In April, Jeremy King and Monica Blackwell from the Marsh ClearSight Regulatory Compliance Team participated in the 2014 Forum conducted by the International Association of Industrial Accident Boards and Commissions (IAIABC). The Forum brings together leaders in workers’ compensation, including regulators, insurers, service providers, medical directors, and claims managers. For those of you who don’t know Jeremy and Monica, both are active in IAIABC leadership: Jeremy is Vice Chair of the IAIABC EDI Systems Committee, and Monica has been an IAIABC EDI Council Member for over seven years.
Here are some highlights from the forum that will be particularly interesting to those of you processing workers’ compensation claims in multiple states:
Adoption of XML Format for Data Submission: Some states are considering accepting or mandating that XML be used for transmittal of data. XML is optimized for Web-based portals and is more flexible and controllable than the current EDI file structure. Unlike the current process, XML allows for attachments. In the future, this could allow states to eliminate extra processes associated with submitting documentation such as electronic copies of paper forms.
Ongoing Efforts to Standardize Claim Reporting Across States: Several issue resolution requests (IRRs) discussed at The Forum relate to the ongoing efforts by the IAIABC Claims Committee to standardize First Report of Injury/Subsequent Report of Injury (FROI/SROI) reporting and develop more precise definitions. These are welcomed improvements, as they will help eliminate confusion, improve the accuracy of data entry, and help companies maintain regulatory compliance.
One IRR addresses standardization of coding definitions for the claims reporting standard Release 3 (R3). Currently, not all states are interpreting Claim Type Codes in the same way, causing inconsistent reporting. Standard definitions are being created for each code to reduce confusion about the code meanings. The addition of new Claim Type Codes to eliminate identified gaps is also under consideration.
Another IRR addresses inconsistent use of the user request maintenance type code (MTC UR) as a catch-up process when states migrate from one reporting standard to another (examples include migrating from R1 to R3, going from paper to electronic reporting, or migrating from FROI-only reporting to SROI reporting). The IAIABC Claims Committee is attempting to define the UR to be used more consistently to report legacy claims.
Other Possible Modifications to R3: Under consideration is allowing the reporting of multiple body parts related to a single accident. Several states are requesting this change so that they can have the ability to segregate body parts into those that are compensable and those that are denied.
Training: The IAIABC is introducing online on-demand EDI training modules. The first module, “Introduction to the IAIABC and EDI,” is available now on the IAIABC website. Designed for those that are new to the IAIABC or EDI, it provides comprehensive knowledge of the IAIABC EDI standards and explains why the standards are so important.
Jeremy, Monica, and other compliance experts at Marsh ClearSight have a deep understanding of the complex and changing compliance landscape and are active participants in the standards evolution process with the IAIABC. The mission of our dedicated Regulatory Compliance Team is to proactively address required regulatory changes such as those described above within our supported Marsh ClearSight regulatory functions.
We’ll continue to update you through blog posts and other communications as we learn about future changes that may impact your claims administration process.