What’s New! EDI POC Release 2.1, Proof of Coverage 2.1 Release Notice, Kentucky EDI Newsletter (June 2008)
EDI Vendor List
Trading Partner Agreement
Trading Partner Profile
Transmission Profile
IAIABC FROI Data Elements
FROI Event Table
EDI Code Instruction Guide
IAIABC SROI Data Elements
SROI Event Table
ISO
Workers' COMP-LINK
IAIABC POC Data Elements
Proof of Coverage Reject Codes
Procedures for Wrap Up (Special Projects) and Split Coverage
NCCI
IAIABC POC Release 2.1 Tables for Kentucky
Kentucky Population Restrictions
Edit Matrix
Kentucky Value Table
New Part of Body Rule
Self-Insured Indicator Update
These terms are used throughout this Web site, and abbreviated definitions are provided for the convenience of those who are new to the principles of EDI. This glossary is not intended to take the place of any information contained in the IAIABC EDI Implementation Guides.
Data Collection Agent (DCA)
A service company which keypunches the information from paper forms and transmits it electronically on behalf of its clients. The fee for this service is agreed upon between the data collection agent and the client. Many third-party administrators are also able to provide this service.
Electronic Data Interchange (EDI)
Acronym for Electronic Data Interchange.
EDI Support
Those individuals responsible for ensuring your EDI System performs properly. May be a part of your company's Data Processing staff or a contractor/vendor.
EDI System
The computer application used for generating EDI transmissions. May be a custom application designed by your company's Data Processing staff or commercial software supported by a contractor/vendor.
IAIABC
Acronym for the International Association of Industrial Accident Boards and Commissions.
KYWC
Acronym for the Kentucky Department of Workers' Claims.
Trading Partner
Each entity transmitting electronic data via EDI.
Value-Added Network
An "electronic post office" which routes the electronic reports and acknowledgments from sender to receiver using electronic mailboxes.
VAN
Acronym for value-added network.
How do I become a trading partner with the Kentucky Department of Workers' Claims?
Obtain the KYWC EDI documentation which contains state-specific information required for submitting electronic reports to the KYWC. Obtain the IAIABC Implementation Guide which contains the standardized information used by all jurisdictions that are receiving workers' compensation reports electronically. Be sure to request the proper guide based on the information provided in the KYWC EDI documentation. Establish a mailbox account with one of the value-added networks used by the KYWC. Complete the Trading Partner Agreement, Trading Partner Profile and Transmission Profile and return them to the KYWC by fax or mail. If we have any questions regarding these profiles, we will contact you using the information provided on the Trading Partner Profile. If your profiles have been completed accurately, you will receive written notification that your trading partner account has been established. Do not begin sending test transmissions until you receive this notification.
What are "test" transmissions?
Test transmissions serve two purposes. Initially, they verify that all technical details regarding the transmission process itself are correct for all three systems involved: yours, the VAN's and the KYWC's. Ultimately, they are used by the KYWC to assess your ability to send acceptable electronic reports.
What types of test reports should I send?
When testing First Reports of Injury (FROI) with the KYWC, send only original reports (MTC "00"). Upon obtaining production status, all additional first report Maintenance Type Codes (MTC) become reportable. Do not send test transmissions for Subsequent Reports of Injury (SROI) until production status has been obtained for First Reports of Injury. When testing subsequent reports, send only initial payment reports (MTC "IP"). Upon obtaining production status, all additional subsequent report MTCs become reportable.
When will I be placed in production status by the KYWC?
The KYWC uses an abbreviated testing process in order to place each trading partner in production status as quickly as possible. Trading partners able to send three consecutive transactions containing at least 10 reports each with no more than 30 percent of the reports rejected per transaction will be given production status.
I just sent an EDI transmission to the KYWC. When can I expect an electronic acknowledgment?
The KYWC downloads incoming EDI transmissions from the VANs each business morning. Functional acknowledgments are returned immediately. Detailed acknowledgments are normally returned by close of business on the same day. Occasionally, the volume of data to be processed causes the detailed acknowledgments to be returned the morning of the following business day.
What's the difference between a Functional Acknowledgment and a Detailed Acknowledgement?
Functional acknowledgments are used to inform the sender that their EDI transmission was received. They are not supported by the IAIABC flat-file standards, and therefore are only returned to trading partners sending ANSI transactions. Detailed acknowledgments are returned to all trading partners after the electronic acknowledgement has been analyzed by the KYWC. These detailed acknowledgments inform the trading partner that their transactions have been accepted, accepted with errors or rejected. If a transaction is accepted with errors or rejected, the detailed acknowledgment includes codes which identify any errors found by the KYWC.
Enough time has passed for me to have received an electronic acknowledgment, but my VAN mailbox is empty. What should I do now?
Contact your value-added network. The VANs keep logs which show when your transmission was uploaded to your mailbox, when the transmission was routed to the KYWC mailbox, when it was downloaded by the KYWC, etc. If this log shows that your transmission was downloaded by the KYWC, contact our office and we will continue this tracking process.
I received a detailed acknowledgment which says that an original First Report of Injury was rejected, and includes the message, "NON-REPORTABLE: LOST TIME IS NOT MORE THAN A FULL WORK DAY" in the free-form text field. What does that mean?
If an original First Report of Injury is received with a Nature of Injury Code (DN0035) lower than "60," it indicates a traumatic injury is being reported. For a traumatic injury to be reportable to the KYWC, the employee must have missed more than one day. This determination is made by comparing the Date Last Day Worked (DN0065) to the Date of Return-to-Work (DN0068), if any. There must be more than a calendar day separating these two dates. If not, the transaction is rejected and the above message is inserted in the free-form text field for clarification.
What does "accepted with errors" mean? (Application Acknowledgement Code TE)
The record has been received and accepted by DWC. However, the coding staff has determined that certain fields within that record required changes to conform to DWC data quality standards. A record with errors in fields other than Nature, Cause, Body Part or SIC code will not be accepted with errors.
I received a detailed acknowledgment which says that an original First Report of Injury was accepted with errors, and includes the message, "DE0025 SB 3465, DE0035 SB 65, DE0036 SB 48, DE0037 SB 82" in the free-form text field. What does that mean?
An original First Report of Injury can be accepted with errors by the KYWC when the only errors found are limited to the following four elements: SIC code (DN0025), Nature of Injury code (DN0035), Part of Body Injured code (DN0036), and Cause of Injury code (DN0037). To assist you in improving your coding skills, a message is inserted in the free-form text field which indicates what the proper code should have been. The above message "DE0025 SB 3465, DE0035 SB 65, DE0036 SB 48, DE0037 SB 82 " is read as follows: "SIC code should be 3465, Nature of Injury code should be 65, Part of Body Injured code should be 48, and Cause of Injury code should be 82." By using this syntax, all four coding errors can be explained using the available space in the free-form text field when necessary.
I have a question about my detailed acknowledgment that is unrelated to the free-form text field. Who should I call?
Your best resource should be those who designed your EDI system. If it is a custom application designed by your company's data processing staff, contact them. A commercial software application should be supported by the contractor/vendor. If you still have questions, e-mail HOWARDC.LAWSON@KY.GOV.
How do I file a first report on a "no lost time" injury so that payment of partial benefits can be reported when the injured party is able to work?
DWC programs are written to calculate the number of lost work days by subtracting the "Date Last Day Worked" from the "Date Returned To Work". "Date Last Day Worked" is a mandatory field, but "Date Returned to Work" is not. File an original First Report of Injury, excluding the "Date Returned to Work". Providing the report meets all remaining edits, it will be accepted. Once the FROI is accepted, you may then file the necessary subsequent reports using the Jurisdiction Claim Number assigned to the Original. Once the Original has been filed, DWC will need for the trading partner to file a Correction Report (CO) showing the return-to-work date. (Filing "no lost time" claims is not necessary under normal circumstances. The scenario above is unique, and requires the filing of a "no lost time" claim to report partial payment. If you have a no lost time claim, and there are no mitigating circumstances that require further filings of other types of reports, then do not file them.)
I filed an Original (MTC 00) first report where the injured worker missed more than one full day of work but returned to work before missing a total of seven days. An IP or FS is not required. Unless circumstances change, this injured worker will never miss a total of seven days. How do I report that the injured worker has returned to work, since the filing of a Suspension of Benefits is not applicable?
File a Change (02) record to the Original showing the return-to-work date as you know it to be.
When a Bi-monthly Periodic Report is filed, how should the Payment Adjustment information be reported?
The Bi-monthly Periodic Report should report the total amount paid to date for each claim.
Which MTC codes generate a Statute of Limitations letter?
Suspension of Benefits for Return to Work or Medically Deemed Capable of Returning to Work (S1). Denial First Reports (04), as of November 1, 1999, and Denial Subsequent Reports (04). There are two types of letters: timely filed and un-timely filed. A fatality letter to the deceased worker's family is also generated based on the Payment Adjustment Code of 010, which states a fatality occurred or on the Original (00) First Report of Injury with a Date of Death. It is very important when filing any Maintenance Type Code requiring payment data, that you refrain from using the 010 code, unless the injured worker has expired due to the work-related injury. DWC staff manually validate each letter before it is mailed, to ensure the claimant receiving the letter is not receiving the letter in error.
Kentucky EDI Newsletter (October 1999)
Kentucky EDI Newsletter (February 2000)
Kentucky EDI Newsletter (June 2008)
