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2. MTC “02” Change Processing Rules
3. 3 Change Processing Rules Transaction Usage MTC 02 (Change) transaction is intended to:
Allow Claim Administrators to correct data previously reported erroneously and/or,
Allow Claim Administrators to update previously reported data.
4. 4 Change Processing Rules Transaction Usage MTC “02” should not be used to report a change in data where other transactions
are intended to serve that purpose.
5. 5 Change Processing Rules Transaction Usage If a data element designated as
FY, fy, Y, Y1, Y2, Y3, Y4 or YC in the MTC 02 column of the Element Requirement table is changed, the Claim Administrator must trigger an “02” (Change) transaction, unless another MTC applies.
6. 6 Change Processing Rules Transaction Usage If a data element designated as N1 in the MTC 02 column of the Element Requirement table is changed, the Claim Administrator can send an “02” (Change) transaction, unless another MTC applies; however, an 02 is not required every time the value in this field changes.
7. 7 Change Processing Rules Transaction Usage An example of a data element designated as N1 is Benefit Type Amount Paid. If you have reported this incorrectly, then an MTC 02 should be sent; however, if the Benefit Type Amount Paid changes because you have paid another bi-weekly check, we do not need or want an MTC 02.
8. 8 Change Processing Rules Florida has expanded on the ERT standard Requirement Codes for MTC 02. See bottom of SROI Element Requirements.
9. 9 Change Processing Rules
R3 Limitations
Known to Date
10. 10 Change Processing Rules R3 Limitations Known to Date The current R3 MTC “02” has several known limitations, e.g., a transaction must not include changes to more than one “Match” data element at a time.
A full listing of these limitations can be found in Section 4 of the Release 3 Implementation Guide (02 Change Processing Rules).
The IAIABC is currently working on resolving these limitations.
11. 11 Change Processing Rules Claim Administrator Considerations
12. 12 Change Processing Rules Claim Administrator Considerations Claim administrators must send MTC “02” (Change) transactions at the appropriate time to avoid transactions rejecting.
(e.g., must send SSN change via MTC 02 before sending next the transaction containing the new SSN).
13. 13 Change Processing Rules Claim Administrator Considerations Claim administrators should analyze Florida’s Element Requirement Table and Edit Matrix to learn how data element(s) will be processed on MTC 02 Change transactions.
14. 14 Electronic Notice of Change
MTC “02”
(Required by Primary Implementation Schedule)
See Rule 69L-56.304, F.A.C.
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19. 19 Electronic Notice of Change
MTC “02”
(Required by Secondary Implementation Schedule)
See Rule 69L-56.3045, F.A.C.
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27. 27 Important: The JCN sent on the SROI MTC “02” must match the JCN ‘on file’ for the existing SSN/DOI.
28. 28 Important: If you are trying to change the date the initial payment was mailed, you must send an 02 change reflecting a new Benefit Payment Issue Date AND Payment Issue Date. DWC’s system will be updated from the corresponding Payment Issue Date in the Payment segment.
29. 29 Important: If you are trying to change certain data related to the initial payment, and subsequent MTC’s have been accepted since the FROI/SROI, the 02 will not update certain fields. You will need to contact your EDI Liaison to make the change manually.
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31. 31 A single MTC 02 transaction can not be sent to change multiple match data elements, such as SSN, Claim Admin. Claim Number, etc.
If two match data elements need to be changed, a second MTC 02 transaction will need to be sent after the first MTC 02 is accepted.
32. 32 Exceptions:
Employee Name fields will be treated as one match data field if more than one aspect of the name is changed;
Employee ID & Employee ID Type Qualifier can both change on a single MTC 02;
The same is true for Claim Administrator FEIN and Claim Administrator Postal Code
33. 33 If multiple MTC 02’s to change match data elements are sent in the same batch (i.e., same transmission, same day), the Claim Administrator will have to incorporate the prior change(s) in each subsequent MTC 02 transaction(s) and risk that each prior MTC 02 was accepted, so that the match data elements will match ‘down the line’.
34. 34 Changes to data elements designated as “N”, “NA” or “X” on FL’s Element Requirement Table, that are sent on an MTC “02” transaction, will not be processed/loaded to the Division’s database.
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Also, invalid data sent on an MTC “02” transaction will not overlay existing data on the Division’s database.
36. 36 Data previously required or reported on another transaction will be expected to be included on the MTC 02 transaction.
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38. 38 Change Previously Sent Data to Spaces Florida will not be setting data to spaces based on MTC 02.
If a data element was reported in error and needs to be removed (vs. changed), the Claim Administrator should contact the Division for special handling.
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43. 43 Reporting a Benefit Redistribution for Child Support
Court-ordered child support in the amount of $50/week has been assessed against the employee’s WC benefits. Amount is to be paid directly to employee’s ex-wife.
44. 44 Reporting a Benefit Redistribution for Child Support
We are going to fill out the Benefit and ACR segment live (time permitting). The following slide is the IP transaction that immediately preceded the Benefit Redistribution.
45. 45 Reporting a Benefit Redistribution for Child Support
The Benefit Redistribution is now to be reported at the time the next bi-weekly is sent. Please complete the Benefit and ACR segment to report this event.
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65. 65 SROI MTC “S1” Scenario Suspension, RTW or Medically Released to RTW
TT Benefits commenced effective 6/16/07.
On 8/27/07, the Clm. Admin. receives notification the EE RTW’d with the same employer on 8/25/07, with no restrictions, and mails the EE’s last TT check.
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77. 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.,
79. 79 No further EDI filings
(e.g., SROI MTC FN) are required to be sent to the Division after the acceptance of MTC “S8”.
80. 80 Reminder: Jurisdiction Transfer Claim administrator then sends the following to the appropriate state (if applicable):
FROI MTC “00”
SROI MTC “IP”
(or other applicable SROI)
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91. 91 SROI MTC “P7” Scenario Previously Submitted Reports:
FROI MTC “00” (Original) sent with
SROI MTC “IP” (Initial Payment)
SROI MTC “CB” (Change in Benefit)
-TTD to IB
and …
92. 92 Previously Submitted Reports:
(cont’d) …
SROI MTC “CB” (Change in Benefit)
- IB to PT
SROI MTC “AB” (Add Concurrent Benefit)
- PT Supp after PT SROI MTC “P7” Scenario
93. 93 Because the employee will reach age 62 on 2/10/09, the claim administrator by law is not required to continue payment of PT Supp Benefits after that date.
SROI MTC “P7” Scenario
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106. A previous Subsequent Report (SROI) must have been filed terminating all indemnity benefits via either:
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110. 110 SROI MTC “RB” Scenario Reinstatement of Benefits by Claim Admin. after Prior Suspension
The Claim Administrator initiated payment of TT Benefits effective 6/16/07 (MTC 00/IP).
The Claim Admin. subsequently suspended all indemnity benefits because the employee RTW’d full duty, no restrictions (SROI MTC S1).
111. 111 SROI MTC “RB” Scenario Reinstatement by Claim Administrator Employee’s doctor determined EE reached MMI on 10/8/07, with a PI rating of 25% to the whole body.
On 10/21/07, Clm. Admin. mails a check to the employee for the initial installment of IB benefits. EE is due IB’s at weekly rate of 50% of
the comp rate.
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117. 117 Electronic Notice of Reinstatement of Employer Paid Benefits
Rule 69L-56.3045(6)(b), F.A.C.
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