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Add Concurrent Benefit Type Electronic Notice of Action/Change

Add Concurrent Benefit Type Electronic Notice of Action/Change Required to be filed with DWC per Rule 69L-56.3045(4), F.A.C. SROI AB. SROI AB - Add Concurrent Benefit Type A SROI AB , EDI DWC-4 equivalent, is required to be filed when: Adding or Reinstating a concurrent BTC.

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Add Concurrent Benefit Type Electronic Notice of Action/Change

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  1. Add Concurrent Benefit Type Electronic Notice of Action/Change Required to be filed with DWC per Rule 69L-56.3045(4), F.A.C. SROI AB

  2. SROI AB - Add Concurrent Benefit Type • A SROI AB, EDI DWC-4 equivalent, is required to be filed when: • Adding or • Reinstating a concurrent BTC.

  3. SROI AB - Add Concurrent Benefit Type • Concurrent BTC’soccur when: • Indemnity benefits are currently being paid, • A second Benefit Type Code begins, • The firstBenefit Type Code is still being paid.

  4. SROI AB - Add Concurrent Benefit Type • Example: • If PT Supplemental Benefits (021) begin after previous payment of ongoing Permanent Total Benefits (020), • SROI ABshould be sent and • Receive TA 14 days after Claim Admin.’s knowledge of entitlement.)

  5. Pop Quiz: What is another example of “Concurrent” Benefit Types?

  6. ANSWER: When Salary in Lieu of Compensation was paid and the EE also had concurrent employment.

  7. Example: • Accident EMPR pays salary in lieu of compensation and later learns of concurrent employment that raises AWW. • EE must now be compensated at 66 2/3% of combined wages (where both 0xx and 240 would be reported for same period.)

  8. SROI AB - Add Concurrent Benefit Type • In this case, DWC’s program allows Start Date of the current BTC being added to equal the Start Date of a previous BTC where: • The previous BTC is 2xx and • Concurrent Employer data is provided.

  9. SROI AB - Add Concurrent Benefit Type • SROI ABfollows the“Event” Benefits segment rules. • MTC AB is only populated in the Benefits segment of the Benefit Type Code that is being added.

  10. Caveats andTips for Successfully Filing SROI MTC AB

  11. Caveats and Tips for Filing SROI AB • The error we see most frequently for SROI AB filings is: BTC MUST = 020 OR 021 IF MTC = AB OR P7 This error indicates that either…

  12. Caveats and Tips for Filing SROI AB • SROI AB is not the correct MTC, or • An incorrect BTC was reported or left off the AB, or • Concurrent Employment was not reported.

  13. Caveats and Tips for Filing SROI AB • The next most frequently occurring error on SROI AB filings is: NO SROI ER OR RB PREVIOUSLY ON FILE This error is generated when DWC reflects indemnity was suspended or denied but not yet resumed prior to receipt of the AB.

  14. Pop Quiz: What MTC would be sent each January to report the new PT Supp Rate?

  15. Answer: SROI CA To report the new Net Weekly Amt for BTC 021 (PTS).

  16. Suspensions (Full) SROI S1-S8 Electronic Notice of Action/Change Required to be filed with DWC per Rule69L-56.3013, F.A.C.

  17. SROI S1 – S8: Suspensions (Full) • SROI S1-S8 (Sx),EDI DWC-4 equivalent, is required If ALLpayments of indemnity benefits have stopped (not just one class of benefits).

  18. SROI S1 – S8: Suspensions (Full) • The following DN’s relate to SROI Sx filings: • Suspension Effective Date(required), • Suspension Narrative(IA),and • Number of Suspension Narratives.

  19. “SUSPENSION EFFECTIVE DATE” • For MTC’s S1-S8 (Suspension): • The last date through which all indemnity benefits are due. Note:This date is not always the last day through which benefits were paid if there was an overpayment.

  20. SUSPENSION NARRATIVE SEGMENT Per IAIABC Variable Segment Rules: • Maximum of 3 “Suspension Narrative” segments may be sent, and • Must equal the “Number of Suspension Narratives” sent. Note: This is an “If Available/Applicable” field for FL, but not required.

  21. Pop Quiz: Are Suspensions an “Event” Benefit Segment, or “Sweep” Benefit Segment?

  22. Answer: “Event” Benefit Segment

  23. SROI S1 – S8: Suspensions (Full) • Therefore,the MTC (Sx) is required to be included in the Benefits segment, as well as all other required benefit segment data.

  24. Caveats andTips for Successfully Filing SROI S1 – S8

  25. Caveats and Tips for Filing Sx • If a DWC-4 was previously filed and it reported suspension of one type of indemnity, BUT NOTALL benefits were truly suspended: • You will have to reinstate benefits (file RB) prior to sending the next event.

  26. Caveats and Tips for Filing Sx • If you filed an incorrect Suspension Code (Sx) MTC: • Send correct Sx code; AND • Suspension Effective Date must be the same as the previous Suspension Eff. Date.

  27. Caveats and Tips for Filing Sx • One of the most frequently occurring errors for Sx filings is: SUSP EFFECT DATE MUST <= LATEST BEN THROUGH DATE

  28. Caveats and Tips for Filing Sx • This particular effective date is not when you took the ‘action’ to suspend; • It is the date through which all benefits were due.

  29. Caveats and Tips for Filing Sx • Therefore, the effective date of the suspension should not be later than the date through which benefits were due. • Exception: Suspension Effective Date may be a future date if IB’s are paid in a lump sum and are currently being suspended (i.e., Sx MTC in Event segment.)

  30. Caveats and Tips for Filing Sx • Also, do not report SROIS1 (RTW) prematurely before the last indemnity payment has been reported on the transaction. • If the “Benefit Period Through Date” on the next transaction is later than the Through Date reported on the S1, the transaction will reject.(Thru Date must not be > prev Thru Date.)

  31. Caveats and Tips for Filing Sx • Future Suspension Effective Dates are allowed: • But must not be more than 2 weeks after DWC Rec’d transmission. • Exception: IB’s (030 or 530) is currently being suspended (where MTC Sx is in the 030/530 Benefits segment)

  32. Caveats and Tips for Filing Sx • Do not send SROI S1 solely to report RTW information. • Suspension codes should only be sent to report the cessation of ALL indemnity benefits.

  33. Caveats and Tips for Filing Sx For Example: • If EE RTW light duty & there is a possibility TP (070) will be paid in the near future, S1 should not be filed. • Instead, RTW data should be reported via MTC 02if the requirement to report RTW (2 weeks after knowledge) falls due prior to changing benefits, or CB.

  34. Caveats and Tips for Filing Sx • Other typical errors we are seeing for Sx filings are: NET WKLY AMT EFF DT CANT BE CHANGED WITH THIS MTC and GROSS AMT MUST CHANGE VIA MTC CB CA 02 AP OR RB

  35. Caveats and Tips for Filing Sx • A new Net weekly rate (with a new Effective Date) cannot be ‘introduced’ via SROI Sx. • Changes or corrections to the AWW/CR that affect the Gross/Net weekly Amounts must first be reported via MTC CA.

  36. Caveats and Tips for Filing Sx • We are also seeing a lot of errors for: DUPLICATE SUSPENSION WITH SAME EFF DATE

  37. Caveats and Tips for Filing Sx • This error usually occurs when benefits are erroneously reinstated, or reinstated to correct a past benefit picture, e.g. RB sent when benefits are not actually being reinstated; then another “same” Sx is sent to try to re-suspend the claim.

  38. Caveats and Tips for Filing Sx • If trying to change Benefit segment data for past benefits, a reinstatement should not be sent. • RB should only be sent if benefits are being reinstated.

  39. Caveats and Tips for Filing Sx • In many situations, MTC 02 can be used to change / correct Benefit segment information, unless introducing a new BTC.

  40. Caveats and Tips for Filing Sx • Do not file a “fake” Sx to get around theDUPLICATE SUSPENSION WITH SAME EFF DATE error. Sx

  41. CLAIMS EDI Caveats and Tips for Filing Sx • Instead of filing an RB and then subsequently sending another Sx, if an RB is sent in error, email the EDI team asking to remove the RB.

  42. Caveats and Tips for Filing Sx • Another frequent error, primarily in relation to SROI S7 (Benefits Exhausted) filings is: CAN NOT ACCEPT SUSP AFTER SUSP W-OUT ER, RB OR EP

  43. Caveats and Tips for Filing Sx • If you filed a Sx and afterwards sent another Sx with a different Suspension Effective Date, you won’t be able to report the ‘second’ suspension until after you file an RB, ER or EP to resume benefits after the ‘first’ suspension.

  44. Caveats and Tips for Filing Sx • If a Suspension (Sx) was filed in error but accepted, and you subsequently receive a rejection when trying to report a CA, CB, etc., • Do not file an RB to get around the edit that is expecting an RB after Sx...

  45. Caveats and Tips for Filing Sx • … Instead, contact the EDI team for special processing assistance. • We may be able to manually remove the suspension status from our file and re-process the CA, CB, etc.

  46. Questions?

  47. Partial Suspension SROI P7 Electronic Notice of Action/Change Required to be filed with DWC per Rule69L-56.3045(5)(j), F.A.C.

  48. SROI P7 - Partial Suspension • P7(Benefits Exhausted) is only used in relation to “concurrent” BTC’s. • Occurs when one of the “concurrent” benefits is suspended, but the other benefit continues.

  49. SROI P7 - Partial Suspension • SROI P7 is required if Permanent Total Supplemental (021) benefits are suspended, but Permanent Total (020) benefits are continuing.

  50. SROI P7 - Partial Suspension • P7, Partial Suspension is considered an “Event”; • Therefore, MTC P7 is reported in the Benefits segment for the “concurrent” benefit type that is being stopped.

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