The Division came closer to meeting its total EDI business environment for submission goal in 2009.
The Claims Handling Entities and their designees electronically submitted 3,906,096 million medical bills, representing the combined group of physician, hospital, dental, pharmacy, and other healthcare providers’ bills, which the Division accepted into the Medical database. This figure represents 100% electronic filing.
The Claims Handling Entities electronically submitted 426,174 Claim form filings, the combined group of the First Report of Injury/Illness, Claim Cost Report, Notice of Action/Change, Notice of Denial, and Change in Claims Administration, which the Division accepted into the Claims database. This figure represents 92% electronic filing.
Insurer designees electronically submitted 726,374 Proof of Coverage filings, representing the combined group of certificates of insurance, endorsements, cancellations, and reinstatements, which the Division accepted into the Compliance database. This figure represents 100% electronic filing.
During the first six months of the 2009-2010 fiscal year, the Division of Workers' Compensation, Bureau of Monitoring and Audit reviewed 37,488 claim files. As a result of these reviews, the Bureau's staff identified $862,885 in benefit underpayments and penalties and interest due from insurers (and subsequently paid) to injured workers.
Technical changes to Rule 69L-26.004, F.A.C. include corrections in statutory citations, updates to Division web addresses, and the addition of an e-mail address for the Bureau of Employee Assistance and Ombudsman Office.
The "Employee Notification Letter" is posted under Publications. Employers and carriers should begin using this letter on or before April 1, 2010.
If you have questions regarding these technical changes to the rule, please contact Pam Macon at (850) 413-1708.