KANSAS EDI TRAINING SEMINAR

1

KANSAS EDI TRAINING SEMINAR
February 25, 2004State Office BuildingWichita,
KansasPresented by Kansas Division of
Workers Compensation Bridium Inc.
2
PURPOSE OF EDI INFORMATION MEETING

• Information on the Divisions Electronic Data
  Interchange (EDI) Program
• Review of Kansas EDI Requirements
• Business Technical Information to Facilitate
  Accurate Reporting

3
David Sprick Research AnalystDivision of
Workers Compensation Kansas Department of Human
Resources
INTRODUCTION OF SPEAKERS
4
Alan Stanton Research AnalystDivision of
Workers Compensation Kansas Department of Human
Resources
INTRODUCTION OF SPEAKERS
5
Sharon MarionEDI Coordinator for KansasBridium
Inc.
INTRODUCTION OF SPEAKERS
6
WHAT IS THE EDI PROCESS?

• Submission of First Reports of Injury (FROI) and
  Subsequent Reports of Injury (SROI)
• From Trading Partners to the Kansas Division of
  Workers Compensation
• Through its application service provider (Bridium
  Inc.)
• In the IAIABC Electronic Data Interchange (EDI)
  format
• In a manner as prescribed by the Divisions EDI
  Implementation Guide

7
Morning Session1000AM Welcome and
Introductions 1010AM Statute Reporting
Overview  1050AM Break  1110AM EDI
Overview1200PM Lunch (on your own)
AGENDA
8
AGENDA

• Afternoon Session115PM Implementation
  Requirements215PM How to Get
  Started Technology Methods315PM Question
  session

9
STATUTORY OVERVIEW
Electronic Filing of Accident Reports in
Kansas Alan Stanton Research Analyst Division of
Workers Compensation Kansas Department of Human
Resources
10
STATUTORY OVERVIEW

• Current Reporting Requirements
• Reporting Option as of 11/15/03
• Compliance
• Confidentiality

11
CURRENT REPORTING REQUIREMENTS

• K.S.A. 44-557(a)
• Employers or agents must send reports on 1101-A
  form to KDWC within 28 days of knowledge for
  injuries beyond remainder of day, shift or turn
• K.S.A. 44-557a(c)
• Insurers or agents must report closed claims data
  to KDWC on proprietary software, on the date
  provided by KDWC

12
REPORTING OPTION as of 11/15/2003

• K.S.A. 44-557a (b)
• Insurers may submit claims information by
  IAIABCs EDI Release 1 as a substitute for Closed
  Claims data
• Regulation K.A.R. 51-9-17 (1/1/2004)
• Allow EDI First Report of Injury to be considered
  same as 1101-A form
• Stop paper reporting

13
REPORTING OPTION as of 11/15/2003

• EDI First Report of Injury (FROI)
• Submit to KDWC within time period specified in
  Kansas EDI Implementation Guide (28 days)
• EDI Subsequent Report of Injury (SROI)
• Submit to KDWC within time period specified in
  Kansas EDI Implementation Guide

14
REPORTING OPTION as of 11/15/2003

• Employer/carrier may continue to report on K-WC
  1101-A to Division
• Employer/carrier may continue to report claims
  study requirement via Division software
• Employer/Carrier must continue to submit all
  medical fee data to Division
• (EDI program constitutes no change to medical fee
  requirements)

15
EXISTING and EDI REPORTING COMPARISON
EDI
Existing
16
EXISTING REPORTING

• Carrier generates or forwards paper 1101-A to
  state, or reports to TPA which then generates or
  forwards paper 1101-A to KWC
• Self-insured employer reports to TPA or sends
  paper 1101-A directly to state
• Duplicates created when both employer and carrier
  or TPA send paper 1101-A to state
• Insurer or TPA selects cases from prior year to
  report using proprietary OCC (now CCS) software

17
EDI REPORTING

• Carrier translates report from employer into
  electronic report to send directly to KWCs EDI
  vendor or reports to TPA which then generates or
  forwards electronic report to KWCs EDI vendor
• Self-insured employer reports to TPA or sends
  electronic report directly to KWCs EDI vendor
• Vendor edits reports, acknowledges back
  electronically to sender, and forwards acceptable
  reports to KWC

18
EDI REPORTING (contin.)

• No duplicates allowed
• If selected to report under CCS program prior to
  approval for production status under EDI program,
  insurer or TPA may report, using IAIABC EDI
  standard, those claims that would have otherwise
  reported using proprietary CCS software

19
COMPLIANCE

• Failure to Submit Reports in Timely Fashion OR
• Failure to meet Data Quality or Technical
  Standards
• May result in revocation of EDI Participation
  and/or Fines and Penalties

20
CONFIDENTIALITY

• K.S.A. 44-550b
• Workers Compensation records are open records
  except for accident reports, medical records and
  form 88's (not filed with the Division since
  1994) and social security numbers
• WC records are open to the following
• Employer after a job offer
• Employer and insurance company and their
  representatives when an employee files for
  benefits
• State and Federal Agencies for investigation of
  Fraud
• Upon order of a court of competent jurisdiction

21
EDI OVERVIEW
EDI OverviewAlan Stanton Research
AnalystDivision of Workers Compensation Kansas
Department of Human Resources
22
EDI OVERVIEW

• What is EDI?
• What is the IAIABC?
• How does Kansas EDI work?

23
WHAT IS EDI?
(And Why Should I Care?)
24
EDI IS

• Electronic
• Data
• Interchange
• Exchange of business documents
• in a non-paper (electronic) environment

25
EDI is...

• Standardized business practices which permit the
  flow of information between organizations without
  human intervention.
• System-to-system communications.
• Technology for cross-organizational exchange of
  standard documents in a machine readable and
  universal format.

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A Brief History of EDI

• The first industry to use EDI, beginning in the
  mid-1970s Transportation
• The most EDI mature industries today are
  transportation, retail, finance, electronics,
  government, automotive
• Roughly 90 of Fortune 1000 companies now using
  EDI

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IAIABC EDI Project History

• IAIABC began standardization of states workers
  comp paper forms during the 1950s
• IAIABC began researching electronic transmission
  during the 1980s
• IAIABC developed EDI reporting standards in the
  1990s
• 1990, IAIABC membership adopted the IAIABC
  Statistics Committees proposal to develop
  standards for communicating data electronically
  between providers, payers and state
  administrators via EDI.

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Developing an Electronic Standard
Bringing Together the Right Participants
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Asking the Right Questions...

• What Should We Be Collecting?
• Why Do We Need It?
• How Do We Use It?
• Who Should We Be Asking For It?
• When Are We Getting Duplicates?
• How Can We Make It Easier?

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Asking the Right Questions...
What are we collecting now?

• First Report of Injury
• Claims
• Safety
• Subsequent Reports
• Claims Status
• Benefits

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Why EDI?
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Why EDI?

• Benefits of EDI
• Quantifiable Benefits
• Strategic Benefits
• Unquantifiable Benefits

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Why EDI?Quantifiable Benefits

• Eliminates delays due to rekeying data
• Eliminates errors due to rekeying data
• Eliminates time spent in non-productive
  human-to-human error resolution (e.g., telephone
  tag)
• Eliminates paper handling, filing, storage, and
  mailing costs

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Why EDI?Strategic Benefits

• Improves the quality and speed of operations
• Reduces operating costs
• Improves trading partner relations by assisting
  in reduction of their costs improving
  operations
• Improves forecasting and planning through
  improved timeliness of reporting information
• Refocuses employee resources on more productive
  business activities

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Why EDI? Unquantifiable Benefits

• Changed business processes
• Changed business relationships
• Changed business perspectives

EDI Brings Opportunities for Change
36
The Evolution of EDI - The Need for Better Data

• Problems associated with data collection in
  workers compensation
• Lack of credible information to identify and
  measure the specific factors driving costs
• Lack of uniformity among forms and terms
• An administrative process that is becoming
  engulfed in paper

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WORKERSCOMPENSATION EDI
The IAIABC promotes EDI standards within the
workers compensation system http\\www.IAIABC.org
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WHAT IS THE IAIABC?

• International
• Association of
• Industrial
• Accident
• Boards and
• Commissions

39
IAIABC INVOLVEMENTWITH EDI

• Acts as a workers compensation standards
  organization
• Members include state jurisdictions, carriers,
  claim administrators, employers, vendors, and
  other workers comp organizations
• Works cooperatively to implement electronic
  standards in both flat file and ANSI X12 formats

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WORKERS COMPENSATION EDI
Payer/Administrator
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IAIABC EDITRANSACTIONS

• First Report of Injury
• Subsequent Report of Injury
• Medical Bills
• Proof of Coverage
• Detailed Acknowledgment

42
IAIABC IMPLEMENTATION GUIDE

• Data Dictionary
• File Layouts (Flat File X12)
• Hard Copies
• Scenarios
• Code Lists
• Decision Table Templates (Event, Element
  Requirement, and Edit)

43
Key Components of EDI

• Hardware/Software
• Communications
• Standards
• Courage

44
STANDARDS

• National standards allow data comparison
• National standards eliminate needless duplication
  of effort to build transaction sets
• National standards allow the entire industry to
  operate more efficiently

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OPTIONS

• Formats Flat File or ANSI
• Build your own Program - flat file 09234 938
  730239 789
• Use existing software - ANSI - 9234938730239789
  
• External Technology Solutions
• Buy off the shelf
• Hire a consultant
• Use a 3rd party collection agent
• Value added network or the Internet

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EDI TRANSMISSION PROCESS
Jurisdiction Mapping, Translation,
Telecommunications Mapping, Translation,
Trading Database and Telecomm.
Network and Telecomm.
Partner Software

Software
Database - Vendor Package
- VAN - Vendor
Package - Develop own
programs - Internet - Develop
own programs
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SOFTWARE

• EDI Translation Software
• Converts application data into a standard EDI
  format
• Converts ANSI format to flat file
• Telecommunication Software
• Initiates communication session
• Establishes protocol
• Validates security
• Transmits the EDI data

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COMMUNICATIONS

• Value-Added Network (VAN)
• Private network
• Internet File Transfer Protocol (FTP) and Secure
  Shell File Transfer Protocol (SSFTP)

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COURAGE

• Change is hard for many organizations
• EDI is a chance to evaluate your entire business
  process BIG CHANGE
• EDI requires cooperative working relationships
  between all partners in the workers compensation
  arena BIG CHANGE

50
IAIABC Standards in Use

• Claims
• Release 1
• Release 2 (No longer supported)
• Release 3/Combined Claims Product (CCP)
• Proof of Coverage
• Release 1
• Release 2
• Medical/Bill Payment Records
• Partially tested by Kentucky and in production
• Remainder has not been beta tested yet

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EDI TRANSACTIONS

• Claims
• 148 First Report of Injury
• A49 Subsequent Report of Injury
• Proof of Coverage
• POC with PC1 Insured Record(s) PC2
• Employer record(s) (No ANSI)
• Medical
• 837 Bill Payment Record

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6 Step EDI Reporting Process
Acknowledgement Transmission
Acceptance or Rejection
Technical Business Edits
Translation
Identification
Submission
53
EDI TRANSMISSION COMPONENTS

• A TRANSMISSION contains
• One or more BATCHES, which contain
• The HEADER
• One or more TRANSACTIONS
• The TRAILER

54
AN EDI TRANSMISION

• Header
• Transaction(s)
• Trailer

BATCH

• Header
• Transaction(s)
• Trailer

TRANSMISSION
BATCH

• Header
• Transaction(s)
• Trailer

BATCH
55
EDI BATCH COMPONENTS

• Header
• One or more Transactions with one or more
• records in each
• Coverage data OR
• Claim data OR
• Medical data
• Note These data are never sent mixed
• Trailer

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EDI HEADER

• Sender ID Return Address
• (Who is sending this data?)
• Receiver ID Address
• (Who is this data being sent to?)
• Transaction Set ID Contents
• (What kind of data is this?)
• Transmission Tracking Information
• (What date and time was it sent?)

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EDI TRAILER

• Transaction Set ID Contents
• (What was included?)
• Detail Record Count How many?
• (Did all the data arrive?)

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EDI Acknowledgement

• AK1 Acknowledgement from Receiver
• Transaction Set ID (match)
• Acknowledgement Code (TA/TE/TR)
• Number of errors
• Detailed error information
• Element Number
• Error Code
• Variable Segment Number (if applicable)

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KANSAS EDI TRANSACTIONS
First and Subsequent Reports of Injury
Acknowledgements
Carrier SIE or SIGP Administrator
Kansas
60
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components
Fax / E-Mail

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• EDI Technical Help Desk

KS EDI Administration
Non-Web Trading Partners
Trading Partner Documents
KS EDI Repository
FROI / SROI

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• Application Maintenance
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

AC-Web
Web Clients
Real Time
AK1
FROI/ SROI Data
FROI / SROI
VANs
O T H E R
KS
ATT
KS Annual Report
AK1
O T H E R

• Bridium Services
• Test Production Mgmt.
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

Advantis
Transmitter
TP1
FROI Data
FROI / SROI
FTP
AK1
KS Production Database
FTP Clients
61
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components
Fax / E-Mail

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• EDI Technical Help Desk

KS EDI Administration
Non-Web Trading Partners
Trading Partner Documents
62
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• Application Maintenance
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

FROI / SROI
VANs
O T H E R
KS
ATT
AK1
O T H E R
Advantis
Transmitter
TP1
63
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components
FROI / SROI

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• Application Maintenance
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

AC-Web
Web Clients
Real Time
AK1

• Bridium Services
• Test Production Mgmt.
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

FROI / SROI
FTP
AK1
FTP Clients
64
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components
KS EDI Repository

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• Application Maintenance
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

FROI/ SROI Data
FROI / SROI
KS Annual Report

• Bridium Services
• Test Production Mgmt.
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

FROI Data
KS Production Database
65
KANSAS EDI PROCESS
State EDI Reporting Process Bridium Product and
Service Components
Fax / E-Mail

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• EDI Technical Help Desk

KS EDI Administration
Non-Web Trading Partners
Trading Partner Documents
KS EDI Repository
FROI / SROI

• Bridium Services
• Trading Partner Set Up
• Test Production Mgmt.
• Application Maintenance
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

AC-Web
Web Clients
Real Time
AK1
FROI/ SROI Data
FROI / SROI
VANs
O T H E R
KS
ATT
KS Annual Report
AK1
O T H E R

• Bridium Services
• Test Production Mgmt.
• Acknowledgments
• EDI Technical Help desk
• Data Base Mgmt.

Advantis
Transmitter
TP1
FROI Data
FROI / SROI
FTP
AK1
KS Production Database
FTP Clients
66
KANSASIMPLEMENTATION GUIDE

• Outlines the EDI requirements of
• the State of Kansas
• Provides contact information
• Documents testing requirements
• Contains required agreements and
• profiles to begin EDI processes

67
Simple Steps To Implementing EDI

• External Review State Reporting Requirements
• Technologies EDI options available
• Assess trading partner capabilities
• Internal review
• Data Collection Process
• Technologies EDI options
• Evaluation
• Time Frame and resources
• Cost-benefit analysis of options Change
• Change
• Adapt, acquire and/or outsource

68
EDI Web Sites

• http//www.iaiabc.org
• http//discussion2.iland.com/jbaxter
• http//www.wcio.org
• http//www2.hr.state.ks.us/wc/html/wcedi.htm

69
IMPLEMENTATION REQUIREMENTS
Kansas EDI Implementation Requirements David
Sprick Research Analyst Division of Workers
Compensation Kansas Department of Human Resources
70
IMPLEMENTATION REQUIREMENTS

• EDI Reports and Related Events
• Business Technical Data Reporting
  Requirements

71
DATA REPORTING REQUIREMENTS

• Series of decision tables to express Kansas
  reporting requirements
• Business or Claim Events
• Data Element Requirements
• Data Quality Edits

72
TYPES OF EDI REPORTS

• MTC - Maintenance Type Code
• Transaction Types
• Business or Claim Event Reports
• 148 - FROI - First Report of Injury
• A49 - SROI - Subsequent Report of Injury
• EDI Receipt
• AK1 - Acknowledgement from the Jurisdiction

73
ACKNOWLEDGEMENTS

• transactions sent back to trading partner from
  the jurisdiction to let you know you file was
  received and what their status is!
• Transaction Accepted (TA) Complete, no further
  action required
• Transaction Accepted with Errors (TE) Correct
  errors identified with CO report
• Transaction Rejected (TR) Correct Resubmit
  entire report

74
REPORT SEQUENCE REQUIREMENTS
FROI
SROI
Data Corrections
Kansas Edits
Claim Admin.
Data Changes
75
FROI SROI BUSINESS (CLAIM) EVENTS
76
FROI SROI BUSINESS (CLAIM) EVENTS
77
FROI BUSINESS (CLAIM) EVENTS

• FROI First Report of Injury
• Original 28 days from employer notification
• Denial Same as Original and as occurs, 5 days
• Cancel Upon improper filing, 5 days
• Acquired 21 days after acquiring claim
• Change As occurs, 5 days
• Correct 5 days after TE Acknowledgement

78
SROI BUSINESS (CLAIM) EVENTS

• SROI Subsequent Report of Injury
• Initial Payment 5 days following initial
  payment of indemnity
• IP Equivalents
• Acquired Payment 5 days following initial
  payment of indemnity by acquiring CA
• Full Salary 5 days following initial payment of
  salary in lieu of compensation
• Compensable Death 5 days following CAs
  knowledge of death of injured worker

79
SROI BUSINESS (CLAIM) EVENTS

• Denial as occurs, 5 days
• Final claim closes, 5 days after CA determines
  no future indemnity to be paid
• Annual within 10 days of June 1
• Change As occurs, 5 days
• Correct 5 days after TE Acknowledgement
• Upon Request specific request for claim
  information

80
REPORT SEQUENCE REQUIREMENTS

• BASIC SEQUENCING RULES
• Must send and have an acknowledgement of TA or TE
  before sending the next report in the sequence
• Must correct errors (TE) with a Correction (CO)
  MTC
• You must send something, before you can change it
  with Change (02) MTC

81
REPORT SEQUENCE REQUIREMENTS
Most Common Type of Report Sequencing
Original First Report of Injury
Stop
82
REPORT SEQUENCE REQUIREMENTS
Typical EDI Report Sequencing on Claims
FROI
SROI
Initial Payment or Equivalent
Final
Original
Annual June 1
Original
Medical Only
83
REPORT SEQUENCE REQUIREMENTS
FROI
SROI
Original
Final
IP or Equiv.
Cancel
Annual June 1
Medical Only
Stop
Denial
Denial
84
REPORT SEQUENCE REQUIREMENTS
OCC Reporting using IAIABC Standards

• Reach back option since EDI is forward going
  only
• Legacy claims

Annual June 1
Original
Same Batch or Separate Transmissions
85
DATA ELEMENTREQUIREMENTS

• KDWC/IAIABC Crosswalk Tables
• Kansas 1101-A Paper form w/IAIABC DN Refs. OCC
  Record layout
• IAIABC Forms w/IAIABC DN References
• IAIABC Flat File Data Element Lists
• FROI/SROI Requirements Table
• FROI/SROI Scenarios in IAIABC Format

86
FROI/SROIREQUIREMENT TABLES

• An Element Requirement Table will tell you
  exactly what elements are
• Mandatory
• Conditional
• Optional
• for EACH Report that is required by the State
• Data Element Number Name
• Purpose(s) of Collecting the Data Element
• By Maintenance Type Code (MTC)
• Mandatory, Conditional, and Optional designation

87
SROIVARIABLE SEGMENTS

• Variable Segment Counters
• How many sets of what kind of data is being
  provided
• Number of Permanent Impairments
• Number of Payment/Adjustments
• Number of Paid to date, Reduced Earnings,
  Recoveries

88
SROIVARIABLE SEGMENTS

• Permanent Impairment
• Body part code Impairment
• Max of occurences per record 6
• Payment/Adjustment
• Code, PTD Weekly Amount
• Max of occurences per record 10
• Paid To Date/Reduced Earn/Recov
• Code Amount
• Max of occurences per record 25

89
DATA QUALITY EDITS

• All Reports submitted to KDWC are edited against
  the appropriate edit tables
• There are several types of edits
• data presence
• data relationships
• data values
• report sequence
• matching a report to a claim

90
DATA QUALITY EDITS

• Each edit table indicates what edits apply to
  each data element for a given report
• Identifies the Error , DN and possibly text
  description of error that is returned by the
  State in Acknowledgement record
• This information found in Edit decision tables or
  edit matrices
• FROI
• SROI
• Header Trailer

91
DATA QUALITY EDITS

• Report Level Edits
• Examples
• Edit 039 no match on Database
• Edit 057 Duplicate transmission
• Edit 053 No Matching First Report
• Edit 063 Invalid Event Sequence

92
MATCH ROUTINES
93
TRANSACTION SEQUENCE REQUIREMENTS (Edit 063)
94
DATA QUALITY EDITS

• Conditional Edits
• Edit Matrix Tables Comments
• Examples
• DN25 Industry Code and Edit 58 Code/ID invalid
• DN02 Maintenance Type Code and edit 42
• Statutory invalid

95
HOW TO GET STARTED TECHNOLOGY METHODS
How to Get Started Technology Methods
Sharon MarionKansas EDI CoordinatorBridium
Inc.
96
HOW TO GET STARTED

• Implementation Schedule

• Roles Responsibility

• Scheduling a Test Date

• Trading Partner Administration

• Testing Procedure

97
IMPLEMENTATIONSCHEDULE
98
ROLES RESPONSIBILITIES

• Claim Administrator

99
ROLES RESPONSIBILITIES

• Claim Administrator

• KS EDI Coordinator

100
ROLES RESPONSIBILITIES

• Claim Administrator

• KS EDI Coordinator

• KDWC

101
TEST DATE SCHEDULING

• Assessment Planning

• Alternatives

• Test Date Assignments

102
TRADING PARTNER ADMINISTRATION

• Trading Partner Agreement

• Trading Partner Profile

• Reporters Trading Partner
• Transmittal Form

Submit These NLT Two Weeks Prior to your Test Date
103
TRADING PARTNER AGREEMENT

• Data, Reports, Definition

• Data Quality Commitment

• Begin Date / Paper - EDI

104
KANSAS TRADING PARTNER PROFILE
Form Data Requirements (M) Mandatory
(C) Conditional (O) Optional
Purpose Submit Change Delete
TP
A. Trading Partner Name ________________________
B. Trading Partner Type Insurer
TPA Self Insured/Admin Stat
Non-Insured
105
KANSAS TRADING PARTNER PROFILE
C. In Production/IAIABC State(s) Y
N
D. Plan to Use KS Web Data Entry Y
N
E. TP (Sender) ID 1. (M) FEIN
________ 2. (O) TP ID_________ 3. (M)
ZIP _________
F. TP Physical Address 1. (M) Street
______________________________ 2. (M) City
______________________________ 3. (M) State
______________________________ 4. (M) ZIP
_________
106
KANSAS TRADING PARTNER PROFILE
G. TP Mailing-Address 1. (O) Street
______________________________ 2. (O) City
______________________________ 3. (O) State
______________________________ 4. (O) ZIP
_________
H. TP EDI Business Contact Info 1. (M) Name
______________________________ 2. (M) Phone
______________________________ 3. (M) Title
______________________________ 4. (M) E-Mail
______________________________ or Fax
_________
107
KANSAS TRADING PARTNER PROFILE
I. Vendor Information 1. (M) Vendor Name
________________________ 2. (M) Contact Name
________________________ 3. (M) Contact Phone
_______________________ 4. (O) Contact E-Mail
________________________
J. EDI TP Technical Contact Info 1. (M) Name
________________________________ 2. (M) Title
________________________________ 3. (M) Phone
________________________________ 4. (O) E-Mail
________________________________ or
Fax _________
108
KANSAS TRADING PARTNER PROFILE
K. EDI Communication Information 1. (M)
EDI File Type IAIABC R1 R2
R3 ANSI 3041 TBD

2. (M) Network ATT
Transmitter ID _______ Advantis
Mailbox _______ Acct
_______ Message class _______
109
REPORTERS TRADING PARTNER TRANSMITTALFORM
FROM (Reporter Name) (Reporter Attention
Line) (Reporter Address Street) (Reporter Address
City, State, Postal Code Reporter Telephone Number
Master FEIN Postal Code Form ____ of ____

110
TESTING PROCEDURES
Step 1 Pretest
Step 2 Technical Capability Test
111
TESTING PROCEDURES
Step 1 Pretest
Step 2 Technical Capability Test
Step 3 Business Content Test (FROI)
Step 4 KS Test Completion (FROI)
112
TESTING PROCEDURES
Step 5 Business Content Test (SROI)
Step 6 KS Test Completion (SROI)
Ongoing Monitoring - Production Status
lt Quality Requirements Out of Compliance
113
HOW TO GET STARTED REVIEW
Step 1 Gather Your Resources
Step 2 Executive Summary KS IG (pg19)
Step 3 Reporting Process Functions/Options
(pg80)
Step 4 Implement your EDI solution
Step 5 Arrange for a Testing Date
Step 6 File Trading Partner Documents
Step 7 Begin Testing Process
114
TECHNOLOGY METHODS

• Kansas Web Entry
• File Formats
• Networks
• Vendors

115
KANSAS WEB ENTRY

• Qualifications lt 100 claims/yr or special
  circumstances
• www.hr.state.ks.us/wc/html/
• wcedinews.htm (SC-Web)
• Data Entry of First Report of Injury
• Data Entry of Subsequent Reports
• Online Error Detection/Correction

116
SC-WEB REQUIREMENTS

• Meet User Qualifications
• File Trading Partner Documents
• Obtain a User ID and Password--EDI
  Coordinator
• Microsoft Browser 5.0 or Above
• Internet Access

117
SC-WEB REQUIREMENTS

• Login Screen
• Welcome Screen
• General System Operations

118
SC-WEB Functions

• First Reports of Injury
• Subsequent Reports of Injury
• Acknowledgements
• Workflow

119
SC-WEB ENTRY
120
FILE FORMATS

• IAIABC Flat File
• ANSI ASC X12

121
FLAT FILE FORMAT

• IAIABC Developed and Maintained

• 148 First Report of Injury
• A49 Subsequent Report
• AK1 Detailed Acknowledgment

122
HD1 - R1 Header Record87 Byte Fixed Length
Record 9 Data Elements
123
HD1 - R1 Header Record87 Byte Fixed Length
Record 9 Data Elements

• Transmission Sample
• (Shown partial and wrapped for display)
• HD1666777888 888777666486029925
  66612122720030624074530 P14801
• 1480020010327PR
  666777888ABC INSURER
  818181818TPA 406 TOPEKA WAY SUITE 6
  TOPEKA
• TR1000000001

124
148 R1 First Report of Injury913 Byte Fixed
Length Record68 Data Elements
125
148 R1 First Report of Injury913 Byte Fixed
Length Record68 Data Elements

• Transmission Sample
• (Shown partial and wrapped for display)
• HD1666777888 888777666486029925
  66612122720030624074530 P14801
• 1480020010327PR
  666777888ABC INSURER
  818181818TPA 406 TOPEKA
  WAY SUITE 6
  TOPEKA
• TR1000000001

126
TR1 - R1 Trailer Record12 Byte Fixed Length
Record 2 Data Elements
127
TR1 - R1 Trailer Record12 Byte Fixed Length
Record 2 Data Elements

• Transmission Sample
• (Shown partial and wrapped for display)
• HD1666777888 888777666486029925
  66612122720030624074530 P14801
• 1480020010327PR
  666777888ABC INSURER
  818181818TPA 406 TOPEKA
  WAY SUITE 6
  TOPEKA
• TR1000000001

128
AK1 R1 AcknowledgmentVariable Length
RecordMinimum Length 208 - - Maximum Length
1099 208 99 of errors x 9
of bytes in variable segment 1099 20 Data
Elements
129
AK1 R1 AcknowledgmentVariable Length
RecordMinimum Length 208 - - Maximum Length
1099 208 99 of errors x 9
of bytes in variable segment 1099 20 Data
Elements

• Transmission Sample
• (Shown partial and wrapped for display)
• HD1666777888 888777666486029925
  66612122720030624074530 P14801
• AK10000000012001032708164466677788834236
  818181818A49TAINSRPTNUM WC29443
  012234995 IP20010314
  0
  00
• TR1000000001

130
ANSI ACS X12 FORMAT

• IAIABC Assists in Development and Work Comp
  Implementation
• American
• National
• Standards
• Institute
• X12 Electronic Data Interchange

• Accredited
• Standards
• Committee

131
ANSI ACS X12 FORMAT

• 148 First Report of Injury
• A49 Subsequent Report of Injury
• 997 Batch Level Acknowledgment
• 824 Detailed Acknowledgment

132
148X12 First Report of Injury
133
NETWORKS

• Value Added Networks
• Proprietary Networks

134
VALUE ADDED NETWORKS

• Secure Public Networks
• Audit Capabilities
• Data Recovery Capabilities
• Interconnects to other VANS
• Per Character Transmission Costs

135
PROPRIETARY NETWORKS

• Secure Transmission
• Audit Capabilities
• Data Recovery Capabilities
• Per Report Transmission Costs

136
EDI VENDORS

• Bridium
• www.bridium.com
• [phone]
• sisaac_at_bridium.com

Red Oak E-Commerce Solutions, Inc. www.roesinc.com
[phone] pcannon_at_roesinc.com
HealthTech, INC. www.health-tech.net (913)
764-9347 sales_at_health-tech.net
Workcomp.net www.workcomp.net (512)
363-4297 pcannon_at_roesinc.com
ISO www.iso.com [phone] info_at_iso.com
137
TECHNOLOGY METHODS REVIEW

• File Formats

• Networks

• Vendors

• Kansas Web Entry