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WCIS

Workers’ Compensation Information System. WCIS. Division of Workers’ Compensation. Goals for WCIS. Help DWC Manage WC system Facilitate Evaluation of Benefits Delivery Assist in Measuring Benefit Adequacy Provide Statistical Data for Research. Components of WCIS. First Reports—FROI

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WCIS

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  1. Workers’ Compensation Information System WCIS Division of Workers’ Compensation

  2. Goals for WCIS • Help DWC Manage WC system • Facilitate Evaluation of Benefits Delivery • Assist in Measuring Benefit Adequacy • Provide Statistical Data for Research

  3. Components of WCIS • First Reports—FROI • Subsequent Reports—SROI • Medical/Bill Payment Reports

  4. Status Report: 2005 & Beyond • Data Collection & Uses to Date • System Reconfiguration • Plans for WCIS • Unresolved Issues

  5. Data Collection – First Report of Injury 2/2004 2/2005 • Trading Partners • Relationships Initiated 256 271 • Submitting Data 205 216 • Claims 3.0 m 3.9 m

  6. Data Collection – Subsequent Reports 2/2004 2/2005 • TPs Submitting Data 69 80 • Claims 403 k 520 k

  7. Data Uses to Date • DWC • DOSH • DLSR • CHSWC • DHS • LAW ENFORCE • EDD • WCIRB • LEGISLATURE • RESEARCHERS

  8. Current Programmed Reports • Injuries by Part of Body, Nature, Cause • Workers’ Demographic and Work Characteristics • Claims by Industry and Region; Benefit Category; Insurer Type • Timeliness of Benefits Delivery • Cost of Injuries

  9. Tables/Reports on WCIS Webpage Tables: • Nature of Injury • Part of Body • Cause of Injury • Injuries by Age and by Gender • Claims by Type of Insurer Report: • Age & Gender by Insurer Type, 2000-04

  10. Database to Date: Tip of Iceberg • Medical Data Collection Beginning Soon • Benefit Data with Two Years’ Maturity Commenced only in July 2002 • Robust Indemnity Data Requires: -Established Baselines for Comparison -Developed Claim Maturity

  11. WCIS Redesign & Enhancement • CA ~ 1/8 of USA • 2002-04 System Redesign • Medical Data Collection

  12. 2001-2 Claims to WCIS vs. ARI • WCIS Approximately 80% of ARI • Large Commercial Insurers Comply • Small TPs and Public Jurisdictions Lag • SROI Reporting Lags

  13. Current Compliance Issues • Alternatives to Update SROI Information • As per Implementation Guide • Submit UR and IP • Compliance Activities: 2003-05 • Set Deadline for Compliance • Require TP Data Submission Plan • Establishing Penalties (FROI/SROI/AN/FN)

  14. Other Potential Innovations • Add SIC/NAICS Industry Codes • Report AN on Claim Anniversary • Accept Future MTC and Benefit Start Dates • Permissible Uses of UR • Other Suggestions? (Adv Cmte Mtg--May)

  15. IAIABC Medical Data Collection • IAIABC Med Implementation Guide (7/02) • CA Medical IG (2/05) • Timeline for Beta Testing & Regulations

  16. Medical Data Reporting • Trading Partners • Beta Testing • Electronic Billing Standards • OAL Regulatory Process

  17. Rulemaking Changes • Standard Billing Forms • Overhaul of CA FROI/SROI IG • Med Data IG • Compliance/Penalties

  18. Other Topics • WCIS Reports, etc. on Website • TP Suggestions Welcome

  19. Integration and Future Design • EDD Linkage • WCAB, VR and DEU Database Links • EDI Release 3

  20. Med Issues & Legislation • Repeal of Treating Physician Presumption • Medical Treatment & Quality in WC Study • Fee Schedules • Access Study • Etc.

  21. Conclusions Re: WCIS • Significant Advances • Continuing Challenges

  22. Wrap–Up and Next Steps Address Questions and comments to: Bill Kahley 415.703.4678 bkahley@dir.ca.gov

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