Division of Workers' Compensation
Claims EDI (non-medical)
CLAIMS EDI RELEASE 3 (updated 5-15-08)
FL Claims EDI Release 3 (non-medical) and Rule 69L-56 Training for
Claim Administrators:
When: Thurs & Fri. August 14-15, 2008 8:30 a.m. – 5 p.m.
Where: University of South Florida
4202 E. Fowler Ave. Tampa, FL 33620
Cost: FREE, but prior registration and confirmation required.
Dress: Casual
Who should attend: This training is very beneficial for any claim
administrator staff responsible for handling R3 Claims EDI reporting
and responding to errors. The training will focus on EDI
terminology; required codes; scenarios; what transactions are due
and when; how to use the data warehouse; lessons learned; tips on
successful transactions; and what not to do. Technical staff are
welcome to attend; however, this training will not cover the
technical training information available on this webpage.
This may be the last training class held outside of Tallahassee so
don’t miss your opportunity to attend.
Seating is limited and confirmations are based on a first come/first
served basis for those who fax this completed form to (850)
488-3453.
Fax multiple forms as needed to list all names.
If you have questions, changes to attendees or cancellations, please
contact Margaret Forsman at 850.413.1727.
Tampa Claims EDI (non-medical) Release 3 Training: (click here [14K
PDF])
Future Claims EDI (non-medical) Release 3
Training:
(click here [14K PDF])
Rule 69L-56, F.A.C., was revised effective January 7,
2007 to require the electronic submission of Claims
(non-medical) filings (in addition to the already
required electronic submission of POC data). All
insurers and claim administrators handling Florida
claims should download and review the requirements of
Rule 69L-56, F.A.C. (click here [210K PDF]).
Insurers will be required to file Claims forms
electronically, and will be grouped by Insurer Code # in
one of three “test to production” phases (calendar year
quarters), beginning November 1, 2007, for testing the
electronic form equivalents required in the Primary
Implementation Schedule (see chart and MTC listing
below). The rule also requires current EDI trading
partners voluntarily using Release 1 for Claims to begin
testing the new R3 EDI standard during the first phase
beginning November 1, 2007. The Secondary Implementation
Schedule (see chart below) will phase in insurers over a
period of 3 quarters for testing the remainder of
electronic form equivalents required by the rule, with
the first phase beginning November 1, 2008. Insurers may
elect to include the electronic form equivalents
required in the Secondary Implementation Schedule (see
required MTC listing below) during its testing of MTC’s
required in the Primary Implementation Schedule.
The IAIABC EDI Implementation Guide for Claims: First,
Subsequent, Header, Trailer & Acknowledgement Detail
Records, Release 3, January 1, 2008, can be ordered from the IAIABC's web site at
http://www.iaiabc.org/edi/implementation.asp.
The IAIABC now charges $95 for the R3 Guide if your
company is not an IAIABC EDI member. The IAIABC's
website also contains other important code tables
required for Release 3 filings. It is recommended that
insurers/claim administrators order this Guide and begin
reviewing it with management and IT staff. If you choose
to print the Guide, please be advised that it is set up
to print double-sided and is 835 pages long.
FL Claims EDI Implementation Manual (click
here [124K
PDF]): The Florida Division of Workers’
Compensation Claims Electronic Data Interchange (EDI) R3
Implementation Manual, September 2006, is incorporated
by reference in Rule 69L-56, F.A.C., and contains the
electronic filing specifications for sending claims data
to the Division. The manual contains the trading partner
forms that are required to be filed with the Division
prior to testing, as well as the Event Table, Element
Requirement Table, and Edit Matrix. IMPORTANT: Do not
print the “Event Table”, “Element Requirement Table” and
the “Edit Matrix” contained in the FL Claims EDI
Implementation Manual; instead print the revised tables
contained in the Supplement, below.
INSURERS THAT ARE REQUIRED TO BEGIN TESTING CLAIMS EDI
RELEASE 3 TRANSACTIONS ON FEBRUARY 1, 2008, should have
already submitted all Claims EDI Trading Partner forms
to
claims.edi@fldfs.com, and should be submitting Test
transactions at this time.
INSURERS THAT ARE REQUIRED BY RULE TO BEGIN TESTING
CLAIMS EDI RELEASE 3 TRANSACTIONS ON MAY 1, 2008, may
submit their forms to
claims.edi@fldfs.com. These forms are necessary to
establish an account in the Claims EDI Data Warehouse
and to provide each Claim Administrator with a
Jurisdiction Claim Number for all existing open claims,
and claims closed within the last year.
FL EDI R3 TESTING
FL Claims EDI R3 Test Process 1/2008 (click here [38K
PDF])
Please send any questions or report any R3 testing errors you do not
understand or feel you received in error to
claims.edi@fldfs.com.
Include the claim number or JCN associated with the
filing, and the specific error message (error number)
received.
Emails sent to this address will be delivered to all
members of the EDI team and will be responded to in a
timelier manner than will emails or voice mails directed
to an individual EDI team member.
Errors and questions reported to claims.edi@fldfs.com
will be researched daily and responded to/corrected as
quickly as possible.
FL Claims EDI Supplement: The Supplement
provides an overview of changes/corrections to the Event Table,
Element Requirement Table, and/or Edit Matrix, that were made after
the date the previous version of the rule was posted to the
Division’s web site (for the Notice of Proposed Rulemaking). The
Supplement also contains the updated tables, which reflect the last
revision date and color-coded changes as tan-shaded cells with blue
text. The May 2008 updates reflect changes made as a result of
issues discovered during Tier 1 & 2 testing.
Supplement
- Overview (REV. 5-15-08) (click
here [264K
PDF])
Claims EDI R3 Event Table Supplement (REV.
5-15-08)
(click
here [100K
Excel])
FL Claims EDI R3 Element Requirement Table Supplement
(REV. 5-15-08) (click
here [592K Excel])
FL Claims EDI R3 Edit Matrix Supplement (REV.
5-15-08)
(click here
[462K Excel])
Florida R3 Claims EDI Migration Strategies (click here [39K
PDF] REV. 2-27-08)
The Florida R3 Claims EDI Migration Strategies document
addresses how a claim administrator should transition
from paper or EDI R1 electronic filings, to R3.
This document also discusses how to obtain the
Jurisdiction Claim Number (JCN), a data element that
will be required on all subsequent electronic filings
sent after the First Report of Injury or Illness.
Helpful FL EDI R3 Resources: The following
resource documents should be reviewed by the claim
administrator to assist in implementing the Claims EDI
R3 filing requirements. Note: Please continue to check
for the posting of additional scenarios/revisions.
FL Claims EDI Release 3 Business Training PowerPoint Slides:
* If there are multiple or subsidiary insurer entities within an
insurer’s corporate structure or organization, the insurer’s
“test to production” period in the Primary Implementation
Schedule will be based on the lowest numeric value assigned to
any of the insurer’s subsidiary companies.
Florida DWC Claims Electronic Data Interchange (EDI) Release
3 Vendor Listing:
The following list comprises a link to known
vendors offering a Claims EDI Release 3 related
product and/or service for submitting claims data
electronically to the Florida Division of Workers’
Compensation. This listing will be updated as more
vendors become known.
This listing is in alphabetical order and does
not represent an endorsement by the Department of
Financial Services, Division of Workers’
Compensation of any vendor listed, or a
recommendation of one vendor over another. The
Department does not warrant or represent that this
information is current, complete and accurate. The
Department assumes no responsibility for any errors
in the information provided, nor assumes any
liability for any damages incurred as a consequence,
directly or indirectly, of the use and application
of any of the contents of this Web site, and shall
be held harmless against all claims, suits,
judgments and/or damages resulting from the
disclosure of any of this information, including all
costs and fees.
NOTE: If you are a vendor and would like to have
your company added or removed, please contact
claims.edi@fldfs.com.
| Claims EDI Release 3 Vendors: |
Contact Name: |
Contact Phone Number: |
E-Mail Address: |
| Cambridge Integrated Services |
Michelle Gullick |
(614) 987-1581 |
michelle_gullick@cambridge-na.com |
| CorVel – Workers’ Compensation |
Michael Smith |
(407) 547-3900x3216 |
Michael.Smith@CorVel.com |
| CS Stars |
Eric Wild |
(212)345-5181 |
ewild@csstars.com |
| Healthtech |
Mark Hughes |
(913) 764-9347 |
mhughes@htedi.com |
| Insurance Services Office (ISO) |
Al Faber |
(201) 469-2375 |
afaber@iso.com |
| Peak Performance Solutions (formerly Claims Harbor) |
Shayne Garner |
(614) 254-5128 |
shayneg@peakpsi.com |
| Quality Resource Management |
Nita Chisari |
(615) 285-1919 |
nitac@qrm-inc.com |
| Red Oak E-Commerce (ROES) |
Pat Cannon |
(866) 363-4297 |
prcannon@ROESINC.com |
| Startech Software |
Mike House |
800-963-3062 |
mhouse@startechsoftware.com |
| Tropics Software |
Nicholas Albon |
(888) 925-1234x308 |
nalbon@GOTropics.com |
| Valley Oak Systems |
Brian Mack |
(925) 242-4607 |
brian_mack@aon.com |
CLAIMS EDI RELEASE 1.0 (updated 1-12-07)
The Division has suspended all pilots using the Claims EDI
Release 1 (R1) national standard for voluntary electronic
submission of Claims EDI filings (DWC-1’s and DWC-13’s).
Claims EDI Contacts:
During implementation of Claims EDI R3, we ask that you
submit all questions/problems to
claims.edi@fldfs.com.
This email address will reach all members of the EDI team, and
our Technical contact, and will enable us to provide you with
the best customer service.
Claims EDI Databases:
Paper vs. Electronic Submission Statistics, Claims Related
Incoming Documents:
Go back to the EDI menu
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