Subject Numbers Regarding Health Provider Authorizations

April 17, 2014

On March 5, 2012, the New York State Workers' Compensation Board (Board) announced via Subject No. 046-477 the mandate to utilize 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) was initiated in June of 2013 and is scheduled to have all Claim Administrators in production by the time the mandate goes into effect on April 23, 2014.

To enforce the mandate, the Board implemented new regulation §300.22, effective April 23, 2014, which mandates FROI/SROI filings for all Claim Administrators. As part of §300.22, certain Board forms (C-2, C-669, C-7, C-8/8.6, VAW-2, and VF-2) have been replaced by their EDI-equivalent FROI/SROI transactions and will no longer be accepted by the Board. Effective May 23, 2014 all Forms C-669, C-8/8.6, or C-7 that are sent to the Board will not be scanned into the case folder nor considered duly filed. The FROI/SROI equivalent will need to be filed and accepted with the Board to be considered duly filed.

To further support this initiative, the Board has created FROI/SROI Transaction Reports for mailing to the parties. These forms take the place of Forms C-2, C-669, C-7, C-8/8.6, VAW-2, and VF-2. A copy of each Transaction Report is placed in the Board’s eCase folder. As announced in Subject No. 046-522, the Transaction Reports are utilized by Claim Administrators to serve on the applicable parties of interest in a case. Service on the parties is mandatory for certain FROI/SROI transactions as outlined in §300.22 and detailed within the NYS Event Table located on the Board website under eClaims – Transaction Reports for Mailing to Parties.

As part of the mandate effective May 23, 2014 employers, and those employers who have a Claim Administrator who will be timely submitting injury/illness information electronically to the Board on the employer’s behalf, should utilize Form C-2F. Form C-2F replaces Forms C-2, VAW-2, and VF-2. These forms will be disabled on the Board’s website and no longer available. Employers should follow the instructions on Form C-2F which state: "Employers are not required to submit Form C-2F to the WCB if the employer's insurer will be submitting the accident information electronically to the Board on the employer's behalf via FROI."

Throughout the planning and execution phases of the project, the Board has conducted extensive outreach to inform Board stakeholders of the objectives and timelines, and to assist with the eClaims implementation. This has included:

• Collaborative work with Claim Administrators and the IAIABC Implementation Team to build tables and requirements.
• Monthly Stakeholder Conferences where Trading Partners were informed of changes and also had an opportunity to ask questions regarding eClaims.
• Extensive training, both in person and via webinars. (eClaims training presentations are available on the Board’s website)
• Legal presentations to Claimant and Carrier Representatives were conducted by the Office of General Counsel at all Board district offices in June 2013.
• Introduction of new Form C-2F, replacing Form C-2, VAW-2, and VF-2, as announced in Subject No. 046-546. The new form has been aligned with the IAIABC Claims Release 3.0 standard and the Board’s Element Requirement Table. This will help Claim Administrators collect the information necessary when submitting a FROI to the Board.

Although the official implementation of eClaims is drawing to a close, the Board will continue to provide eClaims support and conduct outreach on any changes in reporting requirements or updates to the Release 3.0 standard. The Board also has Examiners dedicated to eClaims available to answer any questions.

Questions related to this announcement can be directed to: eClaims@wcb.ny.gov. New York specific requirements and resources can be found on the eClaims section of the Board’s website: www.wcb.ny.gov.