edi newsletter - florida department of financial services · you can reach the edi team by emailing...
TRANSCRIPT
EDI Newsletter
Department of Financial Services Division of Workers’ Compensation Bureau of Data Quality and Collection
Inside this issue
March Puzzle Answer Keys ..........2
Triage Visitors .............................3
Triage is Traveling Now! ..............4
Split Week Calculations ...............4
Crossword ...................................5
MTC SAs ......................................6
Medical EDI updates....................7
Medical EDI Word Search ............8
FAQ .............................................9
Contact Information ....................9
Welcome, Spring!
In this issue we will be discussing a frequent sequencing issue, as
well as calculation tips, and Medical EDI updates. In March the
Triage team had some visitors from Insurance Company of the
West, so we will talk about their experiences in our office. -
Victoria LaPonzina
Spring time, time for warm days, flowers, and
birds.—VL
April 2017 Volume 1, Issue 3
2
March Answer Keys
Insurance Company of the West Team Members: Niall and Isabel
As I mentioned in previous newsletters, our Triage
Team works very hard with individual trading partners
to provide one-on-one training. This past month we
had the privilege of hosting two team members from
the Insurance Company of the West: Isabel and Niall.
They came to Tallahassee to visit us in our offices for
two days to participate in our in-depth EDI training.
When asked what the biggest issues/challenges they
faced with EDI, they responded saying that some of the
biggest issues they face is moving the information from
their system into EDI and that there are a lot of moving
parts. They stated they came to the source by coming
to us with the goal of improving their understanding of
EDI and their acceptance rate.
We had a great time having Niall and Isabel in our
offices for two days of training. They believe that they
have met their goals and told us not to count them out
on coming back, even if their acceptance rates go up.
If you wish to schedule training time with the Triage
Team, please contact:
The Triage Team can assist you through webinar,
conference calls, or office visits.
3 From Left to Right: Margaret, Isabel, Niall, and Peggy
Triage Team
The time is here! The Triage Team
is traveling:
Sarasota—April 3rd and 4th
St. Petersburg—April 5th
Tampa—April 6th and 7th
We hope if you are in these cities
that you took advantage of this
amazing opportunity for one-on-
one, in-depth training.
This is not the only time Triage will
be traveling—if there is sufficient
interest from a city, then Triage
may travel to you. Additionally our
doors (and email addresses and
phones) are always open to assist
you.
Please contact Tonya Granger
for training opportunities.
4
Calculation Tips
There are occasions
when calculating
benefits a Split
Week situation
occurs. In these
instances, it is
important to know
how to calculate benefits, since the IW cannot exceed the Comp Rate for a week, and
it is also important to know that this may cause rejections in our system.
For example if a IW is due both TT and TP in one week, you would follow the below
calculation outline:
As you can see from the calculations above, if you were to pay both benefits in full,
you would have paid the IW more than the IW’s comp rate. Since the IW cannot be
paid more than their compensation rate for the week, the injured worker is only due
the amount for TT. However, you should still report the benefits due for TP, but the
Amount Paid would be reported as $0.00. Currently this will cause a rejection, but you
can contact the EDI team to review the transaction for possible bypass. If you have a
TA-FL error due to a suspected underpayment because of a split week situation,
please contact the EDI Team to review the TA-FL error for closure.
IW Name Joe Smith
AWW $200.00
Comp Rate $133.34
# of days worked per
week
5
Disability
Type
Weekly
Amount
# of days
worked
# of days
due
Daily Rate Total Due
04/02/2017
—
04/06/2017
TTD $133.34 5 5 $26.67 $133.34
04/07/2017
-
04/08/2017
TPD $128.00 5 2 $25.60 $51.20
$184.54
We are currently working on
an exception for the rejection
situation when reporting Split
Week payments. In the future
we hope to introduce an
exception to allow $0.00 to be
reported for TP when the
Comp Rate has been reached
for TT.
5
EDI Puzzler
Across 4. Late Reason Code for Coverage, lack of infor-mation 7. Non-salary remunerations which the employ-er pays 9. An adjudicated Lump Sum Payment of one or more benefits which does not limit future liabil-ity
Down 1. Benefit Credit Code "C" for recoupment of benefit paid but not due 2. Identifies the employee ID being submitted 3. The date associated with an award 5. The date on which the accident occurred 6. Federal Employer Identification Number 7. The Type of transaction filed when once wishes to close the claim 8. Type of suspension filed when the claimants whereabouts are unknown
MTC SAs
6
In continuing our discussion from last month
on MTC SA’s, some claims might be on your
Missing MTC SA list that are closed in your
system; however, they are open in ours! The
claims that are open in our system will show
on your Missing MTC SA report
Some systems auto-generate MTC SA’s every
six months from the Date of Injury even on
closed claims. In these instances, if the MTC
SA is accepted, it will re-open the claim,
causing claims that are closed in your system
to be on your Missing MTC SA list. In these
instances, you can contact us at
[email protected] to review the
transaction for possible removal if it was filed
in error. This will remove the claim from your
Missing MTC SA list and reclose the claim.
Additionally, MTC SA’s are not due when the
initial filing for a claim is a MTC FROI 04 or
MTC 00/PD when Partial Denial Code “A” or
“E” is reported. These claims are closed from
their initial filing and the MTC SA is not
required. If one is sent, it will open the claim.
Please contact us in these instances to review
the MTC SA for removal.
We are currently developing a way to keep MTC
SA’s from re-opening a claim in certain situa-
tions. In the future we are hoping to keep MTC
SAs from reopening the claim when submitted
after a MTC FN and the transaction is not re-
porting any changes to the benefit picture. This
will hopefully aide in lessening the amount of
transactions on your Missing MTC SA lists by not
re-opening claims when MTC SAs are automati-
cally generated by your systems.
Medical EDI Claim Admin Postal Code by Justin Hale
We have seen an increase in emails regarding rejection
issues for Claim Administrator Physical Postal Code (DN09A).
The postal code reported must
be valid and on your Client List.
Per the Medical EDI Implementation Guide (MEIG), it
should also reflect the postal code of the physical address of the location where the claim is
being handled.
If a bill rejects due to a postal code error, please check to make
sure the submitted zip code has been verified by your client and
is on your Client List . A blank copy of this form is located on
page 14 of the MEIG and is
available on the Division
website.
If additional assistance is still needed, please reach out to the
Medical EDI team at: MedicalDataManagementTeam
@myfloridacfo.com.
7
Medical EDI RNR List
For further clarification regarding last month’s article pertaining to rejected bills, if an original bill rejected with the incorrect Insurer Code reported but was later resubmitted to the Division under a new control number, the older bill should be withdrawn. However, if a penalty was assessed for the original (older) bill it will remain in CPS. Please contact your CPS Liaison with any questions. To withdraw a bill, Bill Submission Reason Code 01 should be reported. If at any point throughout the month you need a copy of an updated list of outstanding rejected bills, you may send an email to the team at [email protected].
Please note that effective 03/16/2017 the Division no
longer accepts original Revision E submissions. Any cor-
rections (withdrawals, cancellations, or replacements)
can be made under Revision E or Revision F.
MEDICAL EDI SUBMITTERS—NOTIFICATION
Word Bank
ADMISSIONDATE CLAIMADMIN DIAGNOSISCODE
FTP ORR PRODUCTION
REIMBURSEMENT REPORTCARD REVISIONCODE
TEST
8
Medical EDI Puzzler
T E S T F H Y W D C B I E T R
S G W Z M O D O U Y H D Q G E
N R C I Z J S X J W O E R Y I
I V P U L Y M P H C E Y X D M
M E D O C N O I S I V E R M B
D A D M I S S I O N D A T E U
A R X X V H S R O Z O Q F O R
M Y A I O O D I L G R S E V S
I V I C N Q T V X X R V C D E
A O Z G T C I O H C E M D W M
L F A S U R V Y Y W N M L A E
C I C D Y F O B R E Z E S A N
D X O Q A B T P Y D A F H T T
M R D X D V S P E V R I Y V U
P A D Y U H Z R S R E L F S T
Q: I have a MTC CB that is rejecting for 0072-113 Latest Return to Work Date must be greater than Initial Return
to Work date, but I updated the IRTW on a MTC SROI 02, can you tell us why this rejected?
A: Initial Return to Work information is loaded from a MTC FROI 02, but not a MTC SROI 02. So, if the IRTW should
be updated, please file a MTC FROI 02 to do so.
Q: Our transaction is rejecting for the Initial Date Disability Began being different
than last filed, but we filed a MTC FROI 02, can you tell us why this rejected?
A: Quite opposite to the Initial Return to Work, the IDDB is loaded from a MTC SROI 02,
not a MTC FROI 02. So when you receive this error, please file a MTC SROI 02 to update
the IDDB.
You can review what is accepted on a FROI/SROI by looking at the Element
Requirement Table, which is available here: http://www.myfloridacfo.com/division/wc/EDI/Clms_EDI.htm
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 email
Frequently Asked Questions
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?
We Would Appreciate Your Feedback!
Please contact us!
You can reach the EDI team by emailing us at [email protected]
You can reach the Medical EDI team by emailing us at
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
[email protected] or 850-413-1709.