EDI LIBC-501 (Notice of Temporary Compensation Payable)

EDI LIBC-501The purpose of EDI LIBC-501 is to verify if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Temporary Compensation Payable (LIBC-501) based on the following EDI transaction/maintenance type codes:

  • SROI IP
  • SROI PY
  • SROI AP
  • SROI RB
  • SROI RE
  • SROI 02
  • SROI PD
  • SROI CA

SROI IP

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit an IP transaction with Agreement to Compensate Code (DN0075) = ‘W’ and making sure to populate new Mandatory Conditional Data Elements.

SROI PY

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit a PY transaction with Agreement to Compensate Code (DN0075) = ‘W’ and making sure to populate new Mandatory Conditional Data Elements.

SROI AP

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit an AP transaction with Agreement to Compensate Code (DN0075) = ‘W’ and making sure to populate new Mandatory Conditional Data Elements.

SROI RB

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit an IP transaction with Agreement to Compensate Code (DN0075) = ‘W’ and making sure to populate new Mandatory Conditional Data Elements.
3. Claim Admin uses claim from Step 1 to submit a SROI 04 transaction with Full Denial Reason Code (DN0198) ‘4.A.’
4. Claim Admin submits a SROI RB transaction with Agreement to Compensate Code (DN0075) = ‘W’ to reinstate benefits and making sure to populate new Mandatory Conditional Data Elements.

SROI PD

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit a SROI PD with Agreement to Compensate code (DN0075) “W” and Claim Type Code (DN0074) ‘M’.

SROI RE

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit an IP transaction with Agreement to Compensate Code (DN0075) ‘W’ making sure to populate new Mandatory Conditional Data Elements.
3. Claim Admin uses claim from Step 1 to submit a SROI RE lowering the Average Wage (DN0286) and Calculated Weekly Compensation Amount (DN0134).

SROI 02

1. Claim Admin submits a FROI 00 to create a new test claim.

2. Claim Admin uses the claim created in Step 1 to submit an IP transaction with Agreement to Compensate Code (DN0075) ‘W’.
3. Claim Admin uses claim from Step 1 to submit a SROI 02 updating the Initial Date Disability Began.

SROI CA

1. Claim Admin submits a FROI 00 to create a new test claim.
2. Claim Admin uses the claim created in Step 1 to submit an IP transaction with Agreement to Compensate Code (DN0075) ‘W’.
3. Claim Admin uses claim from Step 1 to submit a SROI CA increasing the Average Wage (DN0286) and Calculated Weekly Compensation Amount (DN0134).

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