3074626, 69L-56 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 3074626

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

Electronic Data Interchange (EDI) Requirements for Proof of Coverage and Claims (Non-Medical)

Overview

RULE:

69L-56

ELECTRONIC DATA INTERCHANGE (EDI) REQUIREMENTS FOR PROOF OF COVERAGE AND CLAIMS (NON-MEDICAL)

PURPOSE:

Rule Chapter 69L-56, F.A.C., is being amended to incorporate by reference the revised Florida Division of Workers’ Compensation Proof of Coverage (POC) Electronic Data Interchange (EDI) Implementation Manual and the International Association of Industrial Accident Boards and Commission (IAIABC) EDI Implementation Guide for Proof of Coverage using the revised Release 2.1 national standard, and to modify transmission filing requirements to allow for daily receipt/processing of electronic POC files by the Division.  Rule Chapter 69L-56, F.A.C., also creates filing requirements of insurers to electronically submit by specified time periods, claims information otherwise reported on Forms DFS-F2-DWC-1, DFS-F2-DWC-12, DFS-F2-DWC-13, DFS-F2-DWC-4, and DFS-F2-DWC-49 adopted in Rule Chapter 69L-3, F.A.C., plus certain electronic changes and cancellation notices for which there are currently no form equivalents promulgated by rule.  The rule also incorporates by reference the Florida Division of Workers’ Compensation Claims EDI Release 3 Implementation Manual and the IAIABC Claims EDI Implementation Guide for Release 3.

SUMMARY:

Rule Chapter 69L-56, F.A.C., is being amended to facilitate Electronic Data Interchange (EDI) transmissions of Proof of Coverage information with the Division, and to mandate the electronic submission of Claims (non-medical) data to the Division. The following changes are being made to Rule Chapter 69L-56, F.A.C.:  Section 69L-56.001, F.A.C., is being amended to incorporate by reference revised EDI Trading Partner forms;  Section 69L-56.002, F.A.C., is being amended to define additional terms used in the rule; Section 69L-56.100, F.A.C., is being amended to require the new Release 2.1 national IAIABC EDI standard effective 4/2/07 for submission of POC data and to provide for daily processing of POC transmissions;  Section 69L-56.200, F.A.C., is being amended to include failure to pay deductible as a reason an insurer may cancel a policy prior to the otherwise required 30 day notification period; Section 69L-56.210, F.A.C., is being amended to provide for an additional Triplicate Code to represent an electronic cancellation;  Section 69L-56.300, F.A.C., is being created to specify Claims EDI reporting requirements and to incorporate by reference the FL Claims EDI R3 Implementation Manual, and to identify the implementation schedules for mandated electronic submission of claims (non-medical) information to the Division;  Section 69L-56.301, F.A.C., is being created to set out the filing requirements and timeframes for the Electronic First Report of Injury or Illness;  Section 69L-56.3012, F.A.C., is being created to set out the filing requirements and timeframes for the Electronic Notice of Denial and Rescinded Denial; Section 69L-56.3013, F.A.C., is being created to set out the filing requirements and timeframes for the Electronic Claim Cost Report;  Section 69L-56.304, F.A.C., is being created to set out the filing requirements and timeframes for the Electronic Notice of Action or Change, including Changes in Claims Administration, required by the insurer’s Primary Implementation Schedule;  Section 69L-56.3045, F.A.C., is being created to set out the filing requirements and timeframes for the Electronic Notice of Action Change, Suspensions, and Reinstatement of Indemnity benefits required by the insurer’s Secondary Implementation Schedule;  Section 69L-56.307, F.A.C., is being created to set out the filing requirements and timeframe for sending Electronic Cancellations of claims;  Section 69L-56.310, F.A.C., is being amended to identify and require the revised FROI and SROI formats and to provide for daily processing of claims EDI transmissions;  Section 69L-56.320, F.A.C., is being created to set out the testing requirements for Claims EDI filings;   Section 69L-56.330, F.A.C., is being amended to provide an exception for reporting the employee’s 8th day of disability  by claim administrators voluntarily sending Electronic First Reports of Injury or Illness via the IAIABC EDI Release 1 standard;  Section 69L-56.500, F.A.C., is being amended to include the timely processing of acknowledgements as another  obligation of an insurer using a third party vendor.

RULEMAKING AUTHORITY:

440.185(7), 440.42(3), 440.591, 440.593 FS.

LAW:

440.185(7), 440.42(3), 440.591, 440.593, 627.4133(4) FS.

PRINT PUBLISH DATE:

10/27/2006 Vol. 32/43

COMMENTS:

From 10/27/2006 To 11/17/2006 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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