Medical EDI Vendors Guidelines
Medical EDI Vendors are subjected to successful completion of required testing before live data transmissions begin. Any vendor that does not successfully complete the required testing will not be permitted to submit EDI transactions on behalf of clients. Vendors that successfully complete the required testing will not be required to complete additional testing to submit EDI transactions on behalf of clients acquired by the vendor after testing is successfully completed.
NCIC FROI Requirement Change to Accept All Claims Filed on or after April 1, 1997, Electronically (EDI)
Effective immediately, NCIC will allow all FROI claims filed on or after April 1, 1997, to be submitted via EDI. With the initial implementation of NCIC FROI EDI, the event per Event Table was based on the Date the Employer had Knowledge of the Injury vs. Trading Partner (TP) Production Date. These events required the continued reporting of claims on paper if the claim was established prior to EDI start date. NCIC has received feedback from its TP’s whose preference is to file all new claims via EDI, and based on this feedback NCIC has implemented the following changes.
In order to allow NCIC to receive all FROI reports via EDI, the Event Table has been changed per ‘A. FROI Event Table’ below, and the edit that restricted the TP’s ability to report all FROI claims has been removed per ‘B. Edit Matrix Population Restriction’ below.
FROI Event Table change:
FROI MTC 00 Original: Adding two new events to replace previous events:A claim must be reported to the Commission using a FROI 00 if medical expenses exceed > $2000 and Date Employer Had Knowledge of Injury (DN0040) is >= 04/01/1997. NCIC will accept all claims in addition to this event.The injured worker misses more than one day of work and Date Employer Had Knowledge of Injury (DN0040) is >= 04/01/1997. NCIC will accept all claims in addition to this event. Also, added the through date of 6-30-14 to the previous FROI 00 Event and removed Note: A FROI 00 is not required to be filed for injuries that would not require a filing of a Form 19.
Edit Matrix Population Restriction:
Claims established prior to Trading Partner approved production implementation date must be filed on paper. Claims established on or after Trading Partner approved production implementation date must be filed via EDI. Removed the following edit on: DN0040 Date Employer Had Knowledge of Injury edit 045 Value is < required by jurisdiction: If DN0104 Test Production Indicator = P, Date Employer Had Knowledge of Injury (DN0040) must be >= Trading Partner approved production implementation date.
- Claims established prior to Trading Partner approved production implementation date must be filed on paper.
- Claims established on or after Trading Partner approved production implementation date must be filed via EDI.
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