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Important News Regarding the "Claims EDI Missing SA Report"

The Division has agreed to extend the deadline for compliance with this report until 1-31-11.

Between now and 1-31-11, Claim Administrators are expected to review the Missing SA listing and provide resources to address all entries on the EDI Missing SA list. This list is cumulative; updated the first day of every month; posted in your Claims EDI R3 Trading Partner Warehouse Account; and is available to anyone from that Trading Partner who is a registered user. If you do not have access to your EDI Trading Partner Warehouse Account, please contact your company’s/TPA’s EDI representative(s) to discuss the list.

On or before 1-31-11, the Division expects that all claim administrators:

  • File the missing MTC SA transactions (or MTC FNs if file is closed).
  • If the case was really a Medical Only claim and no indemnity or settlement is going to take place on this claim, and it should never have been filed with the Division, an MTC 01 ‘Cancel’ should be filed.
  • If the file is on your listing, but has been acquired by another Claim Administrator, you will need to advise the Division that this claim has been acquired, and the company that acquired the claim, if known. This indicates that the Acquiring claim administrator did not report the acquisition to the Division, as required by rule. Insurers, you are responsible for making sure that your current TPA has filed an acquisition transaction to report every claim required by rule that was acquired from your former TPA.

    When a Claim Administrator acquires any open lost time claim and any closed lost time claim with a date of injury that is within five years prior to the date of acquisition, an MTC AQ must be filed to report a change in claims administration. If you have acquired claims since you have been filing via EDI and you have not submitted an MTC AQ to advise the Division of this acquisition, you are not in compliance with Rule 56.304(2) and the EDI Event Table which is incorporated by Rule 56.300(1)(e)1. F.A.C.

To assist Claim Administrators with this Missing SA requirement, the Division has agreed to accept a Paper DWC-13 form for any ‘legacy claim’ (Date Claim Admin’s Knowledge of Injury was prior to Claim Admin’s R3 Implementation Date) IF the claim is now closed, AND the filing is a FINAL. The FINAL legacy paper 13 must be complete and accurate. Medical, Hospital and Drugs/Supplies will not be required. All other indemnity and medical info must be accurate and greater or equal to the amounts on the previous DWC-13 filed.

If the Claim Administrator can not file an MTC 01 to Cancel claims previously filed in error and are now Medical Only, the Division will accept an email to the EDI Team (claims.edi@myfloridacfo.com) with an attached listing (JCN, Name and DOI) and documentation that these claims were previously filed in error and should be canceled because they are Medical Only. If the Division has any documentation of indemnity payments beyond the Initial payment reported on the FROI, they will contact the claim administrator for further clarification of the Medical Only status.

The Division’s EDI webpage has been updated to include a short PowerPoint presentation on the Missing SA process.

Failure to respond and address your Missing SA Reports will result in a referral to the Bureau of Monitoring and Audit for further action.

Please send an email to the EDI Team (claims.edi@myfloridacfo.com) if you have any questions.

 

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