EDI Miscellaneous FAQ
What is Wisconsins definition of the "healing period"?
Wisconsin uses a 6 day week that always excludes Sundays, with the Last Day Worked (LDW) and Return to Work (RTW) exclusive. The RTW is defined as the doctor's release for the employee to return to work, not necessarily an actual return to work.
For example, if the LDW is Monday 6/21/99 and the RTW is Monday 6/28/99, then the healing period is Tuesday, Wednesday, Thursday, Friday and Saturday, for a total of 5/6 of a week. The waiting period in this example is the first 3 days (Tuesday, Wednesday and Thursday), so the days actually paid are Friday and Saturday. This is 2/6th of a week. If there is intermittent TTD then we add the healing period for each set of LDW and RTW. The current release of A49 does not accommodate this, and so we reject claims that have multiple periods of TTD, Salary or TPD. We also reject claims with intermixed payments (e.g. TTD and PPD). Intermittent and intermixed payments can be sent via the Internet WKC-13 on our pending reports website.
Does Wisconsin require the use of the Agency Claim Number?
No, we do not use this number. If it is in your transmission we will try to use it, but the primary access to our database is SSN + INJURY DATE (plus or minus six days). Given the timing of 148 and A49 transmissions you will not have our claim number by the time that you need to send the IP transmission.
What if we need to change the information in a key field, e.g. SSN or date of injury?
You cannot send a 148 02 or 148 CO to accomplish this, since such transmissions will not overlay existing data except the Claim_Administrator_Claim_Number field (IAIABC DN 0015). These transmissions will, however, fill in any fields that were previously blank. If you need to change something like the SSN or date of injury you will need to contact the EDI Coordinator directly. He or she can then make the change manually in our system, and then notify you so that you can send the next transmission for that particular claim with confidence.
If data is in error, what is the procedure?
We evaluate the transmission on a claim-by-claim basis and load all of the successful or warning claims. Warning claims are those that are accepted with errors in non-critical fields. Any claim that has a fatal error, meaning that there is at least one error that requires us to reject the claim, is not loaded. Once a claim is rejected you must fix the problem(s) and then resubmit the claim as an original transmission. Since we evaluate all of the errors you may have more than one error to fix for a given rejected claim.
What does Duplicate mean?
In our system a duplicate does not mean a duplicate EDI transmission; it is not a fatal error and therefore does not affect your electronic reporting accuracy rating. Sometimes we have already received the injury report via the Internet WKC-12. When loading an EDI claim onto our database we always check SSN + INJURY DATE (plus or minus six days) before the claim actually loads. If we discover that the injury was previously reported and is already in our database, we will acknowledge your electronic transmission as a duplicate.
How does Wisconsin calculate the accuracy rating?
We calculate your monthly accuracy rating by counting the total number of claims we received and then compare that with the number of claims that have a fatal error. We do not look at the total number of errors, so a single claim that has two fatal errors is counted as one fatal error claim, not two. A claim that is submitted twice and rejected twice is counted as two fatal errors.
For example, if you send 100 claims and we count 80 Successful (no warnings), 5 Warning (one or more warnings but no fatal errors), 5 Duplicates and 10 Fatal errors (one or more fatal errors), then your accuracy is 90% [(80+5+5)/100]. All of our trading partners have been able to meet or exceed the required 90% accuracy rating.
For more information about EDI Workers Compensation you can e-mail the EDI Coordinator or call (608) 267-6890.