Subject Numbers Regarding Health Provider Authorizations

October 31, 2012

On March 5, 2012, the New York Workers’ Compensation Board (WCB) announced eClaims – the adoption of a national standard for claim administrators to electronically submit employer claims data. The standard is the International Association of Industrial Accident Boards and Commissions' (IAIABC) Claims Electronic Data Interchange (EDI) Release 3.0. The electronic filing of claims data for First Report of Injury/Subsequent Report of Injury (FROI/SROI) will be implemented in phases beginning in spring 2013. The use of eClaims will yield significant benefits for all stakeholders, including improving timely reporting and delivery of benefits, speeding claim assembly and processing at the WCB, reducing costly and error-prone manual, paper-based claims processing, and increasing the availability of data for policymaking.

The WCB has worked closely with a broad range of stakeholders to define the exact requirements of the program and develop a comprehensive program of education and support to ensure a successful transition to electronic filing. Early in the project, the WCB surveyed stakeholders to gauge their readiness for electronic filing and identify the need for education and support. The WCB has conducted multiple meetings and presentations for insurance carriers, self-insured employers, third-party administrators, and trade associations. The WCB also established an eClaims section on its website with up-to-date information and resources related to the mandate and a dedicated email group to respond to inquiries. The WCB has worked closely with industry representatives and the IAIABC Implementation Committee to develop and finalize the precise reporting requirements, addressing stakeholder concerns whenever possible. Finally, the WCB has developed a comprehensive education program, including online training courses and a series of live programs to be held around the state in November.

The WCB has reached a major milestone in the eClaims project: the publication of final requirement tables, an implementation guide, and the implementation schedule for all claim administrators.

eClaims Requirement Tables and Implementation Guide

The eClaims Requirement Tables define all the reportable events and data elements associated with FROI/SROI submissions. Together, these tables contain all of the New York specific requirements for eClaims reporting:

• Event Table: This table defines the Maintenance Type Codes (MTCs) for FROI/SROI events. An MTC represents an event that corresponds to the circumstances under which the report is initiated. The Event Table reflects the time frames and the WCB’s legal mandates and specifications relative to reporting requirements.
• Element Requirement Table: This table defines the required data elements for each MTC, or event, that claim administrators must include in each FROI/SROI filing.
• Edit Matrix: This table defines the edits that will be applied to the data elements and events defined in the Event and Element Requirements Tables. Edits will be applied to individual data elements as well as the sequence or order in which FROI/SROI filings are received. The Edit Matrix also provides the standard error messages associated with these edits.

The eClaims Implementation Guide provides additional information about the requirement tables. The guide further clarifies specific New York requirements and provides important links to resources used in the implementation and production process.

The eClaims NYS Requirement Tables and Implementation Guide have been posted to the eClaims portion of the WCB website.

eClaims Implementation Schedule

The WCB has established an eClaims phased implementation plan beginning in June of 2013 and continuing through March of 2014 which can also be found on the eClaims portion of the WCB website.

Claim Administrators (insurance carriers, self-insured employers and third-party administrators) and EDI Vendors should review the implementation timeline immediately to identify their assigned implementation date. Claim Administrators not identified on this schedule should immediately contact the WCB eClaims team at eClaims@wcb.ny.gov.

Claim Administrators and EDI vendors should also review the New York Implementation Guide for requirements related to Trading Partner registration and eClaims testing requirements. Insurers utilizing the services of third-party administrators for the administration of claims and/or the submission of claims data are reminded of the WCB’s licensing requirements. The WCB website maintains a list of licensed third-party administrators located under WCB Representatives.

More Training

In response to stakeholder demand, the WCB has added two additional dates for eClaims training. As with the training announced in Subject Number 046-494, registration is required to attend these sessions.

They are:

• November 26, 2012–Workers’ Compensation Board, 935 James St., Syracuse, NY 13203
• November 27, 2012–Workers’ Compensation Board, 44 Hawley St., Binghamton, NY 13901

Next Steps

Claim Administrators are strongly encouraged to review the NYS Requirement Tables in preparation for full EDI implementation. These tables should be shared with both business and technical representatives within your organization. We urge claim administrators to pay particular attention to those data elements defined as mandatory or mandatory conditional. It is recommended that insurers, along with their licensed third-party administrators, evaluate both business and technical processes to ensure their ability to collect and transmit information required by the WCB in a timely and accurate manner prior to the mandated implementation date.

For more information on the IAIABC Claims EDI Release 3.0 standard, please visit the EDI Implementation Guide section of the IAIABC website at: www.iaiabc.org . Questions related to this announcement can be directed to: eClaims@wcb.ny.gov. As the WCB publishes more information, including training, it will be posted on the eClaims Overview portion of the WCB website.