Florida Regulations 69L-56.310

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§ 69L-56.310 Technical Requirements for Claims EDI Transmissions.

History:



(1) Insurers shall send Claims EDI Filings required in Rules 69L-56.301, 69L-56.3012, 69L-56.3013, 69L-56.304, 69L-56.3045, 69L-56.307 and 69L-56.330, F.A.C., to the Division using only the following transmission methods:

(a) Advantis Value Added Network (VAN), or

(b) Secure Socket Layer/File Transfer Protocol (SSL/FTP) in accordance with instructions on Form DFS-F5-DWC-EDI-4 (10/1/2006).

(2) Electronic transmissions of Claims EDI Filings shall be sent to the Division using the First Report of Injury (FROI)/148 flat file transaction set, including the R21 companion record, and the Subsequent Report (SROI)/A49 flat file transaction set, including the R22 companion record, described in Section 2, "Technical Documentation", of the IAIABC Claims EDI Release 3 Implementation Guide. The claim administrator shall not send transmissions containing files in the ANSI 148 format to the Division.

(3) (a) Each FROI transmission shall contain at least one batch in the FROI format, a sample of which is located in Section 2, Technical Documentation, in the IAIABC Claims EDI Release 3 Implementation Guide. Each SROI transmission shall contain at least one batch in the SROI format located in Section 2, Technical Documentation, Record Layouts, in the IAIABC Claims EDI Release 3 Implementation Guide.

(b) Each batch shall contain only one of the following transaction types:

1. First Report of Injury (FROI/148 transaction with R21 companion record), or

2. Subsequent Report of Injury (SROI/A49 transaction with R22 companion record).

(c) A batch shall contain the following as set forth in Section 2, Technical Documentation, in the IAIABC Claims EDI Release 3 Implementation Guide:

1. Header Record,

2. One or more transactions - FROI 148 with R21, or SROI A49 with R22,

3. Trailer Record.

(d) Header records shall include the following information:

1. Receiver FEIN for the State of Florida: 596001874,

2. Receiver Postal Code for the State of Florida: 323994226,

3. Sender Identifier. The Sender Identifier (Sender ID) shall consist of the claim administrator's FEIN and Postal Code as reported on Form DFS-F5-DWC-EDI-3 (01/01/2005), EDI Transmission Profile - Sender's Specifications.

(4) To report the electronic equivalent of the First Report of Injury or Illness (Form DFS-F2-DWC-1 adopted in Rules 69L-3.0045 and 69L-3.025, F.A.C.), where total compensability of the claim has not been denied, the claim administrator shall send to the Division both the FROI and SROI within the processing times set out in subsection (5) of this section. If either the FROI or SROI contains an error that results in the rejection of one of the transactions, both the FROI and SROI shall be rejected and the claim administrator shall re-send both the corrected FROI and SROI to the Division within the processing times set out in subsection (5) of this rule section, in order for the two transactions to be processed together. The Division will only pair for processing purposes, FROI's and SROI's that are received by the Division on the same day, as set out in subsection (5) of this rule section.

(5) Transmissions received on or before 9:00 p.m., Eastern Standard Time, shall be processed by the Division the same day the transmission was sent to the Division and acknowledged by the Division the next day. Transmissions received after 9:00 p.m. through 11:59 p.m., Eastern Standard Time, shall be processed by the Division the following day and acknowledged by the Division the next day after the transmission is processed.

(6) During the test phases, the "Test-Production Code" in the Header record shall be set to "T". After the claim administrator has been approved by the Division to send transmissions in production status, the "Test-Production Code" shall be set to "P".

(7) The claim administrator shall have the capability to receive and process the Division's Claims EDI AKC Acknowledgement transaction described in Section 2, Technical Documentation, of the IAIABC Claims EDI Release 3 Implementation Guide. The claim administrator shall update its database with the Jurisdiction Claim Number (JCN) provided by the Division on the EDI AKC Acknowledgement transaction for each successfully filed transaction.

(8) Formats and meaning of data elements reported via EDI to the Division pursuant to this rule shall match format specifications and data element definitions established in Sections 2, 4 and 6 of the IAIABC Claims EDI Release 3 Implementation Guide, unless otherwise defined in Rule 69L-56.002, F.A.C.

(9) The claim administrator's business and technical contacts shall have e-mail system capabilities that support Word, Excel, or PDF attachments from the Division of at least 2 Megabytes.

(10) The claim administrator or other third party vendor shall utilize anti-virus software to screen out and clean any viruses on all electronic transmissions prior to sending transmissions to the Division. The claim administrator or other third party vendor shall maintain anti-virus software with the most recent anti-virus update files from the software provider. If the claim administrator or third party vendor sends a transmission that contains a virus which prevents the Division from processing the transmission, the transmission will not be considered as having been received by the Division.

(11) If a vendor is submitting files on behalf of more than one insurer or claim administrator, the vendor shall send separate header and trailer records for each claim administrator. The Sender ID on the Header Record shall represent the insurer's or claim administrator's FEIN and Postal Code, not that of the vendor.

Specific Authority 440.591, 440.593 FS. Law Implemented 440.593 FS. History-New 5-29-05, Amended 1-7-07.