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Frequently Asked Questions about the EDI Initiative

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Awards

  1. Is the payment made with the SROI or is the SROI filed and the payment is made after it is accepted?

    Essentially, EDI is a way for your system to interact with our system. In general, it will respond to a system trigger. You will adjust your claims process to your internal process and to law, your system will communicate that activity to our computers. In general, you will make a payment and then file a SROI. If it's the first payment you make, that will happen immediately; the report will come simultaneously to the payment being made.

  2. Will this process eliminate the employee's responsibility to file a claim with the VWC within 2 years from the date of accident to be entitled to a lifetime medical award?

    In general, if a person wants something specific that they're not getting, they will have to file a claim within 2 years to get that. If they're getting treatment, and you're paying for it and are reporting that payment to us, then we assume that you are happy with an award being entered for that injury. You will be given an opportunity to object to that.

  3. Are you saying that a SROI must be filed quarterly for each and every open claim?

    If a claim is open, and is currently having indemnity or medical payments made on it, and it passes the quarterly threshold, a Quarterly Report (QT) must be filed.

  4. How will you have access if you are a TPA taking over claims from another TPA?

    In EDI, you are enabled to report to us that you have taken over a claim. You file an "Acquisitions Report" that indicates that you have taken over the claim. In the Web Browser function, you will be able to see the history of what's happened to that claim.

  5. Is the this method of filing the FROI & SROI going to be the same regardless of how many non-minor claims you handle per year?

    The number of non-minor claims (100), determines if you will be required to submit this using EDI or if you will be able to use a VWC provided web browser based application. The timing and data requirements are identical regardless the method of submission.

  6. If initial indemnity payments are made based upon an estimated AWW, will the change of data in our system and the supplemental payment and overlapping payment period update the VWCC records?

    After the Initial Payment (IP) transaction has been received, subsequent payment reports will contain aggregate data representing the payments made to the claimant. VWC is not requiring you to report every change in payment amount. If initial payments are based on an estimated AWW, which is later changed, later payment reports will show the changed AWW.

  7. Will the commission be able to enter more than one tpa for an employer?

    Yes, though not at the same time on the same claim.

  8. Other than the carrier/TPA who else will have access to online portal of claim information?

    All related parties to a specific claim will have managed access to claim information.

  9. For two injuries that occur in the same day, should these be reported as two separate claims (different Claim Administrator Claim Number), or as one claim? I am wondering if your system would be able to distinguish between the two claims based on your Match Data table values.

    I am wondering if your system would be able to distinguish between the two claims based on your Match Data table values. The system will be able to identify two separate claims if the claim administrator is handling these as two separate claims.

  10. Will EDI have any impact/change on the current 45-H system regarding coverage, if so what change(s)?

    VWC is moving to electronic coverage reports as well. This system work begins in summer 2008 and will be functional in early 2009. Stay tuned for details.

  11. How are voluntary payments dealt with?

    Assuming you mean that you are paying, but also denying the claim, you would file a denial. You can continue to make payments, but the claimant would be informed that the claim is denied, and VWC would provide dispute resolution help on request.

  12. How will we be notified that an award has been entered?

    Initially, mail will be used. Long-term, you will be able to register to receive notifications via email.

  13. Will EDI feedback from the VWC be in code or in plain text?

    Feedback returned via EDI will be following the IAIABC standards. These are typically codes.

  14. Average weekly wage, current status requires a 52 week chart-will that change?

    Only if a dispute arises as to that issue; otherwise, report the AWW via EDI and agreement form (and not via a wage chart).

  15. Our organization administers its own claims, and has a very small volume of claims in Virginia; will we be expected to comply?

    All organizations who currently report to the Virginia Commission will be moving to electronic reports, either through EDI or through web-based submissions. If your organization was required to report on 100 or more of these "non-minor" claims annually, using 2007 volume as a guide, you must report via EDI. If you are a TPA, you must report via EDI for those carrier or self-insured customers who meet this threshold.

  16. Our organization uses a Third Party Administrator for all claims handling and data reporting; are we impacted by the EDI Initiative?

    An insurance carrier or self-insured organization who utilizes a TPA for reporting should see no impact from this EDI initiative, provided the organization continues to utilize the TPA’s services for reporting. Ultimately, of course, it is the insurance carrier or self-insured organization that is responsible for compliance.

  17. We are a self-insured entity, who administers its own workers’ compensation claims. We want to continue to adjust our own claims, and also continue to fulfill our reporting requirements. Our volume indicates we will have to use EDI; what should we do?

    You have several choices. You can build an EDI reporting system. If you choose to go this route, please know that Virginia is using industry-standard reporting formats, so if you report in other jurisdictions, this investment should be able to be leveraged elsewhere. You can also get assistance. There are third parties who assist with EDI transmissions to workers’ compensation jurisdictions, who will also assist you for a fee, which is outside our control. Also, it is standard in the industry for third-party administrators (TPAs), in addition to EDI vendors, to perform EDI services for carrier and self-insured customers. The Commission is not promoting any particular vendor or TPA. Many vendors perform EDI services, but very few work in the workers’ compensation industry. The Commission plans to post a list of vendors who have successfully submitted EDI reports in an IAIABC fomat.

  18. How will VA receive claims reports?

    The Virginia EDI initiative involves using a “clearinghouse” to collect reports from our customers, test the reports for accuracy, and forward to the agency’s databases. The Commission's partner, Red Oak E-commerce Systems (ROES, which was recently acquired by Ingenix), will perform this “clearinghouse” service. All EDI reports will first go to ROES in an FTP, flat-file format, and then IAIABC Claims Release 3.0 edits, pursuant to the Virginia Implementation Guide, will be applied by ROES. The reports will then be sent to the Commission, and the submitter will receive an acknowledgement.

  19. How quickly will acknowledgements (AKCs) be sent back?

    Within 24 hours.

  20. Will there be TEs?

    No, Virginia will only accept or reject transactions, which means Carriers will not be required to submit corrections.

  21. When does VWC consider a transaction received?

    Transactions must be received by 8:00 PM EST to be included with the current business day. Any transaction received after 8pm will be included and processed with the next business day's transactions. PLEASE NOTE: An Acknowledgement (AKC) does not mean that your report satisfies all reporting requirements for Virginia, but that your report has passed automated data edits.

  22. Can I file a 00 and IP or PY together?

    Only if the 00 came in with a Judicial Claim Number (JCN). An IP (and all other SROIs) requires a JCN.

  23. Does Virginia utilize the NAIC Codes or SIC Codes? If using NAIC Codes, are the NAIC Codes used Virginia state specific or from the 2002 National List?

    VA will use the 2007 NAICS national codes (6 digit only).

  24. How do you determine which body parts are covered under the award?

    We don't. We say the causally-related treatment that you paid for is covered by the award. We cannot tell, through EDI, what body parts are at issue. If this is not correct, i.e. you've paid for something but do not agree that it should be awarded, you would object. It is important to note that the body parts covered/agreed to will be on the agreement forms. We will report out which body parts are agreed to on the Notification of Award. The parties can agree to all causally-related.

  25. As I understand it, all medical only files will have medical only awards automatically set up, unless we dispute the award, correct?
  26. If you do report payments that are less than $1000.00 thinking that they may get past the $1000.00 would that be a problem?

    No, this will not be a problem.

  27. When is a lifetime medial award entered on a med only claim?

    EDI will not trigger a Medical Only Award. The Carrier must agree to this by responding to a 20-day Order or filing an agreement form.

  28. Is there any chance of raising the $1000 threshold in light of the rising costs of medical treatment?

    This is not something being taken on currently, but it is relevant to this program activity. Suggestions for a specific new threshold are welcomed, and will be submitted to the Commission for consideration.

  29. Has there been any consideration given for the electronic formats to be on the VWC Website to be completed and filed rather than the carriers aligning with a 3rd party vendor?

    Yes, it was considered—this option will be available for small volume filers (less than 100 claims annually). The Commission is not currently equipped to perform these services (and the support required to do it well) on a large scale

  30. Why did the Commission decide to pull the proposed Awards Process regulations?

    We heard from the insurance legal community that there were some jurisdictional constraints on the proposed procedures to do away with certain legal forms. Rather than risk agreement forms generated by EDI being undermined and potentially struck down, the Commission decided not to retire these agreement forms. Therefore, you will (via EDI) submit FROI and SROI reports, but you will also continue to submit paper agreement forms in cases where you make payments according to existing procedures. Agreement forms are NOT part of the forms being retired.

  31. What are the ramifications or fines for being out of compliance.

    The Virginia Workers' Compensation Act stipulates required reports. To address the ramifications for being out of compliance, the Act also contains a fine structur e. See Section 65.2.902 for details.

  32. I do not understand the SROI filing when there is no indemnity, even when payments exceed $1,000. Please explain?

    This refers to medical payments exceeding $1000. There are 7 criteria which define a "non-minor" injury. The two relevant ones for this answer are: 1) if medical costs exceed $1,000 or 2) if indemnity occurs greater than 7 days.

  33. What does Virginia require for accidents that occur in another jurisdication?

    You may or may not be subject to Virginia jurisdiction, depending on certain legal facts and conclusions--you should continue to consult your attorney to determine this. If your position is that you are subject to Virginia jurisdiction, then you must file appropriate EDI reports. If your position is that you are not subject to Virginia jurisdiction, then you are not required to file any Virginia EDI reports at this time; however, you may do so and indicate your denial for “no jurisdiction.” Of course the injured worker might not agree with this position and file a Virginia claim for the injury. If it is determined that you indeed were subject to Virginia jurisdiction, then you would at a minimum be required to “catch up” all appropriate EDI reports, and may be subject to penalties for non-compliance.

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Section A-1: Awards Dispute

  1. How do you object?

    Ultimately, we will have a web-based managed access - you will be able to note an objection through that system (this will be available mid 2009). Until that time, disputes will be handled on paper. The notice you receive will clearly explain how to note your objection.

  2. How do we limit the accepted type(s) of injuries and/or body parts when the claim is submitted electronically?

    You do not limit the body parts through EDI. You would limit body parts by objecting to an award for treatment that you've paid for. The award does not preclude a dispute regarding the causation of future treatment.

  3. On a claim that has medical payments over $1,000 and the carrier/tpa/employer does not want a lifetime medical award entered, will this automatically be moved to a 'dispute resolution'?

    No--the claimant would be notified of the objection to the award and VWC would respond to disputes on request.

  4. Will simply making a payment constitute an award?

    No, only a Commission action such as issuing a Notification of Award from and Agreement Form or a Judicial Opinion constitutes an award.

  5. Am I correct that payments made during investigation of a claim, which is denied after completing the investigation, will result in an award being entered?

    This is NOT correct. The decision to deny is reported through EDI when payments are stopped—it is the “reason” indicator for the “stop payment” report. The Commission will NOT process an award of benefits in this scenario.The Commission will attempt to include language in the proposed regulations to resolve uncertainty around this scenario.

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Section A-2: Awards Forms

  1. If a carrier files the suspension form and stops making payments, what assurance do we have that you have received it and we will not end up years later with an open award we have to pay?

    Terminations of Awards will be handled through the Employer App process. You can suspend with S1 and P1 (Return to Work) but if the supporting documentation is not received, you will have to reinstate. All other types of Suspensions will be processed entirely through the Employer App process.

  2. Will we still need to mail medical reports to the VWC?

    Rule 4.2 requires that all medical reports be filed with the VWC immediately.

  3. Will you send us paper awards as you are now? How can we track our files if you do not?

    Initially, after October 1st for a few months, you will receive paper awards. Ultimately, you will have the ability to log on and see the activity going on. This will also included disputed cases. You will be able to see activity prior to it moving to the dispute process.

  4. I assume the VWC will continue to send the claimant a claim for benefits form when the VWC receives notice via a FROI. Correct?

    Yes, that is correct. Today, we send out a guide. We are required to do this, and we will continue to do so.

  5. If released to rtw, is the release to rtw an edi process followed by the supporting documents?

    Yes

  6. Will the current paper forms continue to be required on claims where the DOI is prior to 10/1/08?

    Yes

  7. Is there any type of map or diagram that will allow us to see what information is needed to successfully file EDI information?

    Required EDI data for filing is contained in report format within the Implementation Guide.

  8. How will a statute toll on a claim if no 45-a, or 45-g are filed?

    The 45-A is going away in place of a FROI with a relaxed data set. You can still file a minor injury report in VA with a reduced data set, and that will satisfy your obligations. This will put the claimant on notice that they have 2 years to act.

  9. Are the on-line forms retroactive and applicable to all prior claims or just new losses after 10/1/08?

    Only for injuries occurring on or after 10/1/08

  10. What forms will no longer be used?

    In the IAIABC format, the FROI (First Report of Injury) and SROI (Subsequent Report of Injury) are used to report accident and payment data. Details about which current VA forms will be replaced by a particular FROI and SROI report are covered in the EDI Implementation Guide available on the EDI Initiative page.

  11. More information is needed regarding the Quarterly Reports. Will there be penalties if not completed timely? Will there be any grace period or consideration given for systems problems or downtime?

    Quarterly reports should be system driven; in other words, whoever programs the “triggers” for your organization to comply with your EDI requirements across the country will program a quarterly report for Virginia to sweep up payment activity during the preceding quarter. The report is due by the end of the month following the period trigger. System issues will most certainly be factored into any compliance proceedings

  12. Will we be able to print the electronic form that is used to submit data?

    This depends on how your organization handles the report submission. There is not a “form” for the data submission. The data that is needed to be collected should be analyzed and submitted either directly out of your systems or submitted to a reporting service, who then forwards it to the Commission. Depending on the reporting service, there are various ways of collecting the needed data—some have a web browser with questions that you answer. The commission also will have a small-volume filer option through the web. We will also have a “FROI” form that insureds can use to collect the data necessary to file a FROI with us. This form will not be filed with us, but will be helpful to a supervisor in an insured’s workplace collecting up accident info

  13. If the claim administrator and/or the insurer name changes, but not the FEIN, how do we report it?

    Changes to Claim Admin or Insurer shoname or address should be submitted in writing to the Commission and you Trading Partner documents should be updated.

  14. If our claim designation changes (part of our claim number, so the entire claim number changes), how do we report it?

    When a claim is transitioning from minor to non-minor status, the Claim Type Code should change when the FROI 00 is sent to replace the FROI UR. All other changes to data submitted on a FROI should be updated via a FROI 02 transaction.

  15. Where can I find the list of standard Nature, Part of Body, and Cause Codes required for VA's EDI system?

    VA will be using the WCIO Standard for these codes. Click here to access these on IAIABC's site, under the header "WCIO Data Specification Code Sheets. Click here

  16. Does the Date of Injury govern when we file paper forms, and when we move to EDI?

    That's correct; injury dates that occur on/after 10/1/08, should dictate this. Example 1: If the accident date is 5/1/08, and you need to file a follow up after 10/1, you will continue to file paper forms. Example 2: If an accident occurs on 9/30/08, and you report on 10/4/08, you STILL file a paper form, even though the first report is after 10/1. The date of accident is the determining factor.

  17. Why can't we use the Body Parts that come across on a FROI to help us populate agreement forms?

    It is a good idea to leverage the data on a FROI for any sort of downstream activity. We have learned that what is initially reported on a FROI often needs to be updated. An employee can dispute what's entered. We will notify people what is on the FROI, and a claimant can notify us of any inaccuracies, but more than likely, the claimant and adjuster will work this out ahead of time.

  18. Who should complete and submit trading partner agreement forms?

    These forms are for all entities who are sending electronic data via EDI to VA.

  19. I am a Third Party Administrator supporting multiple carriers. Do I need to submit multiple trading partner agreement forms?

    In the vast majority of cases, the answer is no. There is no need for multiple trading partner agreement forms. A small minority of TPAs may choose to route raw EDI files back to carriers. If this is the case, please contact the commission to manage this scenario.

  20. Isn't it duplicate work to do a FROI/SROI IP and then to do an Agreement to Pay Benefits, as well as SROI Suspension work, and then paper suspension work?

    The Commission agrees and recommends that carriers who feel this way relay this to their legal counsel. The Commission had hoped to do away with this duplicate work, but in order to address the concerns of the legal community, there will be some degree of duplication required.

  21. Will an injured worker continue to file a dispute using a Claim for Benefit form?

    Yes, but just as today, our vision is to have an online way for this to happen. There will be ways in the future for an injured worker to file claims online, but this will always be available as a paper form.

  22. Are we to file SROI CBs for change in benefits from TT to TP as well as paper forms?

    No, the Implementation Guide does not require SROI CBs. If moving from Temporary Total to Temporary Partial, file the paper forms if the change in benefits is different than what's listed in the open agreement with the claimant. We will receive a Quarterly Report which will alert us to what's paid under Temporary Total and what's paid under Temporary Partial.

  23. Regarding the Catch Up process: 1)For claims occurring on or after 10/1, these claims will require a FROI 00 and the SROI UR. Is this correct? 2) Also, is a FROI 00 require on all injures, or only non-minor injuries?

    1) If payments have been made for a non-minor claim you must also submit the SROI UR transaction. UR stands for "Upon Request," which is a specific EDI transaction type. 2) Send a FROI 00 or a FROI UR in cases of non-minor injury.

  24. Will a FROI generate a notification letter?

    Yes, a FROI will generate a notification letter.

  25. Will EDI change the way medical reports are submitted to the Commission?

    No, there is no change. Continue to file medical reports in the manner they are filed today. There may be changes in the future, but if changes do occur in this process, these will not be driven by any EDI standard or requirement.

  26. Can you continue to pay medical payments, and NOT file an Agreement to Pay form?

    Agreement forms will not be altered by EDI. The only forms that will need to retire are the EAR, 45A, and 45G. If it is your current practice to not file Agreement Forms in Medical Only cases, continue to follow this practice. If the Commission decides to change this, you will be notified.

  27. Will we need to file Termination of Wage forms?

    You will continue to file this in its current paper format. As noted in a previous question, the only forms being retired as part of the EDI Implementation are the EAR, 45A, and 45G.

  28. How should I submit Form 46?

    A 46 Agreement Form will still need to be filed, where it applies, just as it is today, and it will need to be signed, just as it must be today.

  29. If I am a Carrier, with several companies under the main Carrier umbrella, do I need to submit separate Trading Partner Agreement forms for each company, because each company has a separate Tax ID?

    If those companies are individually managing the acknowledgement files and have separate operations, then the answer is Yes. If these companies are managing their EDI data centrally, then a single trading partner agreement form will suffice.

  30. How do we handle forms that require a signature?

    The EAR, 45A, and 45G do require the adjuster to sign. Because these will now be submitted electronically, there will be a way for you to designate an "electronic signature" on these forms. All other forms requiring a signature must be done via pen and paper.

  31. Do we have to file a SROI along with agreement forms, at the same time?

    Per the Implementation Guide, SROI filing should be made when indemnity payments start or if when medical payments exceed $1,000. Agreement forms should be filed as they are done today.

  32. Does the filing of the SROI UR for individual. benefits enter an award for an injured worker?

    No, EDI transactions do not initiate awards for injured workers.

  33. Under Reporting Operations, the third item: ""reporter makes indemnity payments for more than seven days to the injured worker"". The new method states that a SROI will be filed. However, based on the recent e-mail sent out, and we are still using the paper Agreement forms, why do we need to file a SROI since we are going to continue to use the Agreement to Pay Benefits paper form?

    The commission will be using electronic records in concert with paper filing to accomplish its goals of accurate, reliable, accessible claim information. SROI reports contain necessary information to accomplish this vision.

  34. Is it accurate that the Commission will not be able to retire forms due to late reporting?

    Correct. Any forms not specifically retired by the commission as a result of EDI continue to be required.

  35. What are the ramifications or fines for being out of compliance.

    The Virginia Workers' Compensation Act stipulates required reports. To address the ramifications for being out of compliance, the Act also contains a fine structure. See Section 65.2.902 for details.

  36. I do not understand what we are to report if it exceeds the medical thresholds, would this simply be the QT report?

    If only medical payments have been made on a claim and they exceed the $1,000 threshold, a SROI PY report must be filed. If indemnity payments have been started and reported via a SROI IP transaction, additional medical payments are reported through the SROI QT transaction.

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Section A-3: Awards Termination

  1. Is this program retroactive? If an employee RTW, for example in June 2007, and we have been unable to secure a signed agreement, can a suspension report be sent in on this employee to terminate the open award?

    No, If the RTW was in 2007, the Date of Injury will have been before Oct 1, 2008. The existing procedures should be followed.

  2. How do I inform the VWC that we've closed the claim?

    Virginia doesn't ever consider a claim closed. Quarterly reports should only be sent if there have been Indemnity payments made after the late suspension or Medical Payments made after the last PY or QT transaction on an established non-minor claim.

  3. Do I need to follow a Suspension (Sx) transaction with a QT periodic report if the Sx transaction is the last transaction in the quarter?

    You do only if there is activity in the quarter that occurs after you file the suspension.

  4. Having only 2 business days to file supporting documents is of concern. We often can't obtain medical records from providers that quickly. It generally takes a week or two (at minimum) to obtain the actual medical records

    The only case this applies to is the “release to return to work” case. We are assuming that the decision to stop payments is being made after the documentation (the doctor’s release) is received and reviewed. This is the same documentation you would attach to an employer’s application to suspend based on release to return to work, or what you would use to support getting a claimant to sign a Form 46, “Termination of Wage Loss Award”

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Section B: Testing and set up

  1. I noticed there is not a SROI 02 (Change) MTC. How are changes to a SROI data element processed?

    Virginia is not using the SROI/02. For FROI-only data elements, submit those changes on the FROI 02. For SROI only data, changes should be communicated on subsequent SROIs (Sx, Px, QT, etc…). The most recent record value will be considered current.

  2. Where can I find the Trading Partner Agreement form?

    The form is available for download on the EDI Initiative page, which can be accessed by clicking the link to the left.

  3. When are Trading Partner Agreement Forms due, and how will I find out about my specific testing window?

    Generally speaking, two weeks prior to the testing phase. For Carriers in Wave A , please do not send completed TPA forms to edisupport@workcomp.virginia.gov prior to August 15th. Also, ROES will be managing communications related to the testing timeline for each Carrier. Submission dates for Waves B & C are still being determined

  4. What more can you tell me about Trading Partner Agreement Forms?

    All Trading Partners are required to submit TPA forms for the VA EDI Implementation. Prior forms, either for the VA proprietary format or from a previous relationship with ROES, are not valid for this project. The TPA form can be found by clicking the EDI Initiative link to your left.

  5. We are currently filing claims with VA using the Commission's proprietary system. Will there be changes to how we file using EDI?"

    Yes, the current online processes will be retired. Plan to move to the EDI system; consult the Implementation Guide on the EDI Initiative site for more details.

  6. Are trading partner agreement forms filed with the Commission still valid?

    This depends. If the trading partner agreement forms that have been filed are associated with the EDI implementation, then these do not need to be resubmitted unless something changes. Any agreement forms filed that related to the Commission's current proprietary system will not be valid for the EDI implementation. In this instance, new trading partner agreement forms will need to be submitted.

  7. We currently file a 45G on the Commission's website, do we convert back to paper until the EDI Implementation, or will the Commission's proprietary system remain live until the switch to the EDI system?

    No, there is no need to convert back to paper until your go live date with EDI. The Commission's proprietary online system will remain in place throughout the transition

  8. Is it accurate that if a TP has passed FL R3 testing, that VA will waive VA testing and simply start in Prod?

    The limited connectivity test will consist of a R3 Virginia compliant test file (FROI or SROI). Communications via FTP with PGP from the source system to the State of Virginia’s specified FTP URL will be required. The file will be processed by Virginia and acknowledgments will be returned. As long as the file does not error for structural / technical reasons the trading partner will be sent the formal authorization via email to start production. Structural / Technical errors are considered things such as: Incorrect Header information or length, incorrect Trailer information or length, improper 148, A49, R21 or R22 formats, etc. Please see the implementation testing section for more information.

  9. Will EDI reporting negate the need to have an instate vendor to receive notices from the VAWCC?

    No, the EDI mandate does not remove responsibilities specified by current law and regulations.

  10. If we are not currently set up for EDI, who should our IT people contact to get set up?

    If you have read the implementation guide, consulted with your technical staff on how to accomplish this mandate, and do not know how to get EDI enabled, you can reach out to industry resources, such as the IAIABC, or specialized consultants to guide your EDI implementation process.

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Section C: Implementation Timeline

  1. How will legacy claims be handled?

    Claims with an injury date prior to 10/1/2008 will be handled as they are currently. Paper forms and the VWC's proprietary EDI process will continue to function until the claim runs its full cycle or when the volume of legacy cases is small enough to migrate the cases to the new system.

  2. If I go into production after the mandate date of 10/1/2008, would I withhold filing reports until my organization's go-live date?

    No, you will have to file on paper until go-live. After your implementation you are required to 'catch-up' on the electronic filings for the paper claims filed on paper after October 1, 2008.

  3. Will carriers or TPA's who file less than 1000 claims file annually be allowed to start in Wave A so that we don't have to go back and retroactively file reports?

    Yes, carriers effected by the mandate may start reporting on 10/1.

  4. Is the October 1 date for claims received on or after October 1 or for claims occurring on or after October 1?

    For example, we will still be receiving claims which occurred in September after October 1. The Oct 1st date is the date of injury. The Date of Injury is the cut-off date.

  5. If I would be part of Wave C (self-insurer/self-administered) - would it be appropriate for me to participate on October 1st?

    If you happen to have the infrastructure or an agreement to submit EDI payments on your behalf, that would be appropriate. Our assumption is that, for our Wave C participants, you may not have the infrastructure or the volume needs to do this. The Web browser feature coming in mid-2009 will address your needs. However, if you have the infrastructure and the need to submit via EDI earlier, you are welcomed to do that.

  6. Does Wave C include entities that are self-insured and self-administered with less than 100 non-minor claims annually?

    Yes

  7. When will the VWC web-based submissions be available?

    Mid 2009

  8. What is the process to advise the VWC if the company is not ready to begin EDI on 10.1.08?

    Submit an email to TapFeedback requesting a status review. Cases are treated on an individual basis.

  9. What is the overall implementation timeline, and how has that been determined?

    The TAP team has established a phased timeline determined by insurance carrier (or self-insured employer) claim volume. Carriers with high volumes will implement EDI on either October 1, 2008 (more than 1,000 non-minor claims annually) or December 1, 2008 (between 100 - 999 non-minor claims annually). Carriers filing fewer than 100 non-minor claims annually will go live on March 1, 2008. A one-page summary of the Phasing Approach for Carriers can be found on the EDI Initiative page.

  10. I am a Third Party Administrator managing claims for a single carrier, or multiple carriers. Can the Commission provide me with typical business scenarios to help me better understand when I must be prepared to implement EDI?

    As mentioned in Question 10 above, Carrier volume determines the Wave implementation date for Third Party Administrators. Click here to download a table of scenarios which will provide additional information.

  11. I have acquired a claim that was originally submitted via EDI, but I am not yet ready to submit claims via EDI. What should I do?

    Because the Commission's workflows are built to manage a claim submitted via EDI in a prescribed manner, in order to meet the Commission's operational requirements claims originally submitted via EDI must continue to be managed via EDI.

  12. If a carrier is a small volume filer, or has a volume post 10/1, but this carrier wants to submit on 10/1, can they do this?

    Yes, absolutely. If a Carrier wants to go earlier, then they may take appropriate steps to file trading partner agreement forms in the appropriate timeline (i.e. approximately one month prior to the desired go live date - either 10/1 or 12/1, depending upon the situation).

  13. Is there a grace period for continuing to submit paper FROIs if by chance my company has technical issues with EDI at the time of implementation?

    No, there is no grace period. Technical issues can be worked out during the testing window. Once certification for production is granted, you will be required to submit via EDI. Paper FROI forms will no longer be accepted for entities which have been certified as ready.

  14. What is the difference between the March 1, 2009 date and the July 1, 2009 date?

    The March 1, 2009 date is when we will phase in the small volume and self administered/self-insured carriers. July 1, 2009 is the deadline date indicated in the mandate requiring a reporter to be compliant. Failure to file via EDI after July 1, 2009 puts a carrier out of compliance.

  15. A high volume filer which goes 'live' 10/1/08 and then a few employees report late per year. Can we use the Web Browser for reporting?

    No. High-volume filers will be required to use EDI transactions for reporting.

  16. What is the difference between web browser transmission and for those with greater volume & has there been a change-previously wasn't web browser for those in wave b with volume 100-999.

    A method of submitting FROI and SROI data via a Web Browser interface will be provided for those carriers with less than 100 non-minor claims annually - this has not changed since the original announcement. Those insurance carriers with volume exceeding 100 non-minor claims annually will be required to transmit this information using the published EDI format. Options exist in the marketplace that provide web browser solutions that generate EDI reports for their clients.

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Section D: WebFile

  1. If you start a claim in WebFile can you later change the administration of the claim to a 3rd party?

    Yes. If you initiate the claim, then decide to transfer administration to a Third Party Administrator, the TPA will need to submit an EDI transaction (AQ) acquiring the claim.

  2. Can we file via WebFile and then change to file via EDI?

    Yes, you can start filing in WebFile and then choose to move to EDI. However, claims originating in WebFile should continue to be managed through WebFile.

  3. Are medical records still required to be submitted?

    Yes, WebFile does not change that requirement.

  4. Can a Site Administrator and Claim Administrator be the same?

    Yes, a Site Administrator can also file FROI and SROI just like a Claim Administrator.

  5. Why does the First Report of Injury form updated on 10-1-08 have less information than the previous Employers Accident Report?

    When the Commission moved to EDI, it examined the EAR and determined that much of the requested information was not necessary. A decision was made to only collect information that is critical to the running of the claims operation.

  6. Do we have to send copies of filings to claimant if filed online?

    WebFile does not require a copy. However, when submitting an Employers Application you must follow requirements for that transaction. Webfile does not change the requirements set by the VWC for copying the claimant.

  7. I am a Third Party Administrator for a self-insured employer and handle their entire claim process. Do I qualify to use WebFile?

    If all of a TPA's clients file less than 100 claims per year, the TPA can use WebFile. However, if any of its clients file more than 100 claims, the TPA is required to use EDI.

  8. Will I automatically receive an e-mail from the VWC so I can file proper information as a Claim Administrator?

    No, the first step is to express your interest in being set up as a Site Administrator by sending an e-mail to webfilesupport@workcomp.virginia.gov with the following info: Name of organization, Site Administrator name, e-mail address and phone number, FEIN for Site Administrator Organization, FEIN for all those for whom the organization can file claims, Carrier number and an estimate of 2008 claim volume, and Claim Administrator and Insurer Address.

  9. When we file payment information, do we not have to attain the claimant's signature anymore?

    You are still required to submit an agreement form which requires a signature. EDI/WebFile is for reporting the payment activity which does not require a signature.

  10. What is the name of the reference document the Commission put together?

    The WebFile Guide, which can be found on the WebFile site or the Commission's Home Page.

  11. We have an EDI company that we use in three other states, we are in the process of changing to one company for all states, can we use EDI?

    Yes, even if you qualify for WebFile you can still choose to use EDI instead.

  12. Are FROI and SROI in same format as Florida? We have already started filing in Florida?

    FROI and SROI transactions filed in Florida are based on the Florida standard. VWC collects less data. You can continue to use the same format as Florida, WebFile will not require all of the data. Also some values may differ or some data may be required for VWC that's not required by Florida.

  13. What is the e-mail address for questions or requesting Site Administration access?

    webfilesupport@workcomp.virginia.gov

  14. What is the link to access the WebFile System?

    The site is https://webfile.workcomp.virginia.gov but you will not be able to log in until you are approved either as a Site Administrator, or the Site Administrator in your organization provides you with log in information.

  15. Is there a cost for using WebFile?

    No, not at this time.

  16. Are there any paper FROIs that require signatures?

    No, FROIs do not require signatures. Agreements forms, however, still have to be signed and sent in. You also report payments in WebFile, but these do not require signatures.

  17. The set up process seems complicated; what should I do first?

    First select a Site Administrator for your organization. Then, e-mail your desire to be set up in WebFile to webfilesupport@workcomp.virginia.gov. Please see an earlier FAQ for the specific information to include in that e-mail request. Also, the Commission's WebFile Guide is an excellent resource, available on the Commission's Home Page (www.workcomp.virginia.gov).

  18. Will agreement forms remain the same?

    Yes

  19. What address should be submitted when requesting a Site Administrator account? Physical or PO Box?

    Wherever you want mail delivered. Please note the Site Administrator can only have one e-mail address.

  20. Would you like carriers to continue to file 45Gs for claims prior to March 1st?

    Yes, continue current reporting for that.

  21. If so, then after March 1st, do you want quarterly reports to be filed?

    Yes, after March 1st a 45G is no longer required. The EAR, 45A 45G reports are being retired with the rollout of WebFile; everything else is still required. A QT transaction should be submitted after the initial IP or PY.

  22. Once approved as a WebFile user, can we still submit January/ February paper reports?

    Yes. It is required. Injuries before March 1st, 2009 should be filed by paper as normal. Injuries dated March 1st or after should be filed in WebFile (or EDI). If you have an accident occurring before 3/1/09 but are just now reporting (after 7/1/09) it must be reported via WebFile or EDI.

  23. What makes one ready for production?

    After you submit your request for Site Administrator access, you will receive an automated message with a temporary password and other log in instructions.

  24. Is any testing required?

    No, there is no testing required to use WebFile, nor are formal trading partner agreement forms needed. See FAQs for process for requesting to be set up as a WebFile Site Administrator.

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Section E: Key Terms

  1. Does our system have the actual words "Non Minor" and "Minor" as the claim type to report FROI's?

    Your system probably uses the term "EAR" for non-minor claims and "45A" for minor claims.

  2. Referring to quarter, is this a rolling quarter?

    The Quarterly Report is based on 3 months from the month of the date of injury. Every 3-month increment a SROI Quarterly Report must be filed based on the month of injury.

  3. Can you define minor medical? Definition of minor:

    In general - medical payments less than $1000 and indemnity payments less than 7 days. Also, disputed, denied, fatal, or injuries resulting in permanency or disfigurement are not "minor."

  4. Is "disputed" the same as "denied?"ni

    If you "Deny" a claim, the individual who filed the claim will receive notification that the injury claim is denied. If they dispute that and ask for assistance, that will go into a dispute process with the Commission. If you dispute a particular aspect of a claim, but not the claim as a whole, that is a "dispute" such that it is not considered "minor."

  5. Who/what defines a disputed claim?

    A disputed claim exists when a party or their representative raises an objection regarding the status of that claim. A dispute is also a difference of position about a particular aspect of a claim--e.g., claimant believes his AWW is $500 and adjuster believes it is $400.

  6. What does the phrase "ownership of a claim" mean? Does this describe who will have access to information online?

    Anyone with “ownership” of a claim: claimant, adjuster, attorneys representing them.

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Commonwealth of Virginia | Governor