EDI Claims Reporting

EDI Claims Reporting Requirements (Iowa DWC)

The DWC will work with the DWC Vendor to provide initial and ongoing training and guidance to trading partners who need assistance regarding the proper reporting of claim information via EDI. It is imperative that trading partners become familiar with the Iowa EDI Claims Release 3.1 Event Table to know what claim events trigger reporting and the timelines in which a FROI or SROI must be transmitted to the DWC.

By law, injuries are to be reported to DWC within four (4) days when one of three specific conditions exists. The EDI reporting timelines are referenced in the Event Table and self-insured employers, carriers and claims administrators will need to comply with the established standards. Please note that audits and concomitant audit findings relating to timely and complete FROI and SROI filings were in abeyance until March 1, 2019. This affords carriers, self-insured employers, and claims administrator’s ample time to ensure protocols are in place to provide timely filings and avoid possible non-compliance audit findings.

Claims Reporting requirements

New Claims: A FROI that is filed with the DWC on or after EDI Claims Release 3.1 implementation requires an electronic FROI submission. All SROIs associated with a FROI submitted via EDI Claims Release 3.1 must also be submitted via EDI Claims Release.

Legacy Claims: A legacy claim is one that was filed prior to EDI Claims Release 3.1 implementation.

Lump Sum Settlements pursuant to Iowa Code Once the settlement has been approved, an MTC PY must be transmitted to the Division to report payment of the settlement.

Fatality Claims: Interim Summary of Payments shall be filed annually between July to September of each calendar year for fatal claims paying dependent benefits using the SROI MTC AN.

Permanent Total Disability Claims: Interim Summary of Payments shall be filed annually between July to September of each calendar year for total permanent disability claims using the SROI MTC AN.

To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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