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EDI 101 Updated _after 905 Conve

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  • pg 1
									        EDI POC
               IAIABC
     Proof of Coverage Concepts

2008 IAIABC All Committee Conference
    April 8, 2008 in Austin, Texas

IAIABC Website: http://www.iaiabc.org
          EDI POC AGENDA
• Welcome / Intros
• POC Implementation Guide
  – Release 2.1
  – Supporting documents
  – Supporting products
• Proof of Coverage - Electronic Reporting
• WCPOLS to IAIABC
   – Differences
   – WCPOLS Mapping
                                             2
 EDI POC

Presented by:

• Jim Eldridge, ISO
  jeldridge@iso.com
• Gregg Lutz, NCCI, Inc.
  Gregg_lutz@ncci.com


                           3
  Proof of Coverage
Implementation Guide
     Release 2.1
   The Proof of Coverage
Implementation Guide can be
downloaded from the IAIABC‟s
  website: www.iaiabc.org

           www.iaiabc.org




                               5
Implementation Guides




                        6
7
8
9
    POC Implementation Guide
          Supplement
Section of the Implementation guide
 affected by the changes




                                       10
    POC Implementation Guide
          Supplement
The applicable changes to the
 Implementation Guide




                                 11
    POC Implementation Guide
          Supplement
Reason/Purpose of the changes




                                 12
    POC Implementation Guide
          Supplement
Implementation date of the change
 (when applicable)
POC R2.1 Implementation Guide
 Edition date




                                     13
14
Code Reference




                 15
POC Workstation




              16
POC Workstation




                  17
POC Workstation – Standard Code
Structures




                                  18
STANDARD CODE STRUCTURES




                           19
STANDARD CODE STRUCTURES
Unused data element code values
for any IAIABC standards product
   (Claims, Proof of Coverage,
 Medical) are reserved for future
   IAIABC use and may not be
    assigned and used for any
       proprietary purpose.
                                    20
 STANDARD CODE STRUCTURES


Proposals to add new codes should
    be submitted through the
           IRR process.




                                21
    STANDARD USAGE FOR ALL
          PRODUCTS

•   Trading Partner Documents
•   Error Message Dictionary
•   Glossary
•   Interchange version ID and
    acknowledgment mapping
                                 22
Standard Usage for all Products: Trading
Partner Documents




                                           23
Standard Usage for All Products:
Error Message Dictionary, Glossary, Interchange
Version ID & Acknowledgment Mapping (on same
page as Trading Partner Documents)




                                                  24
Trading Partner
  Documents
Trading Partner Documents




                    Jurisdiction
 WC EDI Reporting




     



                                   26
Trading Partner Documents



                    


           WC EDI Reporting



    999999999                 99999 9999




                                           27
  Trading Partner Documents

            Jurisdiction                     mm/dd/yyyy
        
             999999999


POC   2.1                        AKP   EDI



  

                           2300 EST




                                                          28
        Trading Partner Documents

                                                      mm/dd/yyyy
                 Jurisdiction

                                WC EDI Reporting
                                              
                999999999                          99999 9999


POC       2.1                               40-50



    


                                                                   29
Error Message
  Dictionary
   Error Message Dictionary
Definitions of IAIABC standard error messages




                                                31
Error Message Dictionary




                           32
Glossary
           Glossary
The purpose of the glossary is to
acquaint the reader with easy-to-
understand definitions of workers'
compensation terms.




                                     34
            Glossary
The glossary defines terms that
 are common to FROI/SROI, MED,
 and POC EDI reporting.
Not all of the terms are directly
 related to one of the IAIABC EDI
 reporting products, but they are
 commonly used in the business
 and data-reporting environment.     35
           Glossary
Terms that are specific to
 approved data elements will be
 found in the Data Dictionary
 sections of the individual
 Implementation Guides.



                                  36
Glossary



           Alphabetical
           by term



                    37
Interchange Version ID &
Acknowledgment Mapping
Interchange Version ID &
Acknowledgment Mapping




                           39
    Proof of
   Coverage
Trading Partner
    Tables
 Trading Partner Tables
Senders must have a clear understanding of:
• when policy data is to be provided
• what data is expected
• how data will be validated
• what data format is to be used
• what vehicle is to be used to transport the
  data


                                            41
Trading Partner Tables
• Describe the jurisdiction‟s
  Workers‟ Compensation Proof
  of Coverage electronic filing
  requirements
• Are completed and maintained
  by the Jurisdiction


                                  42
EDI Proof of Coverage reporting
requirements are defined:
1. Required          Event Table
   Report(s)

                       Element
2. Required Data     Requirement
                        Table

3. Applied Editing    Edit Matrix
                                    43
              http://www.iaiabc.org/

Download
tables


Event
Table
Element
Requirement
Edit
Matrix

                                       44
Event Table
Event Table
Electronic reports (Triplicate Codes)
that are accepted by the jurisdiction




                                        46
Event Table
Conditions that describe the Jurisdiction
Rule dates and trigger criteria




                                        47
Event Table
And when the report must be filed




                                    48
    Element
Requirement Table
          Element Requirements
Requirement Codes express the
requirement severity for the report type
(PC1, PC2 by Triplicate Code).




                                           50
 Edit
Matrix
Edit Matrix
The Matrix consists of 3 components:
 DN-Error Message contains
  “standard” editing developed for
  R2.1 data elements.
 Value Table expresses the
  jurisdiction‟s acceptable code values
 Population Restrictions contains the
  jurisdiction‟s restrictions applied to
  the data element(s).                     52
Edit Matrix       DN-Error Message
“standard” editing for Proof Of
Coverage data elements.




                                     53
Edit Matrix         DN-Error Message
Edits the jurisdiction will not apply are
grayed out




                                            54
Edit Matrix          Value Table
The jurisdiction describes in the
Value Table which code values are:
  Not Statutorily Valid
  Statutorily valid codes required




                                   55
Population
Restrictions
Edit Matrix         Population Restrictions
Jurisdictions elaborate on data
elements‟ population or accepted values




0118   Employer   111 Must be   Description of
       Name           valid     restriction(s)
                      content

                                                 57
Break Time!




              58
Proof of Coverage
  Electronic
  Reporting

                    59
                             Proof of Coverage
Based on the
Jurisdiction‟s Event Table
when a Policy is:
•   Issued
•   Changed
                        Transaction
•   not renewed
                    (Electronic Report)
                                          Jurisdiction
•   Cancelled
•   Reinstated


                      Acknowledgement
Sender
                                                    60
Transaction
Transaction                     Proof of Coverage
Proof of Coverage transactions consist of:

      One Insured Record (PC1): Identifies insured and
      policy information. It also contains the Triplicate
      Code that identifies what action is being performed
      on the policy and the purpose of the transaction.
and may include one or more Employer Records (PC2):
      Employer Record (PC2): Provides information on the
      employers covered under a policy.

An Insured Record (PC1) is required for all POC transactions.

                                                            62
Transaction                    Proof of Coverage
Transaction Overview in Section 4 summarizes the different
types of transactions that can be accomplished with IAIABC
POC reporting, including the requirement of the PC1/PC2
record(s) to build the transaction (reporting event).




The Submission Type Code describes when an Insured
Record (PC1) is used, when an Insured Record (PC1) is
followed by an Employer Record (PC2), and when a special
set of records (Paired Transactions) are used.          63
Transaction                       Proof of Coverage
Submission Type Code
A      Requires a single Insured Record (PC1) and Employer
       Record (PC2)s for all Jurisdiction locations.
E/M    Requires a single Insured Record (PC1) and one or more
       Employer Record (PC2)s for the impacted Jurisdiction as
       agreed to in the Trading Partner Agreement.
EN/M Requires a single Insured Record (PC1) and any
     Employer Record (PC2)s for employers operating in or
     through the state and not having a physical location in the
     state.
I      Requires a single Insured Record (PC1) only.
PI     Requires paired Insured (PC1) records only.
PE     Requires paired Insured (PC1) records with one
       corresponding Employer Record (PC2) for the impacted
       Jurisdiction location.                                  64
Transaction                    Proof of Coverage
POC transactions are nested based on the Submission Type
Code (STC) requirement of the transaction/triplicate.

For Example:

                   HD1                    Header
                   PC1    Sequence 1      STC – „I‟ Example
        Batch


                                          No PC2‟s
                   PC1    Sequence 2
                                          STC – „E/M‟
                   PC2    Sequence 3      Example with 2
                   PC2    Sequence 4      PC2‟s

                   TR1                    Trailer
For sequencing and in order to relate the PC2‟s to the
appropriate PC1, the PC2‟s must follow the applicable PC165
Batch
Batch                           Proof of Coverage
Batch: A minimum unit of interchange, which consists of:
  • One (1) Header Record – the beginning of the batch
  • One (1) or more Transactions
  • One (1) Trailer Record – the end of the batch

                    HD1                    Header
                    PC1    Sequence 1      Transaction 1
         Batch



                    PC1    Sequence 2
                    PC2    Sequence 3      Transaction 2
                    PC2    Sequence 4
                    TR1                    Trailer


                                                           67
Transmission                      Proof of Coverage
Transmission: Consists of one or more batches sent or
received during a communication session.
                                  HD1
                                  PC1   Sequence 1



                          Batch
           Transmission
                                  PC1   Sequence 2
                                  PC2   Sequence 3
                                  PC2   Sequence 4
                                  TR1

                                  HD1
                          Batch


                                  PC1   Sequence 1
                                  PC1   Sequence 2
                                  TR1                   68
Transmission                             Proof of Coverage
Example of 1 Batch - 1 Transmission                 Header record = HD1
(Shown partial for display):                        Transaction 1 = PC1 and PC2
                                                    Transaction 2 = PC1 and PC2s
                                                    Trailer record = TR1

HD1666777888 888777666999999999 23423424220010327074530 PPOC21
PC10000000010020010327100120010101292918878ABCDEF THE INSURER    ISSUING OFFICE
PC2000000002999888777       EMPLOYER NAME                      EMPLOYER ADD 1
PC10000000030020010327100120010101292918878ABCDEF THE INSURER    ISSUING OFFICE
PC2000000004999888777       EMPLOYER X NAME                    EMPLOYER X ADD 1
PC2000000005999888777       EMPLOYER Y NAME                    EMPLOYER Y ADD 1
PC2000000006999888777       EMPLOYER Z NAME                    EMPLOYER Z ADD 1
TR1000000006




                                                                             69
Transmission                             Proof of Coverage
Example of 2 Batches - 1 Transmission               Header record = HD1
(Shown partial for display):                        Transaction 1 = PC1 and PC2
                                                    Transaction 2 = PC1 and PC2s
                                                    Trailer record = TR1

HD1666777888 888777666999999999 23423424220010327074530 PPOC21
PC10000000010020010327100120010101292918878ABCDEF THE INSURER     ISSUING OFFICE
PC2000000002999888777       EMPLOYER NAME                      EMPLOYER ADD 1
PC10000000030020010327100120010101292918878ABCDEF THE INSURER     ISSUING OFFICE
PC2000000004999888777       EMPLOYER X NAME                    EMPLOYER X ADD 1
PC2000000005999888777       EMPLOYER Y NAME                    EMPLOYER Y ADD 1
PC2000000006999888777       EMPLOYER Z NAME                    EMPLOYER Z ADD 1
TR1000000006
HD1666777888 888777666999999999 23423424220010327074530 PPOC21
PC10000000010020010327100120010101292918876GHIJKL THE INSURER    ISSUING OFFICE
PC2000000002999888776       EMPLOYER NAME TOO                  EMPLOYER ADD 1
PC10000000030020010327100120010101292918876GHIJKL THE INSURER    ISSUING OFFICE
PC2000000004999888776       EMPLOYER R NAME                    EMPLOYER R ADD 1
PC2000000005999888776       EMPLOYER S NAME                    EMPLOYER S ADD 1
TR1000000005



                                                                             70
Records
Records
Insured Record (PC1) is a
Fixed Length Record of 585
bytes.


A Fixed Length Record is
consistently the same number
of data positions each time the
record is assembled.

The data within the record is
always in the same position
based on the record layout
defined in the POC standard.
                                  72
Records                           Proof of Coverage
Insured Record (PC1) contains Transaction data elements
used for processing:
Record Sequence
Number                                              PC1
  • Is incremented by
    one each time a
    record is added to
    the batch.
  • Is used to maintain
    the position of the
    record within the
    batch.
The jurisdiction returns the Record Sequence Number on the
Acknowledgment record. This simplifies reconciliation of the
status of submitted coverage transactions.                     73
Records                       Proof of Coverage
Insured Record (PC1) contains Transaction data elements
used for processing:

                                               PC1
Triplicate Code
indicates:
  • what action is
    being performed
    on the policy
  • the purpose of the
    transaction
  • affects how the
    transaction is        The effective date of the action
    processed             on the policy.
                                                          74
Records                 Proof of Coverage
Insured Record (PC1):


Positions 35 thru
204 identifies the
Insurer that issued
the policy.


Positions 205 thru
266 identifies the
Agency that issued
the policy.

                                            75
Records                 Proof of Coverage
Insured Record (PC1):
Positions 267 thru
480 includes
details about the
primary Insured
that acquired the
policy.


Positions 481 thru
564 includes the
Policy coverage
details.
                                            76
Records                        Proof of Coverage
Insured Record (PC1):

Positions 565 thru
581 includes the
Jurisdiction whose
statutes apply.


  DN0328 Number of Employers, positions 582 thru 585
  indicates the number of Employer records (PC2) that will
  follow the PC1 record in the batch.



                                                             77
Records                        Proof of Coverage
Employer Record (PC2):
The transaction includes an Employer record (PC2) for each
employer indicated by the number in DN0328 Number of
Employers on the PC1 record.
                                              PC2
The Employer
record (PC2) is a
Fixed Length
Record of 202
bytes.




                                                         78
Records                        Proof of Coverage
Employer Record (PC2):
The Record                                     PC2
Sequence Number
continues
incrementing by
one for each record
added to the batch
to maintain its
position in the
batch.

The Employer record (PC2) contains details of all employer
IDs, names and addresses covered by the policy in the
jurisdiction.                                             79
Transaction
Processing

              80
Processing             Proof of Coverage

 Section 4 of the Release 2.1 Proof of
 Coverage Implementation guide provides
 Processing Rules and guidelines for:
    Transaction Sequencing and Processing
    Duplicate Transaction Processing




                                             81
Processing                      Proof of Coverage
POC records within a batch must be processed in the order
that they are positioned in the batch, specifically in Record
Sequence Number order.

When a POC transaction is processed, the record(s) that
make up the transaction (PC1 and related PC2s) are edited
based on the Release 2.1 standards as well as the
Jurisdiction‟s Event Table, Element Requirement Table and
Edit Matrix.

The database is updated as each transaction is processed
and before processing the next transaction in the batch.

The next transaction in the batch may be dependent on the
updated values from the previous transaction in the batch.
                                                             82
Acknowledgments


                  83
Acknowledgments                   Proof of Coverage
The purpose of an acknowledgment record is to notify the
sender of the status of POC records sent to the Jurisdiction.

An entire batch of transactions may be rejected for:
   • Invalid or unapproved sender ID
   • Duplicate batch
   • Header and/or Trailer errors
   • Invalid batch structure
   • Non-consecutive or inconsistent record sequencing


The result of failed Batch editing is:
   • HD (Transmission Rejected)
                                                                84
Acknowledgments                Proof of Coverage
Each POC record is edited for required data elements,
required batch structure, transaction sequencing and against
the jurisdiction‟s Edit Matrix.
The result of editing each transaction is:
   • TA (Transaction Accepted)
   • TE (Transaction Accepted with Error)
   • TR (Transaction Rejected)




                                                          85
Acknowledgments             Proof of Coverage
Record relationship must be considered when
processing and acknowledging POC transactions.

When an Insured (PC1) record passes editing, the
transaction can be accepted even if one or more of
the related Employer (PC2) record (s) fail edits.
PC1   Sequence 1    TA (Transaction accepted)
                                                Update
PC2   Sequence 2    TA (Transaction accepted)   database
PC2   Sequence 3    TA (Transaction accepted)
                                                Return to
PC2   Sequence 4    TR (Transaction rejected)   Sender

                                                      86
Acknowledgments                Proof of Coverage
When an Insured record (PC1) fails editing, related
Employer records (PC2 ), when applicable, must be
rejected because the POC transaction cannot be processed
without the details provided on the PC1 record.




PC1   Sequence 1      TR (Transaction rejected)
PC2   Sequence 2
PC2   Sequence 3     TR (Transaction rejected)
PC2   Sequence 4

                                                       87
Acknowledgments           Proof of Coverage
POC Acknowledgments                 AKP
are returned on the
POC Acknowledgment
Detail Record (AKP)
The POC
Acknowledgment
Detail record is a
variable length record.
The Number of Errors
determines the overall
length of the
Acknowledgment
Detail record.                                88
Acknowledgments          Proof of Coverage
If Number of Errors is             AKP
zero, the
Acknowledgment
Detail record ends at
position 208.

If Number of Errors is
greater than zero, the
Acknowledgment
record is increased by
9 bytes per error.



                                             89
Acknowledgments          Proof of Coverage
Example: 2 errors
were encountered
during transaction
editing.



The 1st error is
indicated in positions
209 thru 217.
The 2nd error is
indicated in positions
218 thru 226.
                                             90
   Matching original batch to AKP batch
        using the Header Record

HEADER RECORD (HD1) for original POC batch
HD1666777888   888777666999999999   23423424220010327074530            PPOC21
1 |2                    |3                   |4      |5    |6     |7   |8|9 |



1 |2                    |3                   |4      |5    |6      |7    |8|9 |
HD1999999999   234234242666777888   8887776662001032808134020010327074530PAKP21
HEADER RECORD (HD1) for AKP
1=Transaction Set ID (DN0001)
2=Sender ID (DN0098) to 3=Receiver ID (DN0099)
3=Receiver ID (DN0099) to 2=Sender ID (DN0098)
4=Date Transmission Sent (DN0100) to 6=Original Transmission Date (DN0102)
5=Time Transmission Sent (DN0101 to 7=Original Transmission Time (DN0103)
8=Test Production Code (DN0104) to 8=Test Production Code (DN0104)
9=Interchange Version ID (DN0105) DIFFERENT                              91
Matching original batch to AKP batch using
               Trailer Record

TRAILER RECORD (TR1) for original POC batch
TR1000000001
                  The count should be the same.

TR1000000001
TRAILER RECORD (TR1) for AKP acknowledgment batch


The Detail Record Count from the original batch should be
matched to the AKP Transaction Count.


                                                            92
  WCPOLS
     Section 7
 Proof of Coverage
Implementation Guide

                       93
    What is WCPOLS?
          WORKERS
          COMPENSATION
          POLICY
          REPORTING
          SPECIFICATIONS
• found in the WCPOLS section of the WCIO Workers
  Compensation Data Specifications Manual
• published by the Workers’ Compensation
  Insurance Organizations (WCIO).
                                               94
WCPOLS
An alternative method of reporting Proof of
Coverage (policy) information. WCPOLS is
for reporting:
   POLICY INFORMATION PAGE,
   CANCELLATION,
   REINSTATEMENT
   AND ENDORSEMENT DATA


                                              95
WCPOLS                                  IAIABC
            Field length differences.
           Some truncation may occur.
                             WCPOLS IAIABC
  IAIABC Data Element         length length
  Insurer Name                 N/A      30
  Issuing Office Name          N/A      30
  Issuing Office Address 1     60       30
  Insured Address 1            60       30
  Employer Name                90       60
  Employer Address 1           60       30
  Employer City                30       15
                                                 96
                             EDI POC
  WCPOLS/IAIABC - Transaction Differences
IAIABC Transactions WCPOLS Transactions
Binders (3 Triplicates)      Coverage Notice (Trans. Code 16)

New Policy (3 Triplicates)   New Policy (Trans. Code 01)

Renew Policy (3              Renew Policy (Trans. Code 02)
Triplicates)                 Annual Rerate Endorsement (Trans. Code 04)
Rewrite/Reissue Policy       Policy Replacement Due to Key Field Change
(3 Triplicates)              (Trans. Code 06)




                                                                          97
                               EDI POC
  WCPOLS/IAIABC - Transaction Differences
IAIABC Transactions            WCPOLS Transactions
Changes                        Endorsements (Trans. Code 03)
(12 Paired Triplicates and 1
Single Triplicate)             Policy Replacement due to Rating Change (Trans.
                               Code 08)

Endorsements (10               Policy Replacement due to Non-Rating Change
Triplicates)                   (Trans. Code 10)

                               Policy Replacement due to Miscellaneous Change
                               / Non-Key Field Change (Trans. Code 14)

                               Policy Replacement due to Add/Delete State
                               Change (Trans. Code 15)
Cancellations (13 Trip.)       Cancellation/Reinstatement (Trans. Code 05)
Nonrenewals (8 Triplicates)
Reinstatements (1 Trip.)                                                     98
                      EDI POC
     WCPOLS/IAIABC - Additional Differences
• Transaction (and Policy) Identification – Where?

  – IAIABC
     • PC1 – Insured Record


  – WCPOLS
     • All Records




                                                     99
 WCPOLS Mapping


WCPOLS     IAIABC




                    100
         WCPOLS Mapping
In order to be
able to follow
the map,
one must                       08
                                 07
understand
                             05 06
some of the       02    04
common                 03
WCPOLS            01
“signs” (Record
Type Code).                           101
Record Type Code                               WCPOLS
                   Description     Contents
 01                Header Record   Policy level information
                                   One header record for each
                                    unique policy number/effective
                                    date/transaction issue
                                    date/transaction code
                                    combination
 02                Name Record     Legal name(s) of the insured




                                                                  102
Record Type Code                                   WCPOLS
               Description         Contents
03             Address Record      Addresses:
                                    Mailing address of the
                                      policyholder
                                    Address(es) of location(s) of
                                      policyholder operations
                                    Address of the insurer‟s office
                                    Address of the agent
 04                State Premium   Premium amount, loss constant
                   Record          amount, expense constant
                                   amount, experience
                                   modification factor
                                                                 103
Record Type Code                                  WCPOLS
               Description         Contents
 05                Exposure Record Classification codes,
                                   manual/charged rates, and
                                   estimated exposure and
                                   premium amounts

 06                Other States    Other states coverage
                   Coverage Record




                                                               104
Record Type Code
                                                WCPOLS

                   Description     Contents
 07                Endorsement     All endorsements that apply to
                   Record          the policy


 08                Cancellation/   Cancellation or reinstatement
                   Reinstatement   information
                   Record

Others Refer to WCPOLS section of the WCIO Workers
       Compensation Data Specifications Manual.

                                                                    105
WCPOLS Record Type
      01
                                              WCPOLS
     Header          Common to all records
       02            Positions 1-43 of each
      Name
                     record type contains
       03            Link Data
     Address
        04                                    Link Data
  State Premium                        Carrier Code
       05                              Policy Number
    Exposure           Link data       Unit/Certificate Number
                                       Policy Effective Date
       06                              Transaction Issue Date
   Other States
                                       Transaction Code
       07
   Endorsement
        08
   Cancellation/
  Reinstatement                                             106
WCPOLS Record Type                                  WCPOLS
            04                                       Link Data
      State Premium
 Link Data (Positions 1-43)                Positions 1-43 of each record type
 State Code (Position 44-45)               contains Link Data
                                              Carrier Code
                                              Policy Number
            05                 Link data      Unit/Certificate Number
         Exposure
                                              Policy Effective Date
 Link Data (Positions 1-43)                   Transaction Issue Date
 State Code (Position 44-45)
                                              Transaction Code

Using the State Code from the WCPOLS State Premium or
Exposure record and Link data, records are selected for
IAIABC POC reporting.

    State Code 1                                 State Code 4
                       State Code 2 State Code 3                          107
WCPOLS                                             IAIABC
  Transaction Set Purpose Code Conversion
                            Link Data
            Transaction Code (positions 42-43)




         WCPOLS



                   IAIABC
                            Description
         03       04        Change
         06       05        Replace
         08                 (two PC1s)
         10       &/or      &/or
         14        00       Original
         15                 (one PC1)
        Others    00        Original




                                            Conversion Result

                                                                108
    WCPOLS                                                                       IAIABC
                   Transaction Set Type Code Conversion
                    Link Data                                            08
     Transaction Code (positions 42-43)                      Cancellation/Reinstatement
                                                    6 Reason for Cancellation Code
 WCPOLS


          IAIABC




                                                    WCPOLS

                                                               IAIABC
                   Description
 16       05       Binder                                               Description
 01       10       New Policy                       04         41       Canceled by Insurer
02/04     20       Renewal Policy / Annual Rerate   03         42       Canceled by Insured
                                                    4 Cancellation/Reinstatement ID Code
 03       30       Endorsement (general)
                                                     3         60       Non-Renewal
 05                Cancellation/Reinstatement
                                                     2         70       Reinstatement
 06       50       Rewrite/reissue




                                                    Conversion result

                                                    Conversion Result
                                                                                              109
WCPOLS                              IAIABC


Transaction Reason Code conversion requires
evaluating Link Data and multiple WCPOLS
record types:
   01 Header
   02 Name
   03 Address
   04 State Premium
   05 Exposure
   07 Endorsements
   08 Cancellation/Reinstatement

                                              110
WCPOLS                                                  IAIABC
   Transaction Reason Code Conversion
                                          Link Data
                           Transaction Code (positions 42-43)




                  WCPOLS



                                 IAIABC
                                          Description
                  06           71         Rewrite/Reissue




                                             Conversion Result
                                                                 111
WCPOLS                                                                IAIABC
                  Transaction Reason Code Conversion
                                         03
                                       Address
                                 Type of Address Code
WCPOLS

         IAIABC




            (Name Link Code and State Code Link Required)
            Description
 6       86 Named Employer(s) with no jurisdiction address
 6       87        Employer(s) with no jurisdiction address
 6       94        Employer Name – Employer With No Jurisdiction address
 6       95        Employer UI Number – Employer with no jurisdiction address
 6       96        Employer FEIN – Employer with no jurisdiction address




                                                         Conversion Result      112
WCPOLS                                                         IAIABC
   Transaction Reason Code Conversion
                                   04
                             State Premium
                    State Add/Delete Code




           WCPOLS
                    IAIABC
                              Description
            A 72              Add a jurisdiction
            D 73              Deleting a jurisdiction




                                                        Conversion Result
                                                                            113
 WCPOLS                                                                 IAIABC
                   Transaction Reason Code Conversion
                                        08
                           Cancellation/Reinstatement
                            Reason for Cancellation Code
WCPOLS

         IAIABC




                  Description
05       59       Non-Payment
09       60       Coverage Placed Elsewhere
10       61       Duplicate Coverage
08       62       Change in Ownership
08       63       Business Sold
04       64       Underwriting Reasons
02       65       No Employees/No Exposure/No Operations/Completed Operations
11       66       Revocation of Voluntary Market Acceptance
12       69       Failure to Pay Deductible
13       70       Misrepresentation of Information on Application



                                                                        Conversion Result
                                                                                        114
WCPOLS Transaction Reason Code Conversion IAIABC
                                       07
                                   Endorsement
                        Endorsement Number & Record Type




                                           IAIABC
                  WCPOLS                             Description
                                            54       Adding an Employer Location
                                            56       Deleting an Employer Location
                                            76       Insured FEIN
                                            77       Employer FEIN
                                            78       Employer UI #
    Value can be captured through different 79       Policy Number
    WCPOLS transactions                     80       No specific location in jurisdiction
                                            81       Policy Effective Date
                                            82       Policy Expiration Date
                                            83       Insurer FEIN
                                            84       Insurer info NOC
                                            85       Employer info NOC
    Endorsement WC000310 Record Type 37 67           Include Corp Officer/Partner/Sole Prop
    Endorsement WC000308 Record Type 38 68           Exclude Corp Officer/Partner/Sole Prop



                                                    Conversion Result
                                                                                          115
WCPOLS                                                          IAIABC
                                    01
                                  Header
                      Link Data (positions 1-43)
                                     Policy Effective Date (positions 31-36)
  WCPOLS field        Description
Policy Changes        Evaluate Policy Changes Effective Date:
Effective Date (36)    • If value equal zero, use Policy Effective Date (Link
                         Data)
                       • Otherwise, use Policy Changes Effective Date




                                                      Evaluation result

                                                                                116
WCPOLS                                            IAIABC
      Link Data
                               Conversion table
Carrier Code (positions 1-5)
                               Carrier Code   •FEIN
   Converted to FEIN                          •Name




                                   Conversion Result
                                   Conversion Result


                                                           117
WCPOLS                                                    IAIABC
                              03
                           Address
                  Link Data (Positions 1-43)
      WCPOLS Field          Value   Description
                                    Address of insurer
  Type of Address Code        3
                                    issuing/servicing office
   Address Structure Code     1     follows structure
  Address   (1)                     Street
  Address   (2)                     City
  Address   (3)                     State
  Address   (4)                     Postal or Zip Code




                                             Street
                                             Street
                                             City
                                             State
                                             Postal or Zip Code    118
  WCPOLS                                                           IAIABC
             01                                     03
           Header                                 Address
Link Data (positions 1-43)              Link Data (positions 1-43)
 WCPOLS                           WCPOLS Field           Value   Description
  field      Description
                               Type of Address Code        5     Producer Address
Producer     Producer
                               Address Structure Code      1     follows structure
Name         responsible for
             placing the       Address (2)                       City
             business with     Address (3)                       State
             insurer




                                                Producer Name
                                                 City
                                                 State

                                                                                     119
WCPOLS                                               IAIABC
                              02
                             Name
                   Link Data (positions 1-43)
   WCPOLS field     Description
                    1 = Personal
  Name Type Code    2 = Commercial
                    3 = Entity String
  Name link ID      Primary name = 001
  FEIN              ID nbr for the name
  Insured Name      name corresponding to the Name Type Code




                                      FEIN
                                      Insured Name




                                                               120
WCPOLS                                                        IAIABC
                                03
                             Address
                    Link Data (positions 1-43)
        WCPOLS Field           Value Description
Type of Address Code             1    Mailing address of insured
Address Structure Code           1    follows structure
Address (1)                           Street
Address (1)                           Street
Address (2)                           City
Address (3)                           State
Address (4)                           Postal or Zip Code
Phone number of Insured (10)




                                                  Street
                                                  Street
                                                  City
                                                  State
                                                  Postal or Zip Code
                                                                       121
                                                  Phone number
WCPOLS                                                    IAIABC
                                   01
                                 Header
                   Link Data (positions 1-43)
          WCPOLS field            Description
  Policy Type ID Code (15)        Type of coverage:
                                   1 = Voluntary
                                   2 = Assigned Risk (involuntary)
  Field Wrap up Code (16)         1 = Wrap up
                                  2 = Non-wrap-up
  Legal Nature of Insured (14)




                                             Policy Type ID Code
                                             Field Wrap-up code
                                             Legal Nature of Insured
                                                                       122
WCPOLS                                                    IAIABC
                                   01
                                 Header
                      Link Data (positions 1-43)
                                         Policy Number (positions 6-23)
            WCPOLS field                 Description
 Employee Leasing Policy Type Code (9)   Identifies the type of Employee
                                         Leasing policy
 Policy Minimum Premium Amount (18)      Policy Minimum Premium must be
                                         compared to Policy Estimated
                                         Standard Premium Total (Field
                                         Number 20). It must also be
                                         checked to the Policy Minimum
                                         Premium State Code (Field 19).




                                                  Policy Number
                                                  EE Leasing Policy Type
                                                  Policy min premium amt
                                                                           123
WCPOLS                                                              IAIABC
                                   01
                                Header
                       Link Data (positions 1-43)
                               Policy Effective Date (positions 31-36)
                               Transaction Issue Date (positions 37-41)
          WCPOLS field                Description
Policy Expiration Date (6)            Expiration date of policy or coverage
                                      note
Prior Policy Number Identifier (11)   Prior Policy number
Assignment Date (33)                  date of notice assigned by the
                                      administrator of involuntary market
                                      coverage




                                                       Transaction Issue Date

                                                       Policy Effective Date
                                                       Policy Expiration Date
                                                       Prior Policy Number ID

                                                       Assignment Date          124
WCPOLS                                                              IAIABC
                                     05
                                  Exposure
                          Link Data (positions 1-43)
          WCPOLS field               Description
State Code (2)                       State code to which the exposure and/or
                                     premium has been assigned
Classification Code (5)              classification code corresponding to the
                                     exposure amount and/or premium
Estimated Exposure Amount (13)       Payroll amount
Calculation: count the number of employer records
following the PC1 (Number of PC2 records)




                                                       State Code
                                                       Classification Code
                                                       Estimated Exposure Amt
                                                       Calculated               125
WCPOLS               Name and Address relationship
                           02
                          Name
               Link Data (positions 1-43)
                                                                A PC2 record is
 WCPOLS field Position
                                                                created for each
                          Description
Name Link ID    49-51     Primary name = 001
                                                                NAME and
FEIN           149-157    Federal ID number for the name        ADDRESS
Continuation   158-160    001 = representing the first record   with matching
Sequence                  for a Name Link Identifier             •Name Link ID
Number (CSN)              002–999 representing continuation
                          records for same Name Link ID
State Code      163-164   state code for the UI number

                           03
                        Address
               Link Data (Positions 1-43)
WCPOLS Field Position     Description
Type of         48        1=Mailing address of insured
                          2=Address of operations location
Address Code              6=No specific location
Name Link ID    152-154   Links location to name
State Link Code 155-156   State covered by the address                        126
WCPOLS                                                        IAIABC
                                 02
                                Name
                      Link Data (positions 1-43)
      WCPOLS field        Position   Description
Name Link ID                49-51
FEIN                       149-157   Federal ID number for the name
State Unemployment Number 165-179    Unemployment number for the State
                                     Code
Insured Name               53-142    Truncated from 90 (WCPOLS length) to
                                     60 (IAIABC length)
State Code                 163-164   state code for the UI number




                                            FEIN
                                            State Unemployment Number
                                            Insured Name
                                                                            127
WCPOLS                                                                 IAIABC
                                     03
                                  Address
                         Link Data (Positions 1-43)
   WCPOLS Field          Position   Description
Type of Address Code        48      1=Mailing address of insured
                                    2=Address of operations location
                                    6=No specific location
Name Link ID             152-154    Links location to name
State Link Code          155-156    State covered by the address
Address Structure Code      50      1 = follows structure
Address (1)               51-110    Street
Address (2)              111-140    City
Address (3)              141-142    State
Address (4)              143-151    Postal or Zip Code




                                             Street
                                             Street
                                             City
                                             State
                                                                            128
                                             Postal or Zip Code
WCPOLS                                                               IAIABC
                                   03
                                Address
                       Link Data (Positions 1-43)
   WCPOLS Field        Position   Description
Type of Address Code      48      1=Mailing address of insured
                                  2=Address of operations location
                                  6=No specific location
Name Link ID           152-154    Links location to name
State Link Code        155-156    State covered by the address
Number of Employees    197-202    Number of Employees
Industry Code          203-208    Industry Code




                                           Industry Code
                                           Number of Employees

                                                                          129
WCPOLS                                                               IAIABC

                                      08
                         Cancellation/Reinstatement
                          Link Data (Positions 1-43)
        WCPOLS Field             Position   Description
State Code                        44-45     the State Code when cancelling or
                                            reinstating a specific state.
Cancellation Mailed to Insured   253-258    date the cancellation notice was
Date                                        mailed to employer.




                                             Cancellation Mailed to Insured Date

                                                                                   130
                         EDI POC

WCPOLS Name and Address Linking
Fields used:
     Name Record
               Name Link Identifier
               Continuation Sequence Number
               Name Link Counter Identifier
     Address Record
               Name Link Identifier
               State Code Link
               Name Link Counter Identifier



                                              131
                                    EDI POC
WCPOLS Name/Address Records > IAIABC Employer Records
                           WCPOLS Name Record (Record Type 02)
       NLI                         Name               FEIN                           CSN
 Positions 49-51              Positions 53-142         Positions 149-157         Positions 158-
                                                                                       160


                          WCPOLS Address Record (Record Type 03)
AT     Street                      City             State     Zip Code     NLI          SCL
Pos    Positions 51-110            Pos 111-140      Pos       Pos 143-     Pos          Pos
48                                                  141-142   151          152-154      155-156




     3 Insured Names with
     2 Addresses in 1 Jurisdiction

     = 5 IAIABC Employer Records (PC2) for Jurisdiction
                                                                                              132
                                  EDI POC
 WCPOLS Name/Address Records > IAIABC Employer Records

                        WCPOLS Name Record (Record Type 02)
  NLI                              Name                       FEIN             CSN
Positions                     Positions 53-142                  Positions    Positions
 49-51                                                          149-157      158-160
001         WILLAMS SPAGHETTI & MACARONI                      598888838     001
002         RIO GRAND RIVER                                   522333333     001
002
002         SUNSHINE SCAFFOLDING & EQUIPMENT
            SUNSHINE SCAFFOLDING & EQUIPMENT                  592222222
                                                              592222222     002
                                                                            002




                                                                                     133
                                     EDI POC
    WCPOLS Name/Address Records > IAIABC Employer Records

                         WCPOLS Address Record (Record Type 03)
AT    Street                  City              State     Zip Code      NLI       SCL
Pos   Positions 51-110        Pos 111-140       Pos       Pos 143-151   Pos       Pos
48                                              141-142                 152-154   155-156
1     10225 SHOCK RD          LARGO             FL        33771         001       09
2     10225 SHOCK RD          LARGO             FL        33771         002       09
2     105 HEART LANE          CHICAGO           FL        34608         002       09




                                                                                        134
                                EDI POC
 WCPOLS Name/Address Records > IAIABC Employer Records

                            IAIABC Employer Record (PC2)
   FEIN     Name                   Street           City          State      Zip Code
Pos 13-21   Pos 37-96              Pos 97-156       Pos 157-171   Pos 172-   Pos 174-
                                                                  173        182
To Florida (continued): :
 To Florida (continued)
598888838 WILLAMS              10225 SHOCK
598888838 WILLAMSSPAGHETTI & 10225 SHOCK RD         LARGO
                                                     LARGO        FL
                                                                   FL        33771
                                                                              33771
          MACARONI
          SPAGHETTI &          RD
522333333 MACARONI RIVER
          RIO GRAND            10225 SHOCK          LARGO         FL         33771
522333333 RIO GRAND RIVER      RD
                             10225 SHOCK RD          LARGO         FL         33771
522333333 RIO GRAND RIVER
522333333 RIO GRAND RIVER          105 HEART LANE
                                 105 HEART LANE     CHICAGO
                                                     CHICAGO      FL
                                                                   FL        34608
                                                                              34608
592222222 SUNSHINE            10225 SHOCK RD         LARGO         FL         33771
592222222 SUNSHINE SCAFFOLDING 10225 SHOCK          LARGO         FL         33771
          SCAFFOLDING &
          & EQUIPMENT           RD
          EQUIPMENT
592222222                       105 HEART LANE
          SUNSHINE SCAFFOLDING105 HEART LANE
592222222 SUNSHINE                                  CHICAGO
                                                     CHICAGO      FL
                                                                   FL        34608
                                                                              34608
          & EQUIPMENT
          SCAFFOLDING &
          EQUIPMENT

                                                                                    135
  EDI POC


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