Madison, WI – Workers’ compensation carriers and insurers are required to file proof of coverage (POC) notices to every jurisdiction identified on their policies and contracts. Electronic POC filings began in the late seventies, enabling jurisdictions to develop enforcement programs to monitor compliance of workers’ compensation laws.
The IAIABC EDI Implementation Guide for Proof of Coverage, Release 3.0, was recently published on July 1, 2012 and is now available. This guide includes reporting requirements for the insured, employer, header, trailer, and acknowledgment records. These requirements are generally common to all states; however, some unique, state-specific data elements are included. Jurisdictions that adopt this guide will likely eliminate hundreds of forms, and therefore will share a tremendous cost savings with insurers.
A key initial accomplishment of the POC standard was the delivery of a data structure for the required POC data elements. The process began in 1994, when representatives from various independent boards and commissions came together to create a POC data reporting standard. WCPOLS, a flat file format used for electronic transmission of policy information from the clam administrator to the data collection organization, was selected as the source for these required elements. The Workers’ Compensation Insurance Organizations (WCIO) agreed to add POC data elements to the WCPOLS specification to support this need, thus providing insurers with the ability to use WCPOLS as a vehicle to provide POC data to the appropriate data collection organizations. More information regarding WCPOLS can be found in the WCIO Workers Compensation Data Specifications Manual.
A primary driver for the development of Release 3.0 was the need for an expanded acknowledgment record to provide a description of any errors found. Jurisdictional interpretation of errors and their intended action vary The error description will providing clear instructions of what action the reporters needs to take to resolve errors and will improve the quality of future POC data reporting. Another key deliverable of POC Release 3.0 was the resolution of field length differences found in common elements in both WCPOLS and the IAIABC EDI products. There have been instances where data was unintentionally truncated during translation due to these field length differences. Finally, in preparation for Release 3.0, a nationwide survey was conducted to identify the individual needs of member jurisdictions as well as the non-member jurisdictions to identify reporting gaps, challenges, or limitations of the current POC standard. As a result, a number of small reporting enhancements were incorporated into this release in order to meet the needs of the industry. For further insight or specific details of the POC Release 3.0 enhancements, please refer to the IAIABC EDI Implementation Guide for Proof of Coverage, Release 3.0.
The IAIABC EDI Implementation Guide for Proof of Coverage, published once a year, documents the current national standard for jurisdictions to collect coverage information via EDI. The IAIABC EDI committees, composed of experts from both the government and other workers’ compensation stakeholders, continuously review and update this and other EDI guides and standards as issues are discovered and resolved. The IAIABC EDI Implementation Guides are available complimentary for IAIABC EDI and U.S. Jurisdictional Members, and available for purchase to others. Download the guide at www.iaiabc.org/store.
Source: IAIABC