POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

1. POP QUIZ: What MTC is used to retract an EDI DWC-1 filed in error with DWC?

2. ANSWER: FROI MTC 01

3. Cancel / Jurisdiction Transfer Rules See Rule 69L-56.307, F.A.C.

4. FROI MTC 01is required to be filed with DWC to report the cancellation of the claim in its entirety. It is not used to cancel an individual MTC sent in error. FROI 01 - Cancel Rules

5. FROI 01 - Cancel Rules • FROI 01 (Cancel) should be sentif a First Report of Injury or Illness has been filed with DWC (paper or EDI), but the claim is subsequently determined to be ‘non-reportable’ because…

6. FROI 01 - Cancel Rules • ... the claim is actually a Medical Only Case. • In this case, the FROI 01 should report Claim Type “B” (Became Medical Only).

7. FROI 01 - Cancel Rules • FROI 01 should also be sent if: • The claim was reported multiple times under different SSN’s/DOI’s & the claim filed with the incorrect SSN/DOI needs to be cancelled (i.e., duplicate submission), in which case…

8. … you will probably want to keep the one filed with DWC the earliest & file MTC 02 to correct SSN/DOI as applicable; then file the FROI 01 to cancel the other one. FROI 01 - Cancel Rules

9. FROI 01 should also be sent if the claim was transferred to another jurisdiction and no indemnity benefits were ever paid/reported to DWC because… FROI 01 - Cancel Rules

10. … Claim was initially denied (FROI 04, 00/PD), or Claim was reported as compensable death, no dependents or volunteer (00/CD, 00/VE). FROI 01 - Cancel Rules

11. Under these circumstances, SROI S8 (Jurisdiction Change) is not applicable because there are no indemnity benefits being suspended. FROI 01 - Cancel Rules

12. Per IAIABC standard Cancel Rules, when FROI 01 is filed, DWC will flag the associated claim in its database as “cancelled”. This means the claim is no longer considered to be “on file” with DWC. FROI 01 - Cancel Rules

13. FROI 01 - Cancel Rules • As such, the claim will be removed from DWC’s online Claims Database on the web.

14. FROI 01 - Cancel Rules • FROI 01requires limited data: • ‘Match Data’ keys (including JCN) so DWC can locate the correct claim in its database. (Designated as “M” – Mandatory on FL’s ERT.) • Fatal technical data elements (Designated as “F” - Fatal on FL’s ERT.)

15. Caveats and Tips for Successfully Filing FROI 01 – Cancel Transactions

16. Caveats and Tips for Filing FROI 01 • FROI 01 should not be used to cancel a claim due to a deficiency in a Claim Admin.’s system that doesn’t allow changes to key data (e.g., SSN, DOI, Claim #, etc.), and instead requires the establishment of another file under the correct key information. • MTC 02 should be used to correct keys.

17. Caveats and Tips for Filing FROI 01 • FROI 01should also not be used to cancel a claim when the wrong MTC was sent (e.g., 00/PD sent when really a FROI 04 should have been sent or 00/EP was sent when 00/IP was sent). • Solution will vary depending on what MTC was sent incorrectly. Sometimes EDI Team intervention is required to “push through” the subsequent MTC.

18. To “un-cancel” a previously accepted FROI 01, the Claim Admin. must file a new Electronic First Report or Injury or Illness via: FROI MTC 00 (or AU) + SROI, or FROI 04, depending on the situation. Caveats and Tips for Filing FROI 01

19. Caveats and Tips for Filing FROI 01 After cancellation/re-establishment, the Claim Admin. will NOT receive credit for the original filing date for the claim that was cancelled. The new FROI/SROI filing will be evaluated for timeliness by DWC.

20. Caveats and Tips for Filing FROI 01 If the FROI 01 was filed in error and the entire claim was never intended to be cancelled, contact the Claims EDI Team for assistance. CLAIMS EDI

21. Caveats and Tips for Filing FROI 01 • If the 01 was filed in error and SROI’s are now rejecting, depending on the circumstances, DWC may be able to remove the ‘cancel’ status so SROI’s can be re-loaded.

22. Caveats and Tips for Filing FROI 01 • If a claim is cancelled in DWC’s system, no further transactions can be accepted unless the claim is re-established with DWC or “un-cancelled” by DWC.

23. Caveats and Tips for Filing FROI 01 • Do not send FROI 01 when: • All indemnity benefits have been voided/cancelled/returned because EE can not be located; • Instead send MTC “S6”, Suspension - Claimant’s Whereabouts Unknown.

24. Caveats and Tips for Filing FROI 01 • Also, do not send FROI 01when: • A claim is transferred fromFLto another jurisdictionafter indemnity payments have been made on the claim; • Instead send MTC “S8”, Suspension - Jurisdiction Change.

25. If a claim is being transferredTO FL …. Cancel/Transfer Rules

26. The FROI/SROI or FROI 04 sent to establish the claim with FL should include Late Reason Code "L4" (Late Notification, Jurisdiction Transfer). Cancel/Transfer Rules

27. Cancel/Transfer Rules • If filing a 00/IP to report the claim, the Payment Issue Date in the Payment segment on the SROI IP should reflect the date associated with the first payment in FL.

28. SROI MTC “S8” Suspension,Jurisdiction Change

29. SROI MTC “S8” Suspension,Jurisdiction Change MTC “S8” is used to report the suspension of all indemnity benefits when a claim is transferred to another jurisdiction after indemnity benefits have been initiated, i.e., • Another state’s workers’ comp Act, Or , • U.S. Longshoremen’s and Harbor Workers’ Compensation Act, Or ,

30. SROI MTC “S8” Suspension,Jurisdiction Change • Federal Employers’ Liability Act, Or, • Federal Employees’ Compensation Act, Or, • Jones Act.

31. No further EDI filings (e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC “S8”. SROI MTC “S8” Suspension,Jurisdiction Change

32. Claim administrator then sends the following to the appropriate state (if applicable): FROI MTC “00” SROI MTC “IP” (or other applicable SROI) Reminder: Jurisdiction Transfer

33. Reminder: Jurisdiction Transfer If a claim is transferred TO FL from another jurisdiction (i.e., a different state, or compensation act, etc.)…

34. Reminder: Jurisdiction Transfer • The claim administrator should send FROI 00 and SROI IP (or other FROI/SROI filing equivalent), and • Report Late Reason Code “L4” – Late Notification, Jurisdiction Transfer .

35. If no indemnity was paid (e.g., 04, 00/PD, 00/CD, or 00/VE on file), or indemnity was paid but check(s) was returned/voided/cancelled prior to the change in jurisdiction, the Claim Admin. should send: • MTC 01 to Cancel the claim with the Division (since indemnity is not being suspended) and not an S8.

36. Questions?

37. Other Helpful Hints and “Lessons Learned”

38. OTHER HELPFUL HINTS • Numeric fields that are not populated on a transaction, should be sent as spaces and not zeros. • Zero is a valid value for some numeric fields.

39. OTHER HELPFUL HINTS • Upper or Lower Case? • Data can be sent in mixed case format; however, • DWC’s ‘match criteria’ requires case be the same between FROI & SROI combos (either all upper case, or all lower, or identical mixed text.)

40. OTHER HELPFUL HINTS • DWC has a“relational database”and storesone EE Name, SSN & DOB. If your system stores multiple names for different DOI’s, an EDI filing could reject if the EE Name does not match name on file an earlier filing (or from a different claim admin.)

41. OTHER HELPFUL HINTS • Note:FL Recently relaxed match data requirements on Middle Initial/Name (i.e., no longer required if on file or previously sent. If middle Initial/Name is not consistent with what is on file you will receive a TA-FL.

42. OTHER HELPFUL HINTS • If DWC receives a FROI/SROI from one Claim Admin., and afterwards a FROI 04 denial from a different Claim Admin., a new JCN is NOT established for the denied claim. However, …

43. OTHER HELPFUL HINTS … if two Claim Admin.’s pay on the same claim, two different JCN’s are established. • If FL’s “relational database” reflects a different name for the EE, the EDI team will contact each of the Claim Admin’s to reconcile the correct EE name.

44. Which MTC’s to Send When…

45. NONE ER EP CB

46. CB then re-file SA (non-standard) ER or RB 02 to rpt RTW CONTACT EDI Team

47. 02 CB RB S7

48. CB if paying wkly, or PY if lump sum PD SA RB

49. MTC 02, or CB with RBAC ‘R’ will also work CB with RBAC ‘R’, no CA needed MTC 02 (CB or RB is not required)

50. MTC 02, but can’t add new BTC or advance Thru Date. (Do Not Send RB) None TT is already ‘on file’.