American Association of State Compensation insurance Fund
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member fund.

CopperPoint Mutual Insurance Company
Phone: (602) 631-2000
Address: 3030 North Third Street
Phoenix, AZ   85012

State Compensation Insurance Fund
Address: 333 Bush Street
Suite 800
San Francisco, CA   94104

Pinnacol Assurance
Phone: (303) 361-4000
Address: 7501 East Lowry Boulevard

Denver, CO   80230-7006

Hawaii Employers' Mutual Insurance Co. Inc.
Phone: (808) 524-3642
Address: 1100 Alakea Street
Suite 1400
Honolulu, HI   96813

Idaho State Insurance Fund
Phone: (208) 332-2100
Address: 1215 West State Street
P.O. Box 83720
Boise, ID   83720-0044

Kentucky Employers Mutual Insurance
Phone: (859) 425-7800
Address: 250 West Main Street Suite 900

Lexington, KY   40507-1724

Louisiana Workers' Compensation Corporation
Phone: (225) 924-7788
Address: 2237 South Acadian Thruway

Baton Rouge, LA   70808

Maine Employers Mutual Insurance Company (MEMIC)
Phone: (207) 791-3300
Address: 261 Commercial Street
P.O. Box 11409
Portland, ME   04104

Chesapeake Employersí Insurance Company
Phone: (410) 494-2000
Address: 8722 Loch Raven Boulevard

Towson, MD   21286-2235

SFM Mutual Insurance Company
Phone: (952) 838-4200
Address: 3500 American Boulevard West Suite 700

Bloomington, MN   55431-4434

Missouri Employers Mutual Insurance
Phone: (800) 442-0590
Address: 101 N Keene St

Columbia, MO   65201

Montana State Fund
Phone: (406) 495-5015
Address: 855 Front Street
P.O. Box 4759
Helena, MT   59604-4759

New Mexico Mutual Group
Phone: (505) 345-7260
Address: 3900 Singer Boulevard NE

Albuquerque, NM   87109

New York State Insurance Fund
Phone: (212) 312-7001
Address: PO Box 66699

Albany, NY   12206

Workforce Safety and Insurance
Phone: (701) 328-3800
Address: 1600 East Century Avenue Suite 1

Bismarck, ND   58506-5585

Ohio Bureau of Workers Compensation
Phone: (800) 644-6292
Address: 30 West Spring Street

Columbus, OH   43215-2256

CompSource Mutual Insurance Company
Phone: (405) 232-7663
Address: 1901 North Walnut Ave.
P.O. Box 53505
Oklahoma City, OK   73152-3505

State Accident Insurance Fund (SAIF)
Phone: (503) 373-8000
Address: 400 High Street SE

Salem, OR   97312-1000

Pennsylvania State Workers Insurance Fund
Phone: (570) 963-4635
Address: 100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA   18505-5100

Beacon Mutual Insurance Company
Phone: (401) 825-2667
Address: One Beacon Centre

Warwick, RI   02886-1378

South Carolina State Accident Fund
Phone: (803) 896-5800
Address: P.O. Box 102100

Columbia, SC   29221-5000

Texas Mutual Insurance Company
Phone: (800) 859-5995
Address: 6210 East Highway 290

Austin, TX   78723-1098

Workers Compensation Fund
Phone: (800) 446-2667
Address: 100 West Towne Ridge Parkway
P.O. Box 2227
Sandy, UT   84070

Washington Department of Labor and Industries
Phone: (360) 902-5800
Address: P.O. Box 44001

Olympia, WA   98504-4001

Wyoming Division of Workers Safety & Compensation
Phone: (307) 777-7159
Address: Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, WY   82002

Workers Compensation Board - Alberta
Phone: (780) 498-3999
Address: 9925-107 Street
P.O. Box 2415
Edmonton, AB   T5J 2S5

Workers Compensation Board of British Columbia (WORKSAFEBC)
Phone: (604) 273-2266
Address: P.O. Box 5350 Station Terminal

Vancouver, BC   V6B 5L5

Manitoba Workers Compensation Board
Phone: (204) 954-4321
Address: 333 Broadway

Winnipeg, MB   R3C 4W3

Phone: (506) 632-2200
Address: 1 Portland Street
P.O. Box 160
Saint John, NB   E2L 3X9

Workers Compensation Board of Nova Scotia
Phone: (902) 491-8999
Address: 5668 South Street
P.O. Box 1150
Halifax, NS   B3J 2Y2

Prince Edward Island Workers Compensation Board
Phone: (902) 368-5680
Address: 14 Weymouth Street

Charlottetown, PE   C1A 7L7

Saskatchewan Workers Compensation Board
Phone: (306) 787-4370
Address: 200 - 1881 Scarth Street

Regina, SK   S4P 4L1

Puerto Rico State Insurance Fund Corporation
Phone: (787) 793-5959
Address: G.P.O. Box 365028

San Juan, PR   00936-5028
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AASCIF Newsletter

An Overview of Claim Reporting EDI

By Matt Holbrook, Director of IT Applications, Maine Employers Mutual Insurance Company (MEMIC)

Electronic data interchange (EDI) has been a common practice across many industries, used to replace the submission of information through paper forms with a more efficient electronic transactional process. In each industry, there usually exists an EDI standard that governs the content, format, and processing of transactions, either enforced by legal authority or adopted by voluntary consensus.

In workers' compensation claim reporting, state agencies have adopted EDI to reduce their reliance on paper forms in fulfilling their legal mandates. The standard for all Claim EDI has been developed by the International Association of Industrial Accident Boards and Commissions (IAIABC). The most current version of the IAIABC standard is Release 3, which incorporates and enhances the prior releases' content while adding new data elements.

Right now, 33 states are in production with EDI based on the IAIABC standard, with EDI being mandatory in 26 of them. Another 8 states are planning or actively working on EDI implementations. And among those already in production there are some contemplating migration to the latest release of the standard. Just this year, Pennsylvania will be migrating and enhancing its EDI program, while New York will be going through a new implementation.

One can see the advantages that EDI offers to a state agency.  In a time of budgetary constraint, EDI reduces the overhead required to input data coming into the agency.  It also increases the accuracy of that data, while also increasing the speed in which it is processed.

There are advantages, too, for the insurance carriers who do the bulk of the reporting to these agencies. Reports are sent to the states much faster, and it is easier to keep track of what was sent when, so carriers have more flexibility meeting statutory deadlines and can more readily track their compliance.

However, there are costs for carriers.  Carriers are generally still required to send paper forms to other parties involved in the transaction, such as injured workers. In addition, some states are unable to translate certain paper forms, for which there is a legal mandate, to EDI transactions. So EDI reduces somewhat, but does not eliminate, paper processing for the carriers. It also may require carriers to spend valuable IT resources to enhance their claim management solutions so that they may generate the transactional data required by EDI mandates.

Here is a brief overview of the typical EDI process. The initial step for any carrier is to become an EDI trading partner with the state agency.  The IAIABC standard provides a specific set of documentation for defining the trading partner relationship. The documentation describes the types of data being sent, the means through which the data will be sent, and the entities whose data will be sent under this relationship. Generally, carriers can choose to be direct trading partners or to send their EDI transactions through an EDI reporting vendor approved by the state agency.  In typical cases, there are testing requirements that need to be fulfilled before a carrier can be approved for production. These requirements confirm that the carrier's process is adhering to the EDI standard as defined by the state agency. (In some cases, the fact that an EDI vendor already has approval to submit in production rescinds the need for carriers using that vendor to go through a testing process.)

There are two types of reports in the IAIABC standard: First Reports of Injury (FROIs) and Subsequent Reports of Injury (SROIs).  Within these report types are a number of transaction types called Maintenance Type Codes (MTCs), which correspond with events in the life of a claim.  When a given event occurs, the insurance carrier will generate the appropriate EDI transaction and transmit the data to the state agency, whether directly or through a vendor.  The state agency runs the transaction through its edits and determines whether to accept or reject the transaction. Its determination is sent back to the carrier as an Acknowledgement transaction, indicating whether the carrier's submission was accepted, and providing error message details if it was rejected.

FROI transactions are accepted by all 33 states in production, but only 20 states accept SROI transactions, with 18 having mandates. The FROI transactions are easier to implement, as they are fewer in number, represent claim-level events, and fit better with existing state forms.  Implementing SROI transactions is a more complex undertaking, and some states have limited their required SROI transactions to just a very few.

Carriers that may be new to claim EDI will be considering the "Build or Buy" question. If one has a claims management system that includes a module to handle EDI reporting, the question has already been answered.  But for those who must modify their systems, "Build or Buy" is not the true choice. There are vendors that provide EDI reporting services. For carriers with low exposure in states with EDI mandates, a vendor with an interactive EDI solution may suffice. But once a carrier's EDI volume reaches a certain point, greater automation is in order. The carrier could still work with a vendor, but the carrier must provide data to the vendor to drive the process, so there will always be a good deal of internal IT work. Working with a vendor adds costs to the EDI process, but it also relieves the carrier of the need to build and maintain the multiple data transfer processes required when working directly with the individual states. So the true choice is to build a completely internal solution, or a hybrid that involves a vendor.



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