What We Accept Via EDI
Accepted EDI formats
We use the standard International Association of Industrial Boards & Commissions (IAIABC) formats for First Report of Injury Release 1 (148, FROI, WKC-12, etc.) and Subsequent Report Release 1A (A49, WKC-13, etc.). Please see the format spreadsheets (FROI and SROI) on our website for the list of required, conditional and optional fields for each layout. We also require the use of the standard IAIABC header and trailer.
The type of data we accept
Worker's Compensation accepts two types of EDI datasets: Flat Files and ANSI files. Our EDI trading partners either do their own programming or they go through a vendor. We currently have trading partners who come in through Claimport and Celerity Technologies (Bridium), Red Oak E-Commerce Solutions (ROES) and Insurance Services Office, Inc. (ISO).
What we accept vis-a-vis paper
Workers Compensation currently accepts the First Report of Injury (our WKC-12, via the EDI 148) and the Subsequent Report of Injury (our WKC-13, via the EDI A49) electronically. For the Subsequent Reports we are currently in production of the Initial Payment (IP), Final (FN), and Suspension - RTW (S1) transmissions using the IAIABCs Release 1A of the Supplemental Report (SROI). We can currently read the compressed format. We do not accept medical reports or wage information via EDI. Medical reports must still come to us on paper. For the submission of wage information you must use our Internet WKC-13A, on our pending reports website, for claims that are not fatalities, litigated or PTD.
The transaction codes we accept
148 - First Report of Injury (WKC-12)
For 148 we currently accept all of the codes except 148 AU (acquired claims). Keep in mind that for 148 01 (cancel), 148 02 (change) and 148 CO (correction) we must have a previous claim in our database based on SSN + date of injury (plus or minus six days), otherwise the transmission will be rejected as "claim not found in database". The 148 02 and 148 CO will fill in data fields that were previously blank, but they will not overlay existing data except in the Claim_Administrator_Claim_Number field (IAIABC DN 0015). We accept the 148 04 (denial) without requiring you to first send a 148 00 (original).
A49 - Subsequent Report of Injury (WKC-13)
For the A49 we currently accept the IP, S1 and FN. We also accept the 02 and CO but process them differently than we do the 02 and CO for the 148. For the A49 02 and CO we simply verify that the claim is in our database and then send back a TA (Accepted) acknowledgement. We do not overlay the Claim Administrator's Claim Number and we do not fill in data fields that were previously reported as blank. All other codes such as RE, FS, QT and CB must have their information transmitted to us via the Internet WKC-13, on our pending reports website.
For the A49 IP we accept TTD (050), TPD (070) and Salary Continued (240). For TTD and TPD the IP must have both a date and amount of first payment, otherwise the transmission will be rejected. For TPD, the submission of the worksheet (for non-litigated claims) must come to us via our Internet WKC-13, on our pending reports website. Salary Continued will not be accepted if the first payment amount is zero or null. For the A49 IP we also accept PPDSch (030), PPDNon (040), DeathF (010), PTD (020), Supben (021), Disfig (090) and Vocrhb (410).
For the A49 S1 and FN, we only accept the payment codes for TTD (050), TPD (070), Salary Continued (240), PPDSch (030) and PPDNon (040).
- We only accept a single period of TTD, TPD or Salary Continued, because the Release 1 A49 does not support intermittent payments. If you attempt to send intermittent payments as if they are a single period of paid disability then the transmission will be rejected.
- We reject transmissions with more than one payment record (e.g. intermixed TTD and TPD or TTD and PPD) because the data from such transmissions is unreliable.
- If a claim on our database already has a period of temporary disability and an S1 or FN for a previous or subsequent period of temporary disability (with either the same or different temporary disability type than is already on the claim) is transmitted, then it will be rejected.
- If a claim on our database already has two periods of temporary disability and an S1 or FN with the payment code for TTD (050), TPD (070), Salary Continued (240), PPDSch (030) and/or PPDNon (040) is submitted, then it will be rejected.
For the above four scenarios, the information that would be rejected if sent via EDI can be submitted to us via the Internet WKC-13, on our pending reports website.
If a claim on our database already has a single period of TTD, TPD or Salary
Continued, then an S1 or FN with either PPDSch or PPDNon can be submitted via
EDI and the transmission will be accepted.
For more information about EDI Workers Compensation you can e-mail the EDI Coordinator or call (608) 267-6890.