BWS EDI Claim Administrator-specific Match Data Elements

BWS EDI ClaimBWS EDI Claim Administrator FEIN (DN0187) must be in a valid format & belong to a valid, PA-registered, Third Party Administrator or a PA-licensed Insurer. Insurers who are not registered to administrate on behalf of another Insurer should not have their FEIN in this field if their FEIN is not also in the Employer FEIN field.

Changes to each match data element must be reported on its own FROI 02 (Change) transaction else, if a match data element does not match what was reported on a previous claim, the transaction will be rejected. All match data elements must be present on a 02 transaction but only one match data element or interested party may be updated per 02 transaction. Match data elements that can be changed on a 02 (Change) transaction are indicated with lower case requirement code on the FROI Element Requirement Table.

Note that, when changing FEINs, if the same FEIN was originally placed in multiple FEIN fields then all fields should be changed at the same time to replace one party with another party.

When changing from one Employee ID type to another, Employee ID Type Qualifier (DN0270) must be changed as well. For example, if a valid employee Social Security number is available after a claim is submitted with an Employee Assigned by Jurisdiction (DN0154), the 02 (Change) transaction should be populated with the new Employee ID Type Qualifier of “S” (SSN) as well as the employee’s Social Security number. Additionally, the Employee Last Name (DN0043) may not be changed except on a FROI 02 and also may not be updated at the same time as the Employee First Name (DN0044) and/or Employee Date of Birth (DN0156).

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