Rule 69L-56, F.A.C., was initially revised January 7, 2007 to require the electronic submission of Claims (non-medical) filings and to require an upgrade to Release 2.1 for electronic filing of Proof of Coverage information required to be implemented by April 2, 2007. (click here).
69L-56, F.A.C., was last revised effective May 17, 2009 to specify insurer requirements for reporting proof of coverage information to the Division to identify a professional employer organization or employee leasing company and its client companies. Additionally, the rule incorporated by reference revised national standard EDI implementation guides for POC (Release 2.1) and Claims (Release 3); updated the Florida POC Implementation Manual containing a new requirement to report Total Payroll and Number of Employees, as well as an updated Florida POC Implementation Manual containing a new requirement to report total payroll and number of employees. The rule also adds a new definition for the meaning of “Cancellation/Non-Renewal Effective Date”. The rule also clarified that the employer address must not be substituted for the employee address when filing the Electronic First Report of Injury or Illness with the Division, and repealed subsection 69L-56.330 Electronic Formats for Reporting the Employee’s 8th Day of Disability and the Claim Administrator’s Knowledge of 8th Day of Disability (a Release 1 Claims EDI filing requirement. Revised EDI forms adopted in conjunction with the revisions to the rule are contained in the revised Florida POC EDI R2.1 Implementation Manual posted below.
The IAIABC Implementation Guide for Release 2.1 was updated on June 1, 2007 and can be obtained from the IAIABC's web site at http://www.iaiabc.org. The IAIABC now charges $95 for the Release 2.1 Guide if your company is not an IAIABC EDI member. The IAIABC's website also contains other important code tables required in Release 2.1..
Florida POC EDI R2.1 Implementation Manual (click here): The Florida POC EDI R2.1 Implementation Manual, contains the filing specifications for sending proof of coverage data to the Division via EDI, as well as the required trading partner forms, and is incorporated by reference in rule 69L-56 F.A.C. This includes the Event Table, Element Requirement Table, and Edit Matrix. IMPORTANT: Do not print the “Edit Matrix” contained in the FL POC EDI R2.1 Implementation Manual; instead print the revised tables contained in the Supplement, below. There are no revisions to the Event Table or the Element Requirement Table at this time.
FL POC EDI Supplement: The Supplement provides an overview of changes/corrections to the Event Table, Element Requirement Table, and/or Edit Matrix, that were made after the date the previous version of the rule was posted to the Division’s web site (for the Notice of Proposed Rulemaking). The Supplement also contains the updated tables, which reflect the last revision date and color-coded changes as tan-shaded cells with blue text. It is recommended that claim administrators/vendors routinely check this site around the 5th day of each month to see if a revised Supplement has been published.
Supplement - Overview (REV. 5-17-09) (click here)
FL POC EDI R2.1 Edit Matrix Supplement (REV. 5-17-09) (click here)
FL POC EDI R2.1 Element Requirement Table Supplement (REV. 5-17-09) (click here)
FL POC EDI R2.1 Event Table Supplement (1-1-09) (click here)
Helpful FL EDI R2.1 Resources: The following documents can be used as resources when implementing POC EDI R2.1 requirements:
Proof of Coverage questions/problems should be sent to firstname.lastname@example.org This email address will reach all members of the EDI team, and our Technical contact, and will enable us to provide you with the best customer service.