elements that are assigned the elements that are assigned the format of $9.2 should be populated format of $9.2 should be populated with with only a valid monetary only a valid monetary amount. amount.

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Monetary Amounts: Type = Monetary Amounts: Type = $9.2:$9.2:Valid entries consist of eleven Valid entries consist of eleven

numeric digits with the dollar numeric digits with the dollar sign assumed (not populated), sign assumed (not populated), and the decimal point between and the decimal point between the ninth and tenth position (2 the ninth and tenth position (2 positions from the right) is positions from the right) is assumed (not populated). assumed (not populated). Example: 00000005000 = $50.00Example: 00000005000 = $50.00

000000050000000050^̂

0000Spaces indicate absence of data. Spaces indicate absence of data. Negative numbers are not Negative numbers are not applicable.applicable.

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Percentage (PI): Type Percentage (PI): Type = 3.2:= 3.2: Data elements Data elements that are assigned that are assigned the format of 3.2 the format of 3.2 should be should be populated populated with only a valid with only a valid percentage.percentage.

125%

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Percentage: Type = 3.2:Percentage: Type = 3.2:Valid entries consist of 0 - 9 Valid entries consist of 0 - 9 and are right justified zero and are right justified zero filled to the left. The decimal filled to the left. The decimal point is assumed (not point is assumed (not populated) between the third populated) between the third and fourth position (2 positions and fourth position (2 positions from the right).from the right). Spaces indicate absence of Spaces indicate absence of data.data.Negative numbers are not Negative numbers are not applicable.applicable.

Example: 05000 = 50.00%Example: 05000 = 50.00%050050^̂0000

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Percentage: Type = 3.2:Percentage: Type = 3.2:

Caution – 0% is a valid PI Caution – 0% is a valid PI rating; therefore, 00000 rating; therefore, 00000 should only be sent when should only be sent when a PI rating is truly a valid a PI rating is truly a valid zero %, and not when this zero %, and not when this field is not populated.field is not populated.

00

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Data elements that are Data elements that are defined in the format of A/N defined in the format of A/N include upper case letters, include upper case letters, lower case letters, numeric lower case letters, numeric digits, space character, and digits, space character, and special characters defined in special characters defined in System Rules of the R3 System Rules of the R3 Implementation Guide Implementation Guide


Alpha numeric: Type = A/N:Alpha numeric: Type = A/N:

Spaces indicate absence of Spaces indicate absence of data. data.

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When using an When using an alphanumeric field the alphanumeric field the significant characters are significant characters are always left justified in the always left justified in the field with any remaining field with any remaining space in the field padded space in the field padded with spaces. with spaces. SMITHSMITH (space)

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Use of any of the Use of any of the alphanumeric characters is alphanumeric characters is permitted in data elements permitted in data elements with the alphanumeric data with the alphanumeric data type type unlessunless otherwise otherwise indicated in an indicated in an Implementation Note or an Implementation Note or an Edit Matrix Population Edit Matrix Population Restriction (e.g. Employee Restriction (e.g. Employee Last Name)Last Name)..

91

Lets start Lets start building a building a SROISROI transactiotransactionn

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The fixed length portion of The fixed length portion of the SROI A49 record is 208 the SROI A49 record is 208 bytes.bytes.Population of the record Population of the record starts out with 208 spaces.starts out with 208 spaces.

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DN0001 (Transaction Set DN0001 (Transaction Set ID) is a 3 digit A/N ID) is a 3 digit A/N (alphanumeric) field.(alphanumeric) field.Valid Transaction Set ID Valid Transaction Set ID replaces the spaces in replaces the spaces in positions 1 through 3.positions 1 through 3.

A49

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DN0002 (Maintenance Type DN0002 (Maintenance Type Code) is a 2 digit A/N Code) is a 2 digit A/N (alphanumeric) field.(alphanumeric) field.A valid MTC replaces the A valid MTC replaces the spaces in positions 4 and 5.spaces in positions 4 and 5.

A49IP

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A49IP

20071201

DN0003 (Maintenance Type DN0003 (Maintenance Type Code Date) is an 8 digit Code Date) is an 8 digit DATE field.DATE field.A valid date replaces the A valid date replaces the spaces in positions 6 spaces in positions 6 through 13.through 13.

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In this example, Employee In this example, Employee Number of Dependents is Number of Dependents is required and the Employee required and the Employee has no dependents. has no dependents. The sender populates with The sender populates with zero.zero.

00

97

If the Employee Number of If the Employee Number of DependentsDependents was not known was not known or the data element was not or the data element was not required/sent, it would be required/sent, it would be populated with spaces populated with spaces (another example: PI rating).(another example: PI rating).


AcknowledgemAcknowledgementsents

Florida

AcknowledgeAcknowledgement ment

OverviewOverview

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What is an Acknowledgement What is an Acknowledgement (AKC)?(AKC)?

Acknowledgement Acknowledgement

Electronic Electronic ReportReport

Claim Claim AdministratAdministratoror

FloridaFlorida

An AKC transaction is An AKC transaction is returned by Florida as a result returned by Florida as a result of a transaction sent.of a transaction sent.

101

What is contained in What is contained in the Acknowledgement?the Acknowledgement?

Enough information to identify Enough information to identify the original transaction and the original transaction and any technical and business any technical and business issues.issues.

102

How does the How does the acknowledgement acknowledgement communicate the status?communicate the status?

By DN0111 - Application By DN0111 - Application Acknowledgement Code, which is Acknowledgement Code, which is located in each acknowledgement located in each acknowledgement record.record.

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What is the Application What is the Application Acknowledgement Code?Acknowledgement Code?

A code used to identify A code used to identify the accepted/rejected the accepted/rejected status of the status of the transaction(s) being transaction(s) being acknowledged.acknowledged.

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Application Acknowledgement Application Acknowledgement Code Values for FL:Code Values for FL:

TA - Transaction AcceptedTA - Transaction AcceptedTR - Transaction RejectedTR - Transaction RejectedHD – Entire Batch RejectedHD – Entire Batch Rejected

(Header or Trailer error)(Header or Trailer error)

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Transaction Accepted Transaction Accepted (TA)(TA)The transaction was The transaction was

accepted by Florida.accepted by Florida.No “fatal” errors No “fatal” errors were found on the were found on the transaction.transaction.Further follow up may Further follow up may be required if “non-be required if “non-fatal” errors are noted fatal” errors are noted in the FL EDI Online in the FL EDI Online Data Warehouse. (TA-Data Warehouse. (TA-FL)FL)

106

An error was An error was found on found on a a mandatory or mandatory or mandatory mandatory conditional conditional data element.data element.

Transaction Rejected Transaction Rejected (TR)(TR)

The transaction was not The transaction was not accepted or added to accepted or added to Florida’s Florida’s system as a system as a reported claim.reported claim.

107


A review of the A review of the error error should should take place totake place todetermine what determine what action should be action should be taken to resolve taken to resolve the the issue.issue.

108

An MTC CO (Correction) is An MTC CO (Correction) is notnot used to used to respond to a TR acknowledgement, respond to a TR acknowledgement, and FL does not accept CO’s.and FL does not accept CO’s.

If a transaction rejects, the original If a transaction rejects, the original MTC must be re-filed (unless wrong MTC must be re-filed (unless wrong MTC was sent).MTC was sent).

If an error is for a duplicate If an error is for a duplicate transaction, invalid event sequence, transaction, invalid event sequence, etc. then resubmission may not be etc. then resubmission may not be required.required.


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The Batch is The Batch is rejected in rejected in

its its entirety.entirety.

Batch Rejected (HD)Batch Rejected (HD)

When a Batch Reject When a Batch Reject occurs, only one AKC record occurs, only one AKC record

will be returned in the will be returned in the acknowledgement batch.acknowledgement batch.

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Batch Reject ReasonsBatch Reject ReasonsInvalid Sender ID (No Invalid Sender ID (No

acknowledgement batch acknowledgement batch will be returned since the will be returned since the sender is unknown). DWC sender is unknown). DWC will try to determine who will try to determine who sent file and advise.sent file and advise.

Invalid data in Header Invalid data in Header RecordRecord

Duplicate BatchDuplicate BatchInvalid data in Trailer Invalid data in Trailer

RecordRecordTransaction not present in Transaction not present in

the batch (invalid batch the batch (invalid batch structure)structure)

111

How does the AKC How does the AKC

transaction transaction communicate communicate

errorserrors

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Number of Errors indicate the Number of Errors indicate the number of ‘Error Segment’ number of ‘Error Segment’ occurrences.occurrences.

Number of Errors Number of Errors (DN0114)(DN0114)

113

The Element Number The Element Number indicates the data element indicates the data element where the error was found.where the error was found.

Element Number Element Number (DN0115)(DN0115)

114

Element Error Number Element Error Number (DN0116)(DN0116)

The Element Error Number The Element Error Number identifies the type of error identifies the type of error found on an element. found on an element.

115

Variable Segment Number Variable Segment Number (DN0117)(DN0117)

The Variable Segment The Variable Segment Number identifies the Number identifies the occurrence of the variable occurrence of the variable segment in error. Default segment in error. Default when not applicable is 00.when not applicable is 00.

116

Variable Segment Number Variable Segment Number (DN0117)(DN0117)

The Claim Administrator The Claim Administrator must be able to identify the must be able to identify the order in which variable order in which variable segments were sent segments were sent because FL’s because FL’s acknowledgement will acknowledgement will reflect the Variable Segment reflect the Variable Segment Number, in the order in Number, in the order in which it was sent in the which it was sent in the transaction, to identify transaction, to identify which variable segment was which variable segment was in error. in error.

117

Element Error Text Element Error Text (DN0291)(DN0291)

The free form Element Error The free form Element Error Text describes the error.Text describes the error.


ManagementManagement

119

Acknowledgement Acknowledgement ManagementManagement

An acknowledgement batch An acknowledgement batch contains AKC transactions contains AKC transactions returned by Florida for returned by Florida for each transaction that was each transaction that was sent in the original FROI or sent in the original FROI or SROI batch.SROI batch.

120

In one day, Claim Admin In one day, Claim Admin sends 3 files of FROI’s sends 3 files of FROI’s containing 2 batches each (6 containing 2 batches each (6 FROI batches total).FROI batches total).

This equates to 6 AKC This equates to 6 AKC batches which FL will return batches which FL will return in 1 file.in 1 file.

Note: SROI’s are sent in Note: SROI’s are sent in separate file.separate file.


121


The file naming The file naming conventions for conventions for R3 R3 acknowledgements acknowledgements returned by the Divisionreturned by the Division are:are:

CLMCLMAKCAKC-userid-CCYYMMDD--userid-CCYYMMDD-HHMMSSz.TXT HHMMSSz.TXT CLMCLMARCARC-userid-CCYYMMDD--userid-CCYYMMDD-HHMMSSz.TXTHHMMSSz.TXT

Note:Note: The date and time on the AKC and ARC The date and time on the AKC and ARC filenames correspond to the date and time filenames correspond to the date and time (including seconds) the file was created and (including seconds) the file was created and does not correspond to any original does not correspond to any original incoming file sent by the trading partner.incoming file sent by the trading partner.

122

AKC for each AKC for each TransactionTransactionFROI ExampleFROI Example

148 Record 1

R21 Record 2

148 Record 3

R21 Record 4

148 Record 5

R21 Record 6

148 Record 7

R21 Record 8

Header

Trailer

FROITransactio

ns

Claim Administrator sends:Claim Administrator sends:

Header (HD1)

Trailer (TR2)

AKC TA Record 1

AKC TA Record 2

AKC TR Record 3

AKC TR Record 4

Florida returns:Florida returns:

123


Each acknowledgement record Each acknowledgement record contains various key data to allow contains various key data to allow the match of the acknowledgement the match of the acknowledgement back to the original report sent…. back to the original report sent….

124

Key Data Key Data ExampleExamples:s:

125

Record Sequence Number Record Sequence Number (DN0107)(DN0107)

The Claim Admin. must be The Claim Admin. must be able to identify the order in able to identify the order in which the transactions which the transactions were sent in the batch, were sent in the batch, because FL’s because FL’s acknowledgement will acknowledgement will reflect the reflect the Record Record Sequence NumberSequence Number in the in the order in which the order in which the transaction was sent in the transaction was sent in the batch, to identify batch, to identify specifically specifically which which transaction was in error. transaction was in error.

126

HEADER RECORD (HD1) for FROIHD1666777888 888777666999999999 23423424220010327074530

P148301 2 3 4 5 6

7 8 9

1 2 3 4 5 6 7 8 9

HD1999999999 234234242666777888 8887776662001032808134020010327074530PAKC30

HEADER RECORD (HD1) for AKC

1=Transaction Set ID (DN0001) 2=Sender ID (DN0098) to 3=Receiver ID (DN0099) 3=Receiver ID (DN0099) to 2=Sender ID (DN0098) 4=Date Transmission Sent (DN0100) to 6=Original

Transmission Date (DN0102)5=Time Transmission Sent (DN0101 to 7=Original

Transmission Time (DN0103) 8=Test Production Code (DN0104) to 8=Test Production Code

(DN0104)9=Interchange Version ID (DN0105) DIFFERENT

Header Record is used toHeader Record is used tomatch the original batch to match the original batch to

AKC batchAKC batchFROI example:FROI example:

127

Trailer Record is used toTrailer Record is used tomatch the original batch to AKC match the original batch to AKC

batchbatch

TRAILER RECORD (TR2) for FROI TR2000000002000000001

TR2000000001000000001TRAILER RECORD (TR2) for AKCTransaction Count (DN0191) is the total number

of transactions sent as part of the batch.The FROI or SROI Transaction Count should be

matched to the AKC Transaction Count.

The count should be the same.The count should be the same.

FROI example:FROI example:

128

Trailer Record Trailer Record ValidationValidation

The claim administrator The claim administrator should actively check should actively check acknowledgements to acknowledgements to determine if the AKC determine if the AKC Transaction Count matched Transaction Count matched the FROI or SROI the FROI or SROI Transaction Count sent.Transaction Count sent.

Note: One Note: One Acknowledgement batch is Acknowledgement batch is returned for each FROI and returned for each FROI and SROI batch sent. SROI batch sent.

AcknowledgeAcknowledgement File/ ment File/

Batch Batch ExamplesExamples

130

AKC Batch FactsAKC Batch FactsInterchange Version ID Interchange Version ID

identifies the batch type:identifies the batch type:– AKC30 (Acknowledgement AKC30 (Acknowledgement batch)batch)

Transaction Set ID values Transaction Set ID values identify the transactions:identify the transactions:–HD1 (Header)HD1 (Header)–AKC (Acknowledgement)AKC (Acknowledgement)–TR2 (Trailer)TR2 (Trailer)

131

AKC Batch FactsAKC Batch Facts

The The Acknowledgement Acknowledgement transaction is a transaction is a Variable Length Variable Length record.record.

132

AKC File/Batch ExampleAKC File/Batch Example

AKCAKC

AKCAKC

TrailerTrailer

HeaderHeader

HeaderHeader

AKCAKC

TrailerTrailer

AKCAKC

AKCAKC

AKCAKC

FileFile

133

AKC Variable Segments Example

Partial display of AKC recordPartial display of AKC recordNumber of Errors Number of Errors

determine the determine the overall record overall record lengthlength

The transaction The transaction

includes two Error includes two Error segmentssegments

Error segment = Error segment = 118 bytes (two 118 bytes (two 59 byte 59 byte segments). The segments). The AKC record ends AKC record ends at position 366at position 366

Fixed length = Fixed length = 248248

Re-Re-Acknowledgement Acknowledgement

(ARC)(ARC)

135

What is a Re-Acknowledgement What is a Re-Acknowledgement (ARC)?(ARC)?

An ARC is a type of acknowledgement transaction that is An ARC is a type of acknowledgement transaction that is returned by Florida as a result of reloading or reprocessing a returned by Florida as a result of reloading or reprocessing a previously acknowledged transaction that was rejected in previously acknowledged transaction that was rejected in error by DWC. The entire batch is re-acknowledged.error by DWC. The entire batch is re-acknowledged.

DWC will credit the Claim Administrator with the original DWC will credit the Claim Administrator with the original filing date.filing date.

136

ARC Batch FactsARC Batch FactsHeader (HD1) Interchange Version Header (HD1) Interchange Version

ID is:ID is:– ARC30 ARC30 (Re-Acknowledgement batch)(Re-Acknowledgement batch)

Transaction Set ID values with the Transaction Set ID values with the ARC batch identify the ARC batch identify the transactions:transactions:

- - ARC ARC (Re-processed Transactions)(Re-processed Transactions)

– AKC AKC (Previously Acknowledged (Previously Acknowledged Transactions that are Transactions that are

unchanged)unchanged)

137

Caution to Claim Caution to Claim AdministratorsAdministrators

If you choose not to process the Re-Acknowledgement or If you choose not to process the Re-Acknowledgement or if your system can not support a 2if your system can not support a 2ndnd acknowledgement acknowledgement outcome for the same transaction, this may result in outcome for the same transaction, this may result in subsequent “duplicate” and “sequencing” errors. subsequent “duplicate” and “sequencing” errors.

Keep in mind that the ARC may contain a Jurisdiction Keep in mind that the ARC may contain a Jurisdiction Claim Number (JCN) that is needed. Claim Number (JCN) that is needed.

138

What is anWhat is an Re-Re-AcknowledgementAcknowledgement (ARC)? (ARC)?

AcknowledgeAcknowledgement ment contains TR(s) contains TR(s)

due to FL errordue to FL error

Electronic Electronic ReportReport

Claim Claim AdministrAdministratorator

FloridaFlorida

Re-AcknowledgementRe-Acknowledgement

139

ARC ExampleARC Example

148 Record 1

R21 Record 2

148 Record 3

R21 Record 4

148 Record 5

R21 Record 6

148 Record 7

R21 Record 8

Header

Trailer

FROITransactio

ns

Claim Administrator sends:Header (HD1)

ARC30

Trailer (TR2)

AKC TA Record 1

ARC TA Record 2

AKC TR Record 3

AKC TR Record 4

Florida returns:


ScenariosScenarios

Validate Validate Batch-Batch-

Header Data Header Data Elements Elements

142

What happens if a What happens if a batch has header batch has header

errors?errors?

The entire batch is The entire batch is rejected. rejected.

The individual The individual transactions in the transactions in the batch are not processed.batch are not processed.

143

Receiver ID invalid for Florida.Receiver ID invalid for Florida.Date Transmission Sent Date Transmission Sent

missing or invalid.missing or invalid.Time Transmission Sent Time Transmission Sent

missing or invalid.missing or invalid.Test/Production Code invalid.Test/Production Code invalid.Interchange Version ID invalid.Interchange Version ID invalid.

What causes a Batch header What causes a Batch header error?error?

144

What will the What will the acknowledgement acknowledgement ‘batch’‘batch’ look like if the batch is look like if the batch is

rejected?rejected?

The acknowledgement The acknowledgement batchbatch that that is returned will consist of:is returned will consist of:

1 Header record 1 Header record 1 Acknowledgement record 1 Acknowledgement record 1 Trailer record1 Trailer record

145

What will the What will the acknowledgement acknowledgement ‘record’‘record’

look like?look like?The acknowledgement The acknowledgement record record (AKC) for a (AKC) for a batch with header errors will contain ‘all batch with header errors will contain ‘all zeros’ in the Record Sequence Number. zeros’ in the Record Sequence Number.

146

‘‘HD’ in the Application HD’ in the Application Acknowledgement CodeAcknowledgement Code

147

Number of Errors that Number of Errors that were found during the were found during the

edit processedit process

148

Error SegmentError SegmentElement Number in errorElement Number in errorElement Error Number for the errorElement Error Number for the errorVariable Segment NumberVariable Segment NumberElement Error TextElement Error Text

149

Remaining fields on the AKC (noted Remaining fields on the AKC (noted inin redred below) should be spaces.below) should be spaces.

Validate Validate Detail Detail

RecordsRecords

151

Validate Detail Validate Detail RecordsRecords

Once the header/trailer Once the header/trailer data elements have been data elements have been validated and the batch validated and the batch structure has been tested, structure has been tested, the next step is to validate the next step is to validate each individual detail each individual detail record (transaction).record (transaction).

152

How does FL do How does FL do this?this?

Florida will use:Florida will use:Trading partner tables (Event Trading partner tables (Event

Table, Element Requirement Table, Element Requirement Table, Edit Matrix, etc.) Table, Edit Matrix, etc.)

System Rules to determine the System Rules to determine the appropriateness of each appropriateness of each transaction and ensure data transaction and ensure data qualityquality

153


As each transaction is As each transaction is edited, FL will assign edited, FL will assign 1 of the 2 Application 1 of the 2 Application Acknowledgement Acknowledgement Code values to each Code values to each AKC transaction; TA AKC transaction; TA or TR.or TR.

154


Let’s Let’s walk walk through through some some scenariosscenarios……

Transaction Transaction AcceptedAccepted

(TA)(TA)

156

Transaction Accepted Transaction Accepted ScenarioScenario

After the transaction (each After the transaction (each data element) is edited for data element) is edited for all applicable requirements all applicable requirements for the specific MTC sent for the specific MTC sent and no errors are found, the and no errors are found, the AKC transaction will contain AKC transaction will contain the following information.the following information.

157

Transaction Accepted AKC Transaction Accepted AKC RecordRecord

Acknowledgement Transaction Set ID Acknowledgement Transaction Set ID indicates the type of transaction indicates the type of transaction being acknowledged, either ‘148’ for being acknowledged, either ‘148’ for FROI or ‘A49’ for SROI.FROI or ‘A49’ for SROI.

158


Application Acknowledgement Application Acknowledgement Code will be ‘TA’ meaning Code will be ‘TA’ meaning Transaction Accepted, there Transaction Accepted, there were no errors found.were no errors found.

159


Number of errors will be 00 which Number of errors will be 00 which indicates there were no errors indicates there were no errors found during the edit process.found during the edit process.

160


There will be no error segments since Number of Errors = 00.There will be no error segments since Number of Errors = 00.The remaining fields on the AKC should be populated from data The remaining fields on the AKC should be populated from data on the transaction (148 or A49) being acknowledged.on the transaction (148 or A49) being acknowledged.

161

Transaction Transaction RejectedRejected

(TR)(TR)ExamplesExamples

162

Transaction Transaction Rejected for Rejected for Invalid Invalid Mandatory Mandatory Data ElementData Element

163

Rejected for Invalid Rejected for Invalid Mandatory Mandatory

Data ElementData ElementAfter the transaction is After the transaction is edited, a fatal error edited, a fatal error (mandatory/mandatory (mandatory/mandatory conditional) is found on conditional) is found on DN0031-Date of Injury.DN0031-Date of Injury.

In this scenario In this scenario DN0031-DN0031-Date of InjuryDate of Injury had an had an invalid date.invalid date.

164

Rejected for Invalid Mandatory Rejected for Invalid Mandatory Data Element AKC RecordData Element AKC Record

Acknowledgement Transaction Set Acknowledgement Transaction Set ID indicates the type of ID indicates the type of transaction is being transaction is being acknowledged, either ‘148’ for acknowledged, either ‘148’ for FROI or ‘A49’ for SROI.FROI or ‘A49’ for SROI.

165

Rejected for Invalid Mandatory Rejected for Invalid Mandatory Data Element AKC RecordData Element AKC Record

Application Acknowledgement Application Acknowledgement Code will be ‘TR’ meaning Code will be ‘TR’ meaning Transaction Rejected (Florida Transaction Rejected (Florida did not accept the transaction).did not accept the transaction).

166

Rejected for Invalid Rejected for Invalid Mandatory Data Element AKC Mandatory Data Element AKC

RecordRecordNumber of errors will depend on the number Number of errors will depend on the number

of fatal errors found during the edit process. of fatal errors found during the edit process. 01 fatal error was found.01 fatal error was found.

167


RecordRecord

Element Number DN 0031 Element Number DN 0031 (Date of Injury)(Date of Injury)

The error segment contains: The error segment contains:

168


RecordRecord

Element Error Number 029 - Element Error Number 029 - Must be a valid date Must be a valid date (CCYYMMDD)(CCYYMMDD)

169


RecordRecord

Variable Segment Number Variable Segment Number = 00 because data element = 00 because data element is not in a Variable Segmentis not in a Variable Segment

170


RecordRecord

Element Error Text Element Error Text provides FL specific error provides FL specific error text.text.

171

Transaction Rejected for Transaction Rejected for Invalid Mandatory Data Invalid Mandatory Data

Element AKC RecordElement AKC Record

Remaining fields on Remaining fields on the AKC will be the AKC will be populated from data populated from data on the transaction on the transaction being acknowledged.being acknowledged.

172

Let’s Look At Let’s Look At Some More Some More

AcknowledgemeAcknowledgement Scenariosnt Scenarios

Invalid Data Invalid Data RelationshipRelationship

174

Invalid Data Relationship Invalid Data Relationship OverviewOverview

The edit process will be The edit process will be used to determine if an used to determine if an improper relationship exists:improper relationship exists:

between two or more data between two or more data elements reported on the elements reported on the same EDI transactionsame EDI transaction

between data on the EDI between data on the EDI transaction and data transaction and data previously reportedpreviously reported

175

Invalid Data Relationship Invalid Data Relationship ScenarioScenario

In this scenario, Florida In this scenario, Florida received SROI MTC VE received SROI MTC VE (Volunteer) transaction (Volunteer) transaction where the Employment where the Employment Status Code (DN0058) was Status Code (DN0058) was reported as ‘1’ reported as ‘1’ (Regular/Full-time (Regular/Full-time Employee).Employee).

176


Florida requires that Florida requires that Employment Status Code Employment Status Code (DN0058) equal ‘9’ (DN0058) equal ‘9’ (Volunteer) when SROI MTC (Volunteer) when SROI MTC VE (Volunteer) is submitted.VE (Volunteer) is submitted.

Florida will consider this a Florida will consider this a fatal error. fatal error.

177

Invalid Data Relationship Invalid Data Relationship ScenarioScenarioSROI A49 is being SROI A49 is being

acknowledged with a TR.acknowledged with a TR.

178


The error segment contains the following:The error segment contains the following:

Employment Status Employment Status CodeCode

1 fatal error was found.1 fatal error was found.

179

Match Data Match Data Element Values Element Values Not Consistent Not Consistent with Previously with Previously Reported Reported

180

What is a Match data What is a Match data Element?Element?

The The Match DataMatch Data table table identifies primary and identifies primary and secondary match datasecondary match data elements. These data elements. These data elements are used toelements are used to identify a transaction as:identify a transaction as:

a new claim to create, ora new claim to create, or

181

What is a Match data What is a Match data Element?Element?

an existing claim for updating an existing claim for updating and processing andand processing and

will be used to match FROI to will be used to match FROI to SROI for ‘combo’ filings.SROI for ‘combo’ filings.

Note: Note: Jurisdiction Claim NumberJurisdiction Claim Number (DN (DN 0005) is 0005) is requiredrequired on all filings after the on all filings after the First Report of Illness or Injury ‘combo’ First Report of Illness or Injury ‘combo’ filing to match to the existing claim.filing to match to the existing claim.

182

What is the Edit Process What is the Edit Process for Match Data Elements?for Match Data Elements?

The edit process The edit process compares compares matchmatch data elements on data elements on the incoming the incoming transaction to transaction to match data match data elements elements previously previously submitted. submitted.

183

Use MTC 02 Change to Use MTC 02 Change to report changes to Match report changes to Match

Data ElementsData Elements

If a change is submitted on a If a change is submitted on a match data element with match data element with any MTC other than the 02-any MTC other than the 02-Change, the transaction will Change, the transaction will be rejected because the be rejected because the keykey value sent is not consistent value sent is not consistent with the value previously with the value previously reported. reported.

184

Match Element Values Not Match Element Values Not Consistent with Previously Consistent with Previously

Reported ScenarioReported Scenario

FL received an MTC FL received an MTC 00 Original FROI 00 Original FROI transaction with the transaction with the field Employee ID = field Employee ID = 332533333 (SSN)332533333 (SSN)

185



This report was followed by a This report was followed by a MTC 01 Cancel FROI on the MTC 01 Cancel FROI on the same claim with same claim with differentdifferent data data in the field Employee ID = in the field Employee ID = 332544444 (SSN)332544444 (SSN)

Note: Originally reported Note: Originally reported Employee ID = 332533333 (SSN)Employee ID = 332533333 (SSN)

186



EDI processing rules EDI processing rules require a MTC 02 require a MTC 02 Change FROI to be Change FROI to be submitted when the submitted when the match data element match data element value changes.value changes.

187



The MTC 02-Change The MTC 02-Change transaction should have transaction should have been sent after the MTC been sent after the MTC 00/SROI and before the 00/SROI and before the MTC 01-Cancel.MTC 01-Cancel.

188


Reported ScenarioReported ScenarioSince Employee ID (SSN) Since Employee ID (SSN) is a “match” element, FL is a “match” element, FL will consider this a fatal will consider this a fatal error and return a TR error and return a TR (Transaction Rejected) (Transaction Rejected) acknowledgement. acknowledgement.

189


ReportedReportedA ‘148’ FROI is being A ‘148’ FROI is being acknowledged with a TR.acknowledged with a TR.

190

1 fatal error was found.1 fatal error was found.


ReportedReported

The error segment contains the The error segment contains the following:following:

Social Security Social Security NumberNumber

191

Invalid Event Invalid Event SequenceSequence

192

Invalid Event Sequence Invalid Event Sequence ScenarioScenario

When Florida receives When Florida receives an MTC, we will an MTC, we will determine if that MTC determine if that MTC is one we accept, and is one we accept, and if so, will perform if so, will perform sequencing edits.sequencing edits.

193


Sequencing edits are based Sequencing edits are based on rules defining the on rules defining the sequence in which business sequence in which business events (MTC) should occur events (MTC) should occur during the life of a claim (see during the life of a claim (see Transaction Sequencing table Transaction Sequencing table on Edit Matrix).on Edit Matrix).

Failure of sequencing rules Failure of sequencing rules will result in the transaction will result in the transaction being rejected.being rejected.

194


In this scenario, FL In this scenario, FL received a MTC S1 received a MTC S1 (Suspension) SROI (Suspension) SROI transaction, but there is transaction, but there is no record of a MTC IP no record of a MTC IP (Initial Payment) SROI (Initial Payment) SROI having been filed for this having been filed for this claim. claim.

195


Florida’s rules require a Florida’s rules require a MTC IP, AP or EP SROI MTC IP, AP or EP SROI transaction to be filed transaction to be filed before benefits can be before benefits can be suspended (MTC S1).suspended (MTC S1).

196


Once the transaction is edited Once the transaction is edited and determined to be and determined to be out of out of sequencesequence, the AKC transaction , the AKC transaction will be returned:will be returned:

with an Application with an Application Acknowledgement Code of ‘TR’ Acknowledgement Code of ‘TR’ (Transaction Rejected)(Transaction Rejected)

with an Element Error Number of with an Element Error Number of ‘063’ (Invalid Event Sequence)‘063’ (Invalid Event Sequence)

Error in Error in Variable Variable SegmentSegment

198

Variable Segment Counters Variable Segment Counters ((‘Number of’‘Number of’ fields in the fields in the segments) contained in the segments) contained in the FROI and SROI records FROI and SROI records indicate how many indicate how many occurrences should be present occurrences should be present for any given segment in the for any given segment in the FROI or SROI records.FROI or SROI records.

Error in Variable Error in Variable Segment Segment OverviewOverview

199

When Florida processes the When Florida processes the FROI or SROI, Florida will:FROI or SROI, Florida will:

Edit the data in the Edit the data in the Variable SegmentsVariable Segments

Keep track of which Keep track of which Variable Segment they are Variable Segment they are editing editing


200


If Florida identifies an error If Florida identifies an error in the variable segments, in the variable segments, Florida will communicate Florida will communicate the segment in which the the segment in which the error occurred by error occurred by populating the Variable populating the Variable Segment Number (DN0117) Segment Number (DN0117) in the AKC.in the AKC.

201

Error in Variable Error in Variable SegmentSegmentScenarioScenario

In this scenario, the SROI R22 In this scenario, the SROI R22 record, Number of Benefits record, Number of Benefits (DN288), contains the value of (DN288), contains the value of ‘02’ which indicates that two ‘02’ which indicates that two Benefit segments are present Benefit segments are present in the SROI.in the SROI.

202

After the transaction is After the transaction is edited, a fatal error is edited, a fatal error is found on found on DN0192-Benefit DN0192-Benefit Payment Issue DatePayment Issue Date in the in the second benefits segmentsecond benefits segment. . The AKC transaction will The AKC transaction will contain the following contain the following information. information.

Error in Variable Error in Variable SegmentSegmentScenarioScenario

203

Error in Variable Segment AKC Error in Variable Segment AKC RecordRecord

SROI ‘A49’ SROI is being SROI ‘A49’ SROI is being acknowledged with a TR.acknowledged with a TR.

204


1 Fatal Error.1 Fatal Error.

205


Element Number 0192 (Benefit Payment Element Number 0192 (Benefit Payment Issue Date – located in Benefits segment)Issue Date – located in Benefits segment)

The error is for:The error is for:

Error Number 029 - Must be a Error Number 029 - Must be a valid date valid date (CCYYMMDD)(CCYYMMDD)

206


The error is in the The error is in the secondsecond occurrence occurrence of the Benefits segment, of the Benefits segment, so the Variable so the Variable Segment Number Segment Number will be ’02’.will be ’02’.

207

ALL QuestionsALL Questions, either , either Business or Technical, Business or Technical,

should be sent via email to should be sent via email to [email protected]

This email address is copied This email address is copied to all members of the EDI to all members of the EDI team on the next 2 slides, team on the next 2 slides, and is also copied to our and is also copied to our Technical Project Manager, Technical Project Manager, Kim Wiley. It is the quickest Kim Wiley. It is the quickest and most efficient way for us and most efficient way for us to respond to your concerns.to respond to your concerns.

208

R3 EDI Contacts at R3 EDI Contacts at DWCDWCLinda YonLinda YonEDI Coordinator 850-413-1702EDI Coordinator 850-413-1702 [email protected]

Karen KubieKaren KubieClaims EDIClaims EDI 850-413-1703 850-413-1703 [email protected]

Margaret ForsmanMargaret ForsmanClaims EDIClaims EDI 850-413-1727 850-413-1727

[email protected]

209

R3 EDI Contacts at R3 EDI Contacts at DWCDWCTonya GrangerTonya GrangerPOC & Claims EDI 850-413-1709 POC & Claims EDI 850-413-1709 [email protected]

Debra LeeDebra LeeClaims EDIClaims EDI 850-413-1701 850-413-1701 [email protected]

Laura CotnerLaura CotnerClaims & POC EDIClaims & POC EDI 850-413-1707 850-413-1707 [email protected]

1 florida division of workers compensation claims edi release 3 technical training 2008

Documents

records slide

sroi slide

fl technical requirements

technical overview slide

record length

dwc edi

fixed length record

variable length record