LIBC-496

Generation of Notice of Compensation Denial (LIBC-496)

In this blog we continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Generation of Notice of Compensation Denial (LIBC-496) purpose is to verify if the Claim Administrator has implemented the necessary changes to their system that would trigger the generation of the Notice of Compensation Denial (LIBC-496) based on the following EDI transaction/maintenance type codes:

  • FROI 04
  • SROI 04
  • FROI 02
  • SROI 02

FROI 04

The Claim Administrator must submit a FROI 04 transaction with Full Denial Reason Code (DN0198) ‘2.B.’. NCD # 1 is generated.

SROI 04

The Claim Administrator must submit a FROI 00 to create a new test claim.  The Claim Administrator follows up with a SROI 04 with Full Denial Reason Code (DN0198) ‘4.A.’ and Denial Reason Narrative. NCD # 5 is generated and the narrative field under # 5 is populated.

FROI 02

The Claim Administrator must submit a FROI 02 to change the claim created in Step 2 with Full Denial Reason Code (DN0198) ‘3.A.’. NCD # 3 is generated.

SROI 02

The Claim Administrator must submit a SROI 02 to change the claim created in Step 2 with Full Denial Reason Code (DN0198) ‘3.I.’. NCD # 3 is generated.

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

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