KANSAS EDI TRAINING SEMINAR

February 25, 2004 State Office Building Wichita, Kansas Presented by: Kansas Di vis ion of Workers Comp en sati on & Bri dium Inc.

PURPOSE OF EDI INFORMATION MEETING
„ Information on the Division’s Electronic Data Interchange (EDI) Program „ Review of Kansas EDI Requirements „ Business & Technical Information to Facilitate Accurate Reporting

INTRODUCTION OF SPEAKERS
Research Anal yst Di vi sion of Worker s Compensati on Kansas D epartm ent of Human Resources

David S prick

INTRODUCTION OF SPEAKERS
Research Anal yst Di vi sion of Worker s Compensati on Kansas D epartm ent of Human Resources

Alan St anton

INTRODUCTION OF SPEAKERS

ED I C oordi nator for Kansas Bri dium Inc.

Shar on Marion

WHAT IS THE EDI PROCESS?
„ Submission of First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI) „ From Trading Partners to the Kansas Division of Workers Compensation „ Through its application service provider (Bridium Inc.) „ In the IAIABC Electronic Data Interchange (EDI) format „ In a manner as prescribed by the Division’s EDI Implementation Guide

AGENDA
Mo rn in g Se ss io n 10:00AM Welcome and Intr oductio ns 10:10AM Sta tute & R eport ing Ov erview 10:50AM Break   11:10AM EDI Ove rv ie w 12:00PM Lunch (o n yo ur own)  

AGENDA
„ Aft ernoon Se ss io n 1:15PM Im ple menta tio n Requirements 2:15PM How to G et S ta rted Technolo gy Meth ods 3:15PM Question s ession

STATUTORY OVERVIEW
Electronic Filing of Accident Reports in Kansas
Research Analyst Division of Workers Compensation Kansas Department of Human Resources

Ala n S ta nto n

STATUTORY OVERVIEW
„ „ „ „ Current Reporting Requirements Reporting Option as of 11/15/03 Compliance Confidentiality

CURRENT REPORTING REQUIREMENTS
„ K.S.A. 44-557(a)

„ K.S.A. 44-557a(c)

Employers or agents must send reports on 1101-A form to KDWC within 28 days of knowledge for injuries beyond remainder of “day, shift or turn” Insurers or agents must report closed claims data to KDWC on proprietary software, on the date provided by KDWC
7-8

REPORTING OPTION as of 11/15/2003
„ K.S.A. 44-557a (b):

„ Regulation K.A.R. 51-9-17 (1/1/2004)
ƒAllow EDI First Report of Injury to be considered same as 1101-A form ƒStop paper reporting

Insurers may submit claims information by IAIABC’s EDI Release 1 as a substitute for Closed Claims data

7

REPORTING OPTION as of 11/15/2003
„ EDI First Report of Injury (FROI)
Submit to KDWC within time period specified in Kansas EDI Implementation Guide (28 days)

„ EDI Subsequent Report of Injury (SROI)
Submit to KDWC within time period specified in Kansas EDI Implementation Guide

REPORTING OPTION as of 11/15/2003
„ Employer/carrier may continue to report on K-WC 1101-A to Division „Employer/carrier may continue to report claims study requirement via Division software „ Employer/Carrier must continue to submit all medical fee data to Division
(EDI program constitutes no change to medical fee requirements)
22-24

EXISTING and EDI REPORTING COMPARISON
Existing
1101-A

Employer

EDI
IA-1 paper

Employer

Insurer/ Group Fund

1101-A

TPA

Insurer/ Group Fund

IA-1 paper

TPA

FROI/ SROI 1101-A 1101-A IAIABC OCC OCC

FROI/ SROI

IAIABC OCC

Kansas

OCC OCC

Kansas
OCC

KS Voluntary EDI Reporting Requirements Claimant KS Current Reporting Requirements
1101-A

Claimant
IA-1 paper

22

EXISTING REPORTING
„ Carrier generates or forwards paper 1101-A to state, or reports to TPA which then generates or forwards paper 1101-A to KWC „ Self-insured employer reports to TPA or sends paper 1101-A directly to state „ Duplicates created when both employer and carrier or TPA send paper 1101-A to state „ Insurer or TPA selects cases from prior year to report using proprietary OCC (now CCS) software

EDI REPORTING
„ Carrier translates report from employer into electronic report to send directly to KWC’s EDI vendor or reports to TPA which then generates or forwards electronic report to KWC’s EDI vendor „ Self-insured employer reports to TPA or sends electronic report directly to KWC’s EDI vendor „ Vendor edits reports, acknowledges back electronically to sender, and forwards acceptable reports to KWC

EDI REPORTING (contin.)
„ No duplicates allowed „ If selected to report under CCS program prior to approval for production status under EDI program, insurer or TPA may report, using IAIABC EDI standard, those claims that would have otherwise reported using proprietary CCS software

COMPLIANCE
„ Failure to Submit Reports in Timely Fashion OR „ Failure to meet Data Quality or Technical Standards „ May result in revocation of EDI Participation and/or Fines and Penalties
8-9

CONFIDENTIALITY
„

K.S.A. 44-550b
ƒ Workers Compensation records are open records except for accident reports, medical records and form 88's (not filed with the Division since 1994) and social security numbers ƒ WC records are open to the following: ‚ Employer after a job offer ‚ Employer and insurance company and their representatives when an employee files for benefits ‚ State and Federal Agencies for investigation of Fraud ‚ Upon order of a court of competent jurisdiction
10

EDI OVERVIEW
EDI Overview
Research Analyst Division of Workers Compensation Kansas Department of Human Resources

Ala n St anto n

EDI OVERVIEW
„ What is EDI? „ „ What is the IAIABC? How does Kansas EDI work?

WHAT IS EDI?
(And Why Should I Care?)

EDI IS
Electronic Data Interchange = Exchange of business documents in a non-paper (electronic) environment

EDI is...
„ Standardized business practices which permit the flow of information between organizations without human intervention. „ System-to-system communications. „ Technology for cross-organizational exchange of standard documents in a machine readable and universal format.

A Brief History of EDI
The first industry to use EDI, beginning in the mid1970s: Transportation The most EDI mature industries today are transportation, retail, finance, electronics, government, automotive Roughly 90% of Fortune 1000 companies now using EDI

IAIABC EDI Project History
„ IAIABC began standardization of states’ workers comp paper forms during the 1950s „ IAIABC began researching electronic transmission during the 1980s „ IAIABC developed EDI reporting standards in the 1990s „ 1990, IAIABC membership adopted the IAIABC Statistics Committee’s proposal to develop standards for communicating data electronically between providers, payers and state administrators via EDI.

Developing an Electronic Standard
Bringing Together the Right Participants

Jurisdictions

Carriers

TPAs

Service Providers & Vendors

Asking the Right Questions...
„ What Should We Be Collecting? „ Why Do We Need It? „ How Do We Use It? „ Who Should We Be Asking For It? „ When Are We Getting Duplicates? „ How Can We Make It Easier?

Asking the Right Questions...
What are we collecting now?
First Report of Injury Claims Safety Subsequent Reports Claims Status Benefits

Why EDI?

Why EDI?
Benefits of EDI Quantifiable Benefits Strategic Benefits Unquantifiable Benefits

Why EDI? Quantifiable Benefits
„ Eliminates delays due to rekeying data „ Eliminates errors due to rekeying data „ Eliminates time spent in non-productive human-to-human error resolution (e.g., telephone tag) „ Eliminates paper handling, filing, storage, and mailing costs

Why EDI? Strategic Benefits
„ Improves the quality and speed of operations „ Reduces operating costs „ Improves trading partner relations by assisting in reduction of their costs & improving operations „ Improves forecasting and planning through improved timeliness of reporting information „ Refocuses employee resources on more productive business activities

Why EDI? Unquantifiable Benefits
„ Changed business processes „ Changed business relationships „ Changed business perspectives

EDI Brings Opportunities for Change

The Evolution of EDI - The Need for Better Data
Problems associated with data collection in workers’ compensation: Lack of credible information to identify and measure the specific factors driving costs Lack of uniformity among forms and terms An administrative process that is becoming engulfed in paper

WORKERS COMPENSATION EDI
The IAIABC promotes EDI standards within the workers compensation system

http:\\www.IAIABC.org

WHAT IS THE IAIABC?

International Association of Industrial Accident Boards and Commissions

IAIABC INVOLVEMENT WITH EDI
„ Acts as a workers compensation standards organization „ Members include state jurisdictions, carriers, claim administrators, employers, vendors, and other workers comp organizations „ Works cooperatively to implement electronic standards in both flat file and ANSI X12 formats

WORKERS COMPENSATION EDI
Medical Bills Medical Bills, First and Subsequent Reports of Injury

Provider

First Reports of Injury Payer/Administrator Employer

State

IAIABC EDI TRANSACTIONS

„First Report of Injury „Subsequent Report of Injury „Medical Bills „Proof of Coverage „Detailed Acknowledgment

IAIABC IMPLEMENTATION GUIDE
„ Data Dictionary „ File Layouts (Flat File & X12) „ Hard Copies „ Scenarios „ Code Lists „ Decision Table Templates (Event, Element Requirement, and Edit)

Key Components of EDI
„ Hardware/ Sof twa re „ Comm un icati ons „ Standards „ Courage

STANDARDS
„ National standards allow data comparison „ National standards eliminate needless duplication of effort to build transaction sets „ National standards allow the entire industry to operate more efficiently

OPTIONS

„ Formats: Flat File or ANSI ƒ Build your own Program - flat file 09234 938 730239 789 ƒ Use existing software - ANSI 9234*938*730239*789 „ External Technology Solutions ƒ Buy off the shelf ƒ Hire a consultant ƒ Use a 3rd party collection agent ƒ Value added network or the Internet

EDI TRA NS MISSI ON PROC ESS

Jurisdiction Mapping, Translation, Telecommunications Mapping, Translation, Trading Database and Telecomm. Network and Telecomm. Partner Software Software Database - Vendor Package - Develop own programs - VAN - Internet - Vendor Package - Develop own programs

SOFT WARE

„ EDI Translation Software ƒ Converts application data into a standard EDI format ƒ Converts ANSI format to flat file „ Telecommunication Software ƒ Initiates communication session ƒ Establishes protocol ƒ Validates security ƒ Transmits the EDI data

COM MU NI CA TIONS
Value-Added Network (VAN) Private network Internet File Transfer Protocol (FTP) and Secure Shell File Transfer Protocol (SSFTP)

COUR AGE
‘Change’ is hard for many organizations EDI is a chance to evaluate your entire business process: BIG CHANGE EDI requires cooperative working relationships between all partners in the workers’ compensation arena: BIG CHANGE

IAIABC Standards in Use
Claims Release 1 Release 2 (No longer supported) Release 3/Combined Claims Product (CCP) Proof of Coverage Release 1 Release 2 Medical/Bill Payment Records Partially tested by Kentucky and in production Remainder has not been beta tested yet

EDI TRANSACTI ONS
Claims: 148: First Report of Injury A49: Subsequent Report of Injury Proof of Coverage: POC with PC1 Insured Record(s) & PC2 Employer record(s) (No ANSI) Medical: 837: Bill Payment Record

6 Step EDI Reporting Process

Acknowledgement Transmission Acceptance or Rejection Technical & Business Edits Translation Identification Submission

EDI TRANSMISSION COMPONENTS
A TRANSMISSION contains One or more BATCHES, which contain The HEADER One or more TRANSACTIONS The TRAILER

AN EDI TRANSMISION
•Header •Transaction(s) •Trailer •Header •Transaction(s) •Trailer •Header •Transaction(s) •Trailer

BATCH

BATCH

BATCH

EDI BATCH COMPONENTS
„Header „One or more Transactions with one or more records in each ƒCoverage data; OR ƒClaim data; OR ƒMedical data

Note: These data are never sent ‘mixed’
„Trailer

EDI HEADER
„Sender ID: “Return Address” (Who is sending this data?) „Receiver ID: “Address” (Who is this data being sent to?) „Transaction Set ID: “Contents” (What kind of data is this?) „Transmission: “Tracking Information” (What date and time was it sent?)

EDI TRAILER
„Transaction Set ID: “Contents” (What was included?) „Detail Record Count: “How many?” (Did all the data arrive?)

EDI Acknowledgement
AK1 Acknowledgement from Receiver „Transaction Set ID (match) „Acknowledgement Code (TA/TE/TR) „Number of errors „Detailed error information ƒElement Number ƒError Code ƒVariable Segment Number (if applicable)

KANSAS EDI TRANSACTIONS

First and Subsequent Reports of Injury

Acknowledgements Carrier SIE or SIGP Administrator Kansas

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s Fax / E-Mail
Non-Web Trading Partners

Trading Partner Documents

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •EDI Technical Help Desk

KS EDI Administration KS EDI Repository
FROI/ SROI Data

FROI / SROI

AC-Web
Web Clients

Real Time FROI / SROI KS O T H E R FROI / SROI

AK1

O T H E R TP1

VANs
AT&T Advantis Transmitter

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •Application Maintenance •Acknowledgments •EDI Technical Help desk •Data Base Mgmt. Bridium Services: •Test & Production Mgmt. •Acknowledgments •EDI Technical Help desk •Data Base Mgmt.

AK1

KS Annual Report
FROI Data

FTP
FTP Clients

AK1

KS Production Database

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s Fax / E-Mail
Non-Web Trading Partners

Trading Partner Documents

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •EDI Technical Help Desk

KS EDI Administration

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s

O T H E R TP1

VANs
AT&T Advantis Transmitter

FROI / SROI KS O T H E R AK1

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •Application Maintenance •Acknowledgments •EDI Technical Help desk •Data Base Mgmt.

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s

FROI / SROI

AC-Web
Web Clients

Real Time

AK1

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •Application Maintenance •Acknowledgments •EDI Technical Help desk •Data Base Mgmt. Bridium Services: •Test & Production Mgmt. •Acknowledgments •EDI Technical Help desk •Data Base Mgmt.

FTP
FTP Clients

FROI / SROI

AK1

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s

FROI / SROI

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •Application Maintenance •Acknowledgments •EDI Technical Help desk •Data Base Mgmt. Bridium Services: •Test & Production Mgmt. •Acknowledgments •EDI Technical Help desk •Data Base Mgmt.

KS EDI Repository
FROI/ SROI Data

KS Annual Report
FROI Data

KS Production Database

KANSAS EDI PROCESS
Stat e E DI Re po rt ing Proc ess: Brid ium Prod uc t a nd S erv ice Co mp one nt s Fax / E-Mail
Non-Web Trading Partners

Trading Partner Documents

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •EDI Technical Help Desk

KS EDI Administration KS EDI Repository
FROI/ SROI Data

FROI / SROI

AC-Web
Web Clients

Real Time FROI / SROI KS O T H E R FROI / SROI

AK1

O T H E R TP1

VANs
AT&T Advantis Transmitter

Bridium Services: •Trading Partner Set Up •Test & Production Mgmt. •Application Maintenance •Acknowledgments •EDI Technical Help desk •Data Base Mgmt. Bridium Services: •Test & Production Mgmt. •Acknowledgments •EDI Technical Help desk •Data Base Mgmt.

AK1

KS Annual Report
FROI Data

FTP
FTP Clients

AK1

KS Production Database

KANSAS IMPLEMENTATION GUIDE
„ Outlines the EDI requirements of the State of Kansas „ Provides contact information „ Documents testing requirements „ Contains required agreements and profiles to begin EDI processes

Simple Steps To Implementing EDI
„ External Review: State Reporting Requirements ƒ Technologies & EDI options available ƒ Assess trading partner capabilities „ Internal review ƒ Data Collection Process ƒ Technologies & EDI options „ Evaluation ƒ Time Frame and resources ƒ Cost-benefit analysis of options & Change „ Change ƒ Adapt, acquire and/or outsource

EDI Web Sites
http://www.iaiabc.org http://discussion2.iland.com/~jbaxter http://www.wcio.org http://www2.hr.state.ks.us/wc/html/wcedi.htm

IMPLEMENTATION REQUIREMENTS
Kansas EDI Implementation Requirements
Research Analyst Division of Workers Compensation Kansas Department of Human Resources

David S pric k

IMPLEMENTATION REQUIREMENTS
„ EDI Reports and Related Events
ƒ Business & Technical Data Reporting Requirements

DATA REPORTING REQUIREMENTS
„ Series of decision tables to express Kansas reporting requirements
ƒ ƒ ƒ Business or Claim Events Data Element Requirements Data Quality Edits

TYPES OF EDI REPORTS
MTC - Maintenance Type Code Transaction Types Business or Claim Event Reports ƒ 148 - FROI - First Report of Injury ƒ A49 - SROI - Subsequent Report of Injury „ EDI Receipt ƒ AK1 - Acknowledgement from the Jurisdiction „ „ „

ACKNOWLEDGEMENTS
„ transactions sent back to trading partner from the jurisdiction to let you know you file was received and what their status is! „ Transaction Accepted (TA) Complete, no further action required „ Transaction Accepted with Errors (TE) Correct errors identified with CO report „ Transaction Rejected (TR) Correct & Resubmit entire report

46

REPORT SEQUENCE REQUIREMENTS
FROI
Data Corrections

Correction Report Acknowledgement Change
46

SROI

Claim Admin.
Data Changes

Kansas Edits

FROI & SROI BUSINESS (CLAIM) EVENTS
Simplified Report Selection Guide What Report (MTC) to And This Specific Situation Applies: Use If This Occurs If First Report to a Jurisdiction by a Claim 1 A New Claim Use This To Submit This Report MTC
00 AU 04 Original Acquired / Unallocated Denial

Administrator If Full First Report to a Jurisdiction by Acquiring Claim Administrator If First Report to a Jurisdiction by a Claim Administrator is a full denial If First Report sent in error (Claim will no longer exists in that jurisdiction) If injured worker died and payments pending investigation to determine dependents or payees If Claim Administrator denies Claim

2 Canceling a Claim

01

Cancel

3 Initial continuing benefits are NOT being paid 4 Denying Claim

CD

Compensable Death

04

Denial

48

FROI & SROI BUSINESS (CLAIM) EVENTS
Simplified Report Selection Guide What Report (MTC) to And This Specific Situation Applies: Use If This Occurs
5 Initial continuing benefits ARE being paid If Employer paying salary in lieu of comp (1 per claim) If initiated by Claim Administrator (1 per claim) If initiated by Acquiring Claim Administrator (may include accrued lump sum due) (1 per claim) If all benefits being paid have been suspended or denied and no future payments anticipated

Use This To Submit This Report MTC
FS IP AP Full Salary Initial Payment Acquired Payment

6 Claim Closing

FN

Final

7 Periodic information request

If a medical only closed the previous year, or an indemnity claim closed the previous year that had financial information posted after the closing. A State request's a claim specific or broader scope data requirements, within the IAIABC specifications, to assist their implementation, resolve an EDI production problem, or study If jurisdiction designated data has changed, and another claim event does not apply If responding to a transaction acknowledged with errors

AN

Annual

8 State Special Data Request

UR

Upon Request

9 Change

02

Change

10 Correction

CO

Correction

FROI BUSINESS (CLAIM) EVENTS
FROI= First Report of Injury „ Original: 28 days from employer notification „ Denial: Same as Original and as occurs, 5 days „ Cancel: Upon improper filing, 5 days „ Acquired: 21 days after acquiring claim „ Change: As occurs, 5 days „ Correct: 5 days after TE Acknowledgement

40 Narrative, 42 CE Table

SROI BUSINESS (CLAIM) EVENTS
SROI= Subsequent Report of Injury „ Initial Payment: 5 days following initial payment of indemnity IP Equivalents: „ Acquired Payment: 5 days following initial payment of indemnity by acquiring CA „ Full Salary: 5 days following initial payment of salary in lieu of compensation „ Compensable Death: 5 days following CA’s knowledge of death of injured worker
40 Narrative, 42 CE table

SROI BUSINESS (CLAIM) EVENTS
„ Denial: as occurs, 5 days „ Final: claim closes, 5 days after CA determines no future indemnity to be paid „ Annual: within 10 days of June 1 „ Change: As occurs, 5 days „ Correct: 5 days after TE Acknowledgement „ Upon Request: specific request for claim information

40 Narrative, 42 CE Table

REPORT SEQUENCE REQUIREMENTS
„ BASIC SEQUENCING RULES „ Must send and have an acknowledgement of TA or TE before sending the next report in the sequence „ Must correct errors (TE) with a Correction (CO) MTC „ You must send something, before you can change it with Change (02) MTC

REPORT SEQUENCE REQUIREMENTS
Most Common Type of Report Sequencing Original First Report of Injury

Stop

43

REPORT SEQUENCE REQUIREMENTS
Typical EDI Report Sequencing on Claims FROI Original Original Initial Payment or Equivalent
Medical Only
43

SROI Final Annual June 1

REPORT SEQUENCE REQUIREMENTS
Acquired FROI SROI IP or Equiv.
Medical Only

Original
OR

Final Annual June 1

Cancel Stop Denial
44

Denial

REPORT SEQUENCE REQUIREMENTS
OCC Reporting using IAIABC Standards
•“Reach back” option since EDI is forward going only •Legacy claims

Original Same Batch or Separate Transmissions
47

Annual June 1

DATA ELEMENT REQUIREMENTS
„ KDWC/IAIABC Crosswalk Tables „ Kansas 1101-A Paper form w/IAIABC DN Refs. & OCC Record layout „ IAIABC Forms w/IAIABC DN References „ IAIABC Flat File Data Element Lists „ FROI/SROI Requirements Table „ FROI/SROI Scenarios in IAIABC Format

(1) 26-28,27-32 (2)33,34-37 (3)58,59 (4)56-58,60-1 (5)51,52 (6)117-129

FROI/SROI REQUIREMENT TABLES
„ An Element Requirement Table will tell you exactly what elements are: ƒ ‘M’andatory ƒ ‘C’onditional ƒ ‘O’ptional for EACH Report that is required by the State „ Data Element Number & Name „ Purpose(s) of Collecting the Data Element „ By Maintenance Type Code (MTC) „ Mandatory, Conditional, and Optional designation
51 & 52

SROI VARIABLE SEGMENTS
„ Variable Segment Counters
ƒ How many sets of what kind of data is being provided ƒ Number of Permanent Impairments ƒ Number of Payment/Adjustments ƒ Number of Paid to date, Reduced Earnings, Recoveries

52

SROI VARIABLE SEGMENTS
„ Permanent Impairment „ Payment/Adjustment
ƒ Body part code & % Impairment ƒ Max # of occurences per record: 6 ƒ Code, PTD & Weekly Amount ƒ Max # of occurences per record: 10

„ Paid To Date/Reduced Earn/Recov
ƒ Code & Amount ƒ Max # of occurences per record: 25
52

DATA QUALITY EDITS
„ All Reports submitted to KDWC are edited against the appropriate edit tables „ There are several types of edits
ƒ ƒ ƒ ƒ ƒ data presence data relationships data values report sequence matching a report to a claim
F-67-70, S-69-74, H-73-74

DATA QUALITY EDITS
„ Each edit table indicates what edits apply to each data element for a given report „ Identifies the Error #, DN # and possibly text description of error that is returned by the State in Acknowledgement record „ This information found in Edit decision tables or edit matrices
ƒ ƒ ƒ FROI SROI Header & Trailer

F-67-70, S-69-74, H-73-74

DATA QUALITY EDITS
„ Report Level Edits

„ Examples
ƒ ƒ ƒ ƒ Edit Edit Edit Edit 039 057 053 063 no match on Database Duplicate transmission No Matching First Report Invalid Event Sequence

64 & 65

MATCH ROUTINES
IAIABC Match Data Employee ID (SSN) Employee Date of Birth Employee First Name Employee Last Name Date of Injury Agency Claim Number Claim Administrator Claim Number Insurer FEIN Claim Administrator FEIN (TPA FEIN) Non-IAIABC Match Data Time of Injury Employer FEIN KS Initial Implementation (Primary) KS Proposed Match Data & Process FROI W/O Agency Claim # W/Agency Claim # (Primary) Secondary Third Third Third (Primary) Third Secondary (Primary) (Primary) Secondary Secondary Third Secondary

(Primary)

Secondary Secondary Secondary

(Primary) Secondary Secondary Third Secondary

78 & 79

TRANSACTION SEQUENCE REQUIREMENTS (Edit 063)
If Last Submitted FROI MTC is:
None 00 04 AU 01 02 CO IP FS CD AP 04 FN AN UR 02 CO

If Last Submitted SROI MTC is:
None None

Allow MTC(s):
00 04 AU UR 04 AU 01 02 CO IP FS CD AP 04 AN UR AU 02 CO IP FS CD AP AN UR 04 AU 01 02 CO FS CD AP 04 AN UR CO UR NA NA 02 CO FS CD AP 04 FN AN UR 02 CO 02 CO IP CD AP 04 FN UR 02 CO 02 CO IP AP 04 FN UR 02 CO 02 CO FS CD 04 FN UR 02 CO AU 01 02 CO IP FS CD AP FN AN UR 02 CO 02 CO AN UR 02 CO UR 02 CO All NA NA

Reject MTC(s):
01 02 CO IP FS CD AP 04 FN AN 02 CO 00 FN 02 CO 00 04 01 04 FN 02 CO 00 IP FN 02 CO 00 04 AU 01 02 IP FS CD AP 04 FN AN 02 CO NA NA 00 04 AU 01 IP 00 04 AU 01 FS AN 00 04 AU 01 FS CD AN 00 04 AU 01 IP AP AN 00 04 04 00 04 AU 01 IP FS CD AP 04 FN 00 04 AU 01 02 CO IP FS CD AP 04 FN AN NA NA NA

65

DATA QUALITY EDITS
„ Conditional Edits „ Edit Matrix Tables Comments „ Examples
DN25 Industry Code and Edit 58 Code/ID invalid ƒ DN02 Maintenance Type Code and edit 42 Statutory invalid ƒ

75

HOW TO GET STARTED & TECHNOLOGY METHODS
How to Get Started & Technology Methods
Kansas EDI Coordinator Bridium Inc.

Sharon Ma rion

HOW TO GET STARTED
 Implementation Schedule
 Roles & Responsibility  Scheduling a Test Date  Trading Partner Administration  Testing Procedure

IMPLEMENTATION SCHEDULE

Voluntary EDI Reporting Date 1/1/04 10/15/2003 Testing Begins Test Date Assignments Currently Available 2/5/04 KS Educational Session & Complete TP Documents 9/11/2003 KS EDI Implementation Guide available www.hr.state.ks.us/ Workers Compensation / EDI Project

ROLES & RESPONSIBILITIES
 Claim Administrator

ROLES & RESPONSIBILITIES
 Claim Administrator  KS EDI Coordinator

ROLES & RESPONSIBILITIES
 Claim Administrator  KS EDI Coordinator  KDWC

TEST DATE SCHEDULING

 Assessment & Planning  Alternatives  Test Date Assignments

Report proc 80, Tech lead summ 111

TRADING PARTNER ADMINISTRATION
 Trading Partner Agreement  Trading Partner Profile  Reporter’s Trading Partner Transmittal Form
Submit These NLT Two Weeks Prior to your Test Date
86

TRADING PARTNER AGREEMENT
 Data, Reports, Definition  Data Quality Commitment  Begin Date / Paper - EDI

90

KANSAS TRADING PARTNER PROFILE
Form Data Requirements: (M) Mandatory (C) Conditional (O) Optional Purpose: [ ] Submit [ ] Change [ ] Delete TP

A. Trading Partner Name: __ __ __ ___ ___ __ __ ___ ___ __ B. Trading Partner Type: [ ] Insurer [ ] TPA [ ] Self Insured/Admin [ ] Stat Non-Insured

93

KANSAS TRADING PARTNER PROFILE
C. In Production/IAIABC State(s): D. Plan to Use KS Web Data Entry: E. TP (Sender) ID [ ]Y [ ]N [ ]Y [ ]N

F. TP Physical Address 1. (M) Street ______________________________ 2. (M) City ______________________________ 3. (M) State ______________________________ 4. (M) ZIP _________ 93

1. (M) FEIN ________ 2. (O) TP ID_________ 3. (M) ZIP _________

KANSAS TRADING PARTNER PROFILE
G. TP Mailing-Address 1. (O) Street ______________________________ 2. (O) City ______________________________ 3. (O) State ______________________________ 4. (O) ZIP _________ H. TP EDI Business Contact Info 1. (M) Name ______________________________ 2. (M) Phone ______________________________ 3. (M) Title ______________________________ 4. (M) E-Mail ______________________________ or Fax _________ 93

KANSAS TRADING PARTNER PROFILE
I. Vendor Information 1. (M) Vendor Name ________________________ 2. (M) Contact Name ________________________ 3. (M) Contact Phone _______________________ 4. (O) Contact E-Mail ________________________ J. EDI TP Technical Contact Info 1. (M) Name ________________________________ 2. (M) Title ________________________________ 3. (M) Phone ________________________________ 4. (O) E-Mail ________________________________ or Fax _________ 93

KANSAS TRADING PARTNER PROFILE
K. EDI Communication Information 1. (M) EDI File Type IAIABC R1 [ ] R2 [ ] ANSI 3041 [ ] TBD [ ] R3 [ ]

2. (M) Network [ ] AT&T [ ] Transmitter ID _______ [ ] Advantis Mailbox _______ Acct _______ Message class _______
93

REPORTER’S TRADING PARTNER TRANSMITTAL FORM
FROM: (Reporter Name) (Reporter Attention Line) (Reporter Address Street) (Reporter Address City, State, Postal Code Reporter Telephone Number *M aster FE IN: Form ____ of ____ # LE GAL NAME 1   2   3  
99

*Po stal Code: FE IN      

TESTING PROCEDURES
Step 1: Pretest Step 2: Technical Capability Test

103-110

TESTING PROCEDURES
Step 1: Pretest Step 2: Technical Capability Test Step 3: Business Content Test (FROI) Step 4: KS Test Completion (FROI)

103-110

TESTING PROCEDURES
Step 5: Business Content Test (SROI) Step 6: KS Test Completion (SROI)

Ongoing Monitoring - Production Status

< Quality Requirements = Out of Compliance
103-110

HOW TO GET STARTED REVIEW
Step 1: Gather Your Resources Step 2: Executive Summary KS IG (pg19) Step 3: Reporting Process Functions/Options (pg80) Step 4: Implement your EDI solution Step 5: Arrange for a Testing Date Step 6: File Trading Partner Documents Step 7: Begin Testing Process

TECHNOLOGY METHODS
    Kansas Web Entry File Formats Networks Vendors

KANSAS WEB ENTRY
 Qualifications < 100 claims/yr or special circumstances  www.hr.state.ks.us/wc/html/ wcedinews.htm (SC-Web)  Data Entry of First Report of Injury  Data Entry of Subsequent Reports  Online Error Detection/Correction

SC-WEB REQUIREMENTS
 Meet User Qualifications  File Trading Partner Documents  Obtain a User ID and Password--EDI Coordinator  Microsoft Browser 5.0 or Above  Internet Access

SC-WEB REQUIREMENTS  Login Screen
 Welcome Screen  General System Operations

SC-WEB Functions
    First Reports of Injury Subsequent Reports of Injury Acknowledgements Workflow

SC-WEB ENTRY

FILE FORMATS
 IAIABC Flat File  ANSI ASC X12

FLAT FILE FORMAT
IAIABC Developed and Maintained
 148

First Report of Injury  A49 Subsequent Report  AK1 Detailed Acknowledgment

HD1 - R 1 Header R ecor d
87 Byte Fi xed Length Recor d 9 Data El ement s

IAIABC DN 0001 0098

IAIABC DATA ELEMENT NAME Transaction Set ID Sender ID Sender FEIN Filler Sender Postal Code

IAIABC FORMAT 3 A/N 25 A/N 9 A/N 7 A/N 9 A/N 25 A/N 9 A/N 7 A/N 9 A/N Date Time Date TIme 1 A/N 5 A/N 3 A/N 2 A/N

POSITIONS BEG 1 4 3 28 END

0099

Receiver ID Receiver FEIN Filler Receiver Postal Code

29

53

0100 0101 0102 0103 0104 0105

Date Transmission Sent Time Transmission Sent Original Transmission Date Original Transmission Time Test/Production Indicator Interchange Version ID Transmission Type Code Release Number

54 62 68 76 82 83

61 67 75 81 82 87

76

HD1 - R 1 Header R ecor d
87 Byte Fi xed Length Recor d 9 Data El ement s

Tr ansmiss ion S ample (S ho wn par tial and w r apped f or dis pl ay ):

HD1666777888 1480020010327PR TOPEKA WAY TR1000000001

888777666486029925 SUITE 6

66612122720030624074530

P14801

666777888ABC INSURER TOPEKA

818181818TPA 406

148 – R1 Fir st R epor t of Injur y
913 Byte Fi xed Lengt h Recor d 68 D ata E lem ents
IAIABC GROUPING TRANSACTION IAIABC DN 0001 0002 0003 JURISDICTION 0004 0005 CLAIM ADMINISTRATOR 0006 0007 0008 0009 0010 0011 0012 0013 0014 0015 INSURED 0016 0017 0018 Transaction Set ID Maintenance Type Code Maintenance Type Code Date Jurisdiction Agency Claim Number Insurer FEIN Insurer Name Third Party Administrator FEIN Third Party Administrator Name Claim Administrator Address Line 1 Claim Administrator Address Line 2 Claim Administrator City Claim Administrator State Claim Administrator Postal Code Claim Administrator Claim Number Employer FEIN Insured Name Employer Name IAIABC DATA ELEMENT NAME

IAIABC FORMAT 3 A/N 2 A/N DATE 2 A/N 25 A/N 9 A/N 30 A/N 9 A/N 30 A/N 30 A/N 30 A/N 15 A/N 2 A/N 9 A/N 25 A/N 9 A/N 30 A/N 30 A/N

POSITIONS BEG 1 4 6 14 16 41 50 80 89 119 149 179 194 196 205 230 239 269 END 3 5 13 15 40 49 79 88 118 148 178 193 195 204 229 238 268 298

56 & 57

148 – R1 Fir st R epor t of Injur y
913 Byte Fi xed Lengt h R ecor d 68 Data El em ents

Tr ansmiss ion S ample (S ho wn par tial and w r apped f or dis pl ay ):
HD1666777888 888777666486029925 66612122720030624074530 P14801

1480020010327PR 406 TOPEKA WAY TR1000000001

666777888ABC INSURER SUITE 6 TOPEKA

818181818TPA

TR1 - R 1 Tr ai ler Recor d
12 Byte Fi xed Length Recor d 2 Data El ement s

IAIABC DN 0001 0106

IAIABC DATA ELEMENT NAME Transaction Set ID Detail Record Count

IAIABC FORMAT 3 A/N 9N

POSITIONS BEG 1 4 END 3 12

76

TR1 - R 1 Tr ai ler Recor d
12 Byte Fi xed Length Recor d 2 Data El ement s

Tr ansmiss ion S ample (S ho wn par tial and w r apped f or dis pl ay ):
HD1666777888 888777666486029925 66612122720030624074530 P14801

1480020010327PR 406 TOPEKA WAY TR1000000001

666777888ABC INSURER SUITE 6 TOPEKA

818181818TPA

Varia ble Length R ecor d Minimum Length = 208 - - M axim um Length = 1099 208 + 99{ # of er ror s} x 9 {# of b ytes in varia ble s e gment} = 1099 20 Da ta Elem ent s

AK1 – R 1 A cknowle dg men t

IAIABC GROUPING TRANSACTION

IAIABC DN 0001 0107 0108 0109 0006 0014 0008 0110 0111 0028 0015 0005 0002 0003 0112 0113 0114 Transaction Set ID

IAIABC DATA ELEMENT NAME Record Sequence Nuimber Date Processed Time Processed Insurer FEIN Claim Administrator Postal Code Third Party Administrator Fein Acknowledgement Transaction Set ID Application Acknowledgment Code Insured Report Number Claim Administrator Claim Number Agency Claim Number Maintenance Type Code Maintenance Type Date Request Code (Purpose) Free Form Text Number of Errors

IAIABC FORMAT 3 A/N 9N Date Time 9 A/N 9 A/N 9 A/N 3 A/N 2 A/N 25 A/N 25 A/N 25 A/N 2 A/N Date 3 A/N 60 A/N 2N

POSITIONS BEG 1 4 13 21 27 36 45 54 57 59 84 109 134 136 144 147 207 3 12 20 26 35 44 53 56 58 83 108 133 135 143 146 206 208 END

Variable Segment Error Code 0115 0116 0117 Error Code Occurs Number of Errof Times Element Number Element Error Number Variable Segment Number 4N 3N 2N 209 213 216 212 215 217

77

Varia ble Length R ecor d Minimum Length = 208 - - M axim um Length = 1099 208 + 99 {# of er r or s} x 9 {# of byt es in v aria ble se gment} = 1099 20 Da ta Elements

AK1 – R 1 A cknowledg men t

Tr ans mis sion S ample (Sho wn par tia l a nd wr apped f or dis play ): HD1666777888 888777666486029925 66612122720030624074530 P14801

AK10000000012001032708164466677788834236 818181818A49TAINSRPTNUM WC29443 012234995 IP20010314 0 00 TR1000000001

ANSI ACS X12 FORMAT
IAIABC Assists in Development and Work Comp Implementation

 American
 National  Standards  Institute

 Accredited  Standards  Committee

 X12 Electronic Data Interchange

ANSI ACS X12 FORMAT
    148 A49 997 824 First Report of Injury Subsequent Report of Injury Batch Level Acknowledgment Detailed Acknowledgment

148 –X12 Fi r st Repor t of I nj ur y
ISA
ISA*00*0000000000*00*0000000000*ZZ*SENDER ID(15-characters)*31*RECEIVER ID(15-characters)*YYMMDD*HHMM*U*00304*1 *(P or T)*(Hex code(1F)~ GS*IJ *TP Supplied Sender ID*TP Receiver ID*YYMMDD*HHMM*Unique Number*X*003041~ DATA STREAM IAIABC DN # BUSINESS INTERPRETATION HL/LOOP POSITION

TABLE 1
ST*148*1003~ BGN*00*456*20020707*1430*ES*FN~ 0104 0100 0101 0001 '0105 Report of Injury or Illness & your uniquely assigned transaction Control# Original (Production) { Simulation (Test) { 00} 77} Batch/ID Control# Date Transmission Sent 7/7/02 Time Transmission Sent 2:30 P.M. East Std. Reference Number Transaction Set ID & Interchange Version ID (first three positions) Equals "148" If [ST01 = 148 & BGN07 = FN] Equals "A49" If [ST01 = 148 & BGN07 = " "]

NETWORKS
 Value Added Networks  Proprietary Networks

VALUE ADDED NETWORKS
     Secure Public Networks Audit Capabilities Data Recovery Capabilities Interconnects to other VANS Per Character Transmission Costs

82

PROPRIETARY NETWORKS
    Secure Transmission Audit Capabilities Data Recovery Capabilities Per Report Transmission Costs

84

EDI VENDORS
Bridium www.bridium.com (866) 448-1776 sisaac@bridium.com HealthTech, IN C. www.health-tech.net (913) 764-9347 sales@health-tech.net ISO www.iso.com (800) 888-4476 info@iso.com
116

Red Oak E -Commerce S olutions, Inc. www.roesinc.com (512) 363-4297 pcannon@roesinc.com Workcomp.n et www.workcomp.net (512) 363-4297 pcannon@roesinc.com

TECHNOLOGY METHODS REVIEW
 File Formats  Networks  Vendors  Kansas Web Entry