Discontinuation of Agreement Between a Fraud Vendor

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					                                                               Injury - Claims




Number   Subject Matter Area Type             Requirement                                                                         Glossary Link
                               (Business or
                               Technical)
  1      New /Initiating Claim Business       System notification through an automatic workflow event that a new claim
                                              has been received in the system through predetermined staff assignment
                                              rules. Describe how the system will send notification through an automatic
                                              workflow event that a new claim has been received in the system through
                                              predetermined staff assignment rules.
  2      New /Initiating Claim   Business     Adjusters should have viewable access to any documentation that has
                                              been received or sent with regard to a claim based on WSI business rules.
                                              Describe how the system will provide adjusters viewable access to any
                                              documentation that has been received or sent with regard to a claim.

  3      General Claim           Business     Ability to track and modify information with respect to a claim. Ability to
         Management                           track and modify specific information with respect to a claim such as claim
                                              status (active, denied, pending, reopen), type of injury (wage loss or
                                              medical only), nature of injury, date of injury, time of injury, cause of injury,
                                              body part, location of injury, description of injury, ICD-9, etc... This
                                              information should be readily accessible to the adjuster when managing a
                                              claim and customizable for additional categories to be added. A viewable
                                              history of this information should be available where appropriate.

  4      General Claim           Business     Ability to enter 3-point contact triage information and have the system
         Management                           prompt adjusters with dynamically (interactive decision tree) appropriate
                                              questionnaires based on body part and injury type.                                  3 point contact
  5      General Claim           Business     Upon completion of the questionnaire response entries, the system
         Management                           assigns a triage risk score on the claim according to WSI business rules.
                                                                                                                               Triage risk score
  6      General Claim           Business     Ability to consolidate two matching and or duplicate claims (to include data
         Management                           and imaged information).                                                         Consolidate
  7      General Claim           Business     Ability to record and modify all parties with a relationship to a claim, and
         Management                           the ability to track their role (primary, treating, consultant), effective date,
                                              and view their legal entity.




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                                                     Injury - Claims


8    General Claim        Business   Ability to create, in whole or part, a claim file copy from the system through
     Management                      a single interface that allows the user to select claim documentation and/or
                                     data items from a list which incorporates WSI business rules and security
                                     roles.
9    General Claim        Business   Ability to create/update multiple locations tied to one employer account.
     Management
10   General Claim        Business   Ability to view, update and keep history of Designated Medical Provider
     Management                      (DMP), adjuster assignment, and employer contact information on the
                                     employer's legal entity for each employer location, based on WSI business Designated
                                     rules.                                                                       Medical Provider
11   General Claim        Business   Ability to assign a claim to one or more employers and to allocate a certain
     Management                      % of costs according to WSI business rules.
12   General Claim        Business   Ability to update and track all information related to child support
     Management                      withholding specific to a claim and/or legal entity.
13   General Claim        Business   Ability to set up a new claim on a closed, cancelled, uninsured, and open
     Management                      policy.
14   General Claim        Business   Ability to view a claim or search for a claim by entering predefined
     Management                      parameters. Parameters such as: policy number, Social Security Number,
                                     injury date, etc.
15   General Claim        Business   Ability to view policyholder's information by entering predefined
     Management                      parameters. Parameters such as: employer name, policy number, etc.

16   General Claim        Business   System should display the current claim number, claimant name, and date
     Management                      of injury in the window/page title bar or some obvious location to indicate
                                     what claim is currently being worked on.
17   Auto adjudicate      Business   The ability to auto adjudicate and then auto pay claims according to WSI
                                     business rules.
                                                                                                                      Auto adjudicate
18   Indemnity Payments   Business   Ability to select a benefit type according to WSI business rules (e.g.
                                     Temporary Total Disability, Permanent Total Disability, etc.).
19   Indemnity Payments   Business   Ability to create an injured worker's average weekly wage (AWW) based
                                     on their wage information (pre-injury, post-injury, and earnings capacity
                                     wages) and WSI business rules.                                                   AWW
20   Indemnity Payments   Business   Ability to automatically calculate a Weekly Compensation Rate (WCR)
                                     based on WSI business rules. Describe the system's ability to
                                     automatically calculate a Weekly Compensation Rate (WCR) using WSI
                                     business rules.                                                                  WCR



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                                                     Injury - Claims


21   Indemnity Payments   Business   Ability to manually override a WCR.
22   Indemnity Payments   Business   Automatically calculate appropriate payment amount, based WSI business
                                     rules.
23   Indemnity Payments   Business   Ability to specify one or more payees, effective dates, and distribution      Idemnity
                                     amount(s) for indemnity payments.                                             payments
24   Indemnity Payments   Business   Ability to indicate loss of earnings (LOE) and recurrent loss of earning
                                     (RLOE) dates.                                                                 LOE
25   Indemnity Payments   Business   Ability to schedule payments for one or more payment periods.
26   Indemnity Payments   Business   Ability to enter and apply offsets according to WSI business rules (e.g.
                                     nursing homes, social security, overpayments, aggravations, suspended
                                     benefits ).                                                                   Offsets
27   Indemnity Payments   Business   Ability to recalculate one or more payments in a single interaction and see
                                     a history of those changes.
28   Indemnity Payments   Business   Ability to view a summary of all payments related to a claim and/or legal
                                     entity and ability to sort by payment parameters.
29   Indemnity Payments   Business   Ability to create and issue lump sum payments such as settlements and
                                     Permanent Partial Impairment (PPI), according to WSI business rules.

30   Indemnity Payments   Business   Ability to produce a compensation remittance/indemnity payment
                                     summary.
31   Indemnity Payments   Business   Provide a rate calculator tool to assist an adjuster in establishing payment
                                     amounts.                                                                     Rate Calculator
32   Indemnity Payments   Business   Ability to automate a schedule or series of schedules of indemnity
                                     payments to an injured worker according to WSI business rules.
33   Indemnity Payments   Business   System should be able to issue and track Indemnity Payments
                                     automatically and manually as needed. Describe the system's ability to
                                     issue and track Indemnity Payments automatically and manually as
                                     needed.
34   Indemnity Payment    Business   Ability to generate a discontinuation notice letter linked to the indemnity
                                     payment.
35   Indemnity Payments/ Business    System should disburse indemnity and medical payments on a daily basis.
     Medical Payments

36   Medical Payments     Business   System should have the ability to sort and filter medical bills by entering
                                     search criteria such as date range, bill number, type of service
                                     performed/expense code, etc.




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                                                    Injury - Claims


37   Medical Payments   Business   Ability to attach narrative text to a specific medical bill. This narrative link
                                   should tie in directly to the overall notepadding function on the claim.

38   Medical Payments   Business   System should have the capability of automatically attaching the image of
                                   the bill to the medical bill record in the system such as CMS1500 and UB-
                                   92.
39   Medical Payments   Business   Ability to transfer bill data and supporting documentation between claims.

40   Medical Payments   Business   Ability to update a bill regardless of status based on WSI business rules.

41   Medical Payments   Business   Ability to request a medical note from the provider off of a medical bill for a
                                   particular date of service through automatic form generation.
42   Other payments     Business   System should allow for automatic application of travel reimbursement
                                   rates according to WSI business rules.
43   Reserves           Business   Ability to establish and update reserves according to WSI business rules.
                                                                                                                      Reserves
44   Reserves           Business   Ability to integrate with third party software for reserve predictions.
                                   Describe the system's ability to integrate with third party software for
                                   reserve predictions.
45   Reserves           Business   Ability to view indemnity, allocated loss adjustment expense (ALAE) and
                                   medical reserve history.
46   Reserves           Business   Ability to track suspended benefits. Describe how your system handles
                                   suspended benefits and how it impacts reserves, such as third party
                                   recovery, subrogation and reinsurance.
47   Collections /      Business   System should have the ability to record and track overpayment activity
     Overpayments                  specific to a claim and/or legal entity.
48   Medical Events     Business   Ability to enter, modify, and track WSI ordered evaluations and services.
                                   Such as Independent Medical Evaluations (IME), Functional Capacity
                                   Assessments, Chronic Pain Evaluations, etc.




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                                                           Injury - Records




                                                                                                                           Glossary
Number   Subject Matter Area Type           Requirement                                                                    Link
                             (Business or
                             Technical)
  1      File Copies         Business       Capability to bill the customer for file copy requests or services.
  2      File Copies         Business       Track status of file copy request.
  3      File Copies         Business       Ability to track and integrate bar-coding of files according to WSI business
                                            rules.
  4      File Copies          Business      Ability to pull, store and export specific imaged file content according to
                                            predefined security and business rules.
  5      File Copies          Business      Ability to integrate with a third party software vendor that can deliver an
                                            electronic file copy.
  6      File Copies          Business      Ability to integrate with an FTP site for posting electronic files.
  7      File Copies          Business      Ability to produce paper file copies via an image printer.
  8      File Copies          Business      Ability for customer to request a file copy online.
  9      File Copies          Business      Ability to add global and/or individual messages to each file copy request,
                                            whether paper or electronic.
  10     File Copies          Business      Ability to establish automatic schedules for file copy updates.
  11     Document             Business      Given appropriate security, ability to delete a document that has been
         Management                         scanned incorrectly.
  12     Document             Business      Given appropriate security, ability to modify incorrect index values and
         Management                         have automatic workflow event(s) sent according to WSI business rules.

  13     Document             Business      Ability to separate a multiple page image into separate documents after
         Management                         indexing.
  14     Document             Business      Ability to associate an existing image with multiple electronic files.
         Management
  15     Document             Business      The system must have the ability to manually or automatically purge
         Management                         imaged records in accordance with WSI business rules.
  16     Records Retention    Business      The system must have the ability to purge database records in accordance
                                            with WSI business rules.
  17     Claim Registration   Business      The system must have the ability to register a First Report of Injury (FROI)
                                            based on WSI business rules. Describe the system's ability to register a
                                            new claim (FROI).



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                                                    Injury - Records


18   Claim Registration   Business   Ability to register a new claim through an online process and return a claim
                                     number to the user immediately.
19   Claim Registration   Business   System automatically identifies and flags duplicate claims.
20   Claim Registration   Business   Ability to associate multiple claims resulting from a single event.
21   Bill Entry           Business   Ability to process medical and non-medical bills based on WSI business
                                     rules. Describe this process.
22   Bill Entry           Business   Ability to enter duplicate bills in order to accommodate correct records
                                     retention needs.
23   Bill Entry           Business   Ability to detect, identify and create workflow when a duplicate bill has been
                                     entered.
24   Bill Entry           Business   Electronically receive medical bills and records and incorporate them into
                                     an imaging system.
25   Verification         Business   Ability to interface with Optical Character Recognition (OCR).
26   Document Entry /     Business   Ability to manage (e.g. scan, view, print, attribute notes, delete, invoke
     Indexing                        automatic mailing, auto purge) all documentation electronically without a
                                     file number in a queue until it can be associated to a file.
27   Document Entry       Business   Ability to interface with FileNet Capture or a third party imaging product.

28   Document Entry                  If your product interfaces with a third party imaging product, please explain
                                     how your product performs the following tasks: scanning, indexing,
                                     committal, retrieval, search/look up, batch management (creation, deletion
                                     and interruption of batches), image management (page count, image
                                     rotation, text message annotations, printing) and navigation within a batch
                                     (include detail on image ID and batch ID).
29   Document Entry       Business   If your product does not interface with a third party imaging product, please
                                     explain how it performs the following tasks: scanning, indexing, committal,
                                     retrieval, search/look up, batch management (creation, deletion and
                                     interruption of batches), image management (page count, image rotation,
                                     text message annotations, printing) and navigation within a batch (include
                                     detail on image ID and batch ID).
30   Document Entry       Business   Ability to interface with Captaris - FileNet OEM Edition or a third party fax
                                     server product.
31   Document Entry       Business   If your product interfaces with a third party fax server, please explain how
                                     your product performs the following tasks: batch assembly, document
                                     separation, image management (rotation, text message annotations,
                                     printing), application of index values, search/look up, and navigation within
                                     a batch.


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                                                     Injury - Records


32   Document Entry       Business   If your product does not interface with a third party fax server, please
                                     explain how your product performs the following tasks: batch assembly,
                                     document separation, image management (rotation, text message
                                     annotations, printing), application of index values, search/look up, and
                                     navigation within a batch.
33   Fax                  Business   Describe your system's ability to send and receive faxes and maintain
                                     records of all faxing activity.
34   Fax Server           Business   Describe the ability to archive electronic documents directly to the imaging
                                     system.
35   Document Retention   Business   Describe your ability to identify and retain, in original format, electronic files
                                     and data records for the purpose of document retention.

36   Document Retention   Business   Ability to automatically identify and schedule disposal of electronic records
                                     based on WSI's retention schedule.
37   Document Retention   Business   The system should have the ability to manually purge electronic records
                                     once the retention schedules have expired. Describe this process.

38   Document Retention   Business   Ability to show what requested information was released and to what
                                     outside party.
39   Document Retention   Business   Ability to accept and directly associate electronic information to an
                                     electronic file.
40   Document Retention   Business   Ability to automatically identify and notify designated WSI staff of paper
                                     records ready for disposal based on WSI's retention schedule.
41   Document Retention   Business   Ability to track the volume of electronic data removed from the system
                                     based on WSI retention schedule.




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                                                       Injury - Customer Support




                                                                                                                           Glossary
Number    Subject Matter Area Type           Requirement                                                                   Link
                              (Business or
                              Technical)
                                             Ability to view, on a single summary screen the following claim information:
                                             SSN, name, DOB, address, phone number, dependents, date of injury, all
                                             injured body parts, ICD-9 codes, primary treating physician, claim history
                                             (including claim number, date of injury and body part), employers' name,
                                             employers' address, employers' phone number, claim status, adjuster
         1 General Support    Business       name, adjuster extension, MMI date.                                          MMI
                                             Ability to view, on a single summary screen the following benefit
                                             information: exact amount of check(s), date check was or will be issued,
         2 General Support    Business       payee and address check(s) was mailed to, status of check.
                                             Ability to view , on a single summary screen the following medical
                                             information: authorized physicians, primary physician, designated medical
         3 General Support    Business       provider, diagnosis and conditions both compensable/denied.

                                             Ability to view, on a single summary screen, medical treatment
         4 General Support    Business       authorizations and requests including past and pending authorizations.
         5 General Support    Business       Ability to engage in live web chats.
                                             Ability to automatically retrieve imaged information when entering a unique
         6 General Support    Business       identifier.
                                             Ability for the customer to access claim/account information through an
         7 General Support    Business       Interactive Voice Response (IVR) system.
                                             Ability to view, on a single summary screen, the following employer
                                             information: account number, business name, contact name, phone
                                             number, address, minimum and total of premium balance and assessment
                                             balance including; due dates, current policy period, status of account,
                                             underwriters name and number, status of certificate, payment history,
                                             collection information, assessment/deductible information, and payroll
         8 General Support    Business       report status.
                                             Ability to view individuals or businesses with an affidavit of non-
         9 General Support    Business       employment on file.

     10 General Support       Business       Ability to view application for insurance including those pending coverage.



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                                          Injury - Customer Support


11 General Support   Business   Ability to support multiple document interface.




                                                    9 of 57
                                                        Injury - Medical Services




Number   Subject Matter Area Type           Requirement                                                                          Glossary Link
                             (Business or
                             Technical)
  1      Pharmacy Services   Business       The ability to import pharmacy fill transaction data that follows the National
                                            Council on Prescription Drug Program (NCPDP) standard.
                                            The ability to export WSI's claimant information as defined by the NCPDP
                                            standard.                                                                            NCPDP
  2      Pharmacy Services   Business       Ability to allow overrides on plan limits based on WSI business rules, such
                                            as drugs that require prior authorization, number days supply, number of
                                            daily dosages, and maximum dollar amount.
  3      Pharmacy Services   Business       Ability to 'lock in'/restrict an injured worker into a specific pharmacy or a
                                            specific physician provider.
  4      Pharmacy Services   Business       Ability to receive and hold "first fill" information on injured workers that are
                                            not in our system (i.e. they have no claim number) until it can be mapped
                                            to a claim number.
  5      Pharmacy Services   Business       Ability to process/map a held "first fill" charge on injured workers that are
                                            not in our system to a claim of any status.
  6      Pharmacy Services   Business       Provide an alert notification that would be able to identify potential matches
                                            of "first fill" injured workers with data currently in the system.
  7      Pharmacy Services   Business       Ability to process and pay administrative fees and unmapped first fill
                                            charges.
  8      Pharmacy Services   Business       Ability to map administrative charges to specific claims.
  9      Pharmacy Services   Business       Ability to apply pharmacy fee schedules to bills that do not come through
                                            the Pharmacy Benefit Administrator (PBA).                                            PBA
  10     Pharmacy Services   Business       Ability to see individual ingredients in a compound prescription.
  11     Pharmacy Services   Business       Capability to import and store data fields related to "captured" pharmacy            captured pharmacy
                                            transactions.                                                                        transactions
  12     Pharmacy Services   Business       Ability to establish limits relative to the override decision of plan limits, such
                                            as, if we change the daily dose there needs to be ability to indicate amount
                                            changed the new amount would become our new plan limit for that claim.

  13     Pharmacy Services   Business       Ability to view the override history of plan limits.
  14     Pharmacy Services   Business       Ability to track consultation information in a claim.



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                                               Injury - Medical Services


15   Pharmacy Services   Business   Ability to identify a rejected pharmacy prescription transaction based on
                                    WSI business rules, apply automated approval, and provide an alert if the
                                    automated approval fails.
16   Pharmacy Services   Business   Ability to process and track pharmacy rebates.
17   Bill Processing     Business   The ability to process fee schedules from submitted medical billing codes.

18   Bill Processing     Business   Ability to automatically apply a fee schedule according to WSI's fee
                                    schedule methodologies. Existing Fee schedules include: Medical,
                                    Durable Medical Equipment (DME), Outpatient/inpatient hospital, Home
                                    healthcare, Ambulance, Ambutory Surgical Center, Pharmacy, Maximum
                                    Allowable Cost (MAC) pricing.                                                  DME
19   Bill Processing     Business   Ability to manually audit a medical bill(s).
20   Bill Processing     Business   Describe how your system can provide the following:
                                    - Ability to change a CPT code
                                    - Add/update a modifier
                                    - Ability to deny a charge
                                    - Ability to approve part of the charge (partial payment)
                                    - Ability to review claimant information, prior authorization information, and
                                    provider service information
                                    - View medical bills
                                    - View medical notes
                                    - Access to internal generated notes
                                    - Ability to change a bill status (audit, pending, released)                   CPT
21   Bill Processing     Business   Ability to automate medical bill payment processing according to WSI
                                    business rules.
22   Bill Processing     Business   Ability to assign multiple ICD-9 codes to a single bill line item charge.      ICD-9
23   Bill Processing     Business   Ability to automatically process medical bills line-by-line, approving or
                                    denying charges according to ICD-9 codes.
24   Bill Processing     Business   Ability to manually approve medical bills that might have been rejected in
                                    the automated process.
25   Bill Processing     Business   Ability to adjust and reprocess bills.
26   Bill Processing     Business   Ability to manually override assignment of fee schedules.
27   Bill Processing     Business   Ability to maintain multiple fee schedules in order to pay old bills according
                                    to any of these schedules, where appropriate.




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                                             Injury - Medical Services


28   Bill Processing   Business   Ability to maintain past as well as add new medical codes such as ICD-9,
                                  CPT, Correct Coding Initiative (CCI) rules, HCPCS, conversion factors,
                                  modifiers, relative values, etc.                                              CCI
29   Bill Processing   Business   Ability to automatically apply edits such as CCI edits, Global Packaging
                                  edits and modifiers and produce notification when these edits occur.
                                                                                                                Global Packing
30   Bill Processing   Business   Ability to process bills by applying alternative fee schedules according to
                                  WSI business rules.
31   Bill Processing   Business   Ability to automatically apply the appropriate reason codes to each line
                                  item charge for all reductions/denials during automated bill processing.

32   Bill Processing   Business   Ability to enter notes related to the reasons for the denial or reduced
                                  charge of a medical bill.
33   PPI               Business   Ability to track on a single, unique identifier all Permanent Partial
                                  Impairment (PPI) evaluations/awards to an injured worker with multiple
                                  claims.                                                                       PPI
34   PPI               Business   Ability to track all Permanent Partial Impairment (PPI) evaluations/awards
                                  for a specific claim.
35   PPI               Business   Ability to enter and track Permanent Partial Impairment (PPI)
                                  evaluation/awards such as:
                                  - % whole body awarded
                                  - dollar amount awarded
                                  - specific body part(s) evaluated from customizable code list
                                  - date award was issued
                                  - number of weeks
                                  - PPI evaluation date
                                  - PPI audit date
36   PPI/MMI           Business   Ability to enter and track Maximum Medical Improvement (MMI)
                                  information such as:
                                  - date IW reached MMI status
                                  - reviewer's name
                                  - date review performed
                                  - reviewer's recommendation/results
                                  - prior impairment
                                  - specific body part(s) to be reviewed                                        MMI




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                                                 Injury - Medical Services


37   Utilization Review    Business   Ability to enter and modify Utilization Review (UR) requests for
                                      preauthorization of services such as: patient information, requesting
                                      provider information, facility information, specific service details and
                                      contact information.                                                             UR
38   Utilization Review    Business   Ability to view the UR history both globally and by claim.
39   Utilization Review    Business   Ability to enter, modify, and track UR resolution fields such as: reviewer,
                                      service approval decision (approved, denied, partial), WSI
                                      recommendation, decision reasoning, review status, date of decision and
                                      type of review.
40   Utilization Review    Business   Ability to send a service request and supporting documentation to an
                                      external reviewer in real time.
41   Utilization Review    Business   Ability to enter, modify, and track information from an outside
                                      reviewer/business which notifies WSI of preauthorization resolutions such
                                      as: Chiropractic from OCC, PT, etc.                                              OCC
42   Utilization Review    Business   Ability for third parties to electronically review and provide a
                                      recommendation directly into our system.
43   Utilization Review    Business   Ability to automatically approve a UR request according to WSI business
                                      rules.
44   Medical Remittances   Business   Ability to produce a remittance advice to coincide with a medical bill pay
                                      run.
45   Medical Remittances   Business   Ability to design and incorporate a custom WSI remittance advice
                                      template.
46   Medical Remittances   Business   Ability to insert a customized message on the remittances.

47   Claims / Treatment    Business   Ability to create a treatment entry automatically or manually when a
     history                          medical bill, medical note, or medical event is received.
48   Claims / Treatment    Business   Ability to view treatment history by a single, unique identifier to an injured
     history                          worker with multiple claims .
49   Claims / Treatment    Business   Ability to track injured worker satisfaction/success feedback.
     history
50   Claims / Treatment    Business   Describe if/how your system supports tracking of information related to a
     history                          'point of service' notification when an injured worker attends a treatment
                                      visit.
51   Online Services       Business   Ability to provide an online service to look up claim information based on
                                      WSI business rules.




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                                             Injury - Medical Services


52   Online Services   Business   Ability to provide an online service to submit UR requests and supporting
                                  medical notes from a treating provider for pre-authorization of services.

53   Online Services   Business   Ability to provide an online service to view WSI's return
                                  authorizations/decisions on their UR requests based on WSI business
                                  rules.
54   Online Services   Business   Ability to provide an online service that displays all provider billing
                                  information.
55   Online Services   Business   Ability to provide an online service where providers could access and
                                  submit from a library of WSI fillable forms.
56   Other             Business   Ability to enter, modify and track information specific to providers that
                                  participate in special programs or meet qualification standards such as:
                                  enrollment information, qualifying status, active participation dates, attach
                                  imaged documents, type of certifications, certification effective, etc.

57   Other             Business   Ability to automatically auto adjudicate, process, build a custom plan, and
                                  pay the medical provider based on data from the system, ODG and CPT
                                  codes.




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                                                       Injury - Return to Work




                                                                                                                         Glossary
Number   Subject Matter Area Type           Requirement                                                                  Link
                             (Business or
                             Technical)
  1      Triage              Business       Ability to automatically triage and generate a customized claims
                                            management plan from collected data.
  2      Voc Rehab               Business   Ability to enter, update and track vocational rehabilitation services
                                            information by claim number.
  3      Voc Rehab               Business   Ability to enter, update and track case management services information
                                            by claim number.
  4      Voc Rehab               Business   Ability to view vocational rehabilitation information by a legal entity.
  5      Voc Rehab               Business   Ability to enter and track return to work statistics based on WSI business
                                            rules.
  6      Disability Guidelines   Business   Ability to automate workflow events by incorporating WSI business rules
                                            and third party disability guidelines.
  7      Preferred Worker        Business   Ability to enter, modify and track Preferred Worker Program (PWP)
                                            information.
  8      Preferred Worker        Business   Ability to automatically request a disbursement of PWP payments.
  9      Preferred Worker        Business   Ability to view payment history on all PWP expenses.




                                                               15 of 57
                                                        Employer - Collections




Number   Subject Matter Area Type           Requirement                                                                 Glossary Link
                             (Business or
                             Technical)
                                            Ability to record and track employer account collection activity based on
  1      Collections Process   Business     WSI business rules.                                                         Collection
                                            Ability to record and track claims overpayment collection activity based on
  2      Collections Process   Business     WSI business rules.
                                            Ability to write-off balances of claims overpayments based on WSI
  3      Collections Process   Business     business rules.
                                            Ability to write-off balances of an employer account based on WSI
  4      Collections Process   Business     business rules.
                                            Ability to manually or automatically assess and waive penalties and other
  5      Collections Process   Business     charges based on WSI business rules.
                                            Describe the standard reports and queries available that pertain to
  6      Collections Process   Business     collections.
                                            Ability to manually or automatically modify the status of an employer
  7      Collections Process   Business     account based on WSI business rules.
  8      Collections Process   Business     Ability to track multiple collection types for an employer account.
                                            Ability to manually or automatically open and close a collection case based
  9      Collections Process   Business     on WSI business rules.
                                            Ability to record multiple judgments against an employer based on WSI
  10     Collections Process   Business     business rules.
                                                                                                                        Amortization
  11     Collections Process   Business     Provide an amortization schedule for alternative payment arrangements.      schedule
                                            Ability to automatically manage accounts in bankruptcy based on WSI
  12     Collections Process   Business     business rules.                                                             Bankruptcy
  13     Collections Process   Business     Ability to invoice a claims overpayment.
                                            Ability to display collection status on a policyholder's certificate of
  14     Collections Process   Business     coverage.




                                                               16 of 57
                                                    Employer - Payroll Processing




                                                                                                                        Glossary
Number   Subject Matter Area Type           Requirement                                                                 Link
                             (Business or
                             Technical)
  1      Input/Audit         Business       Capture payroll information on a periodic basis.
                                            Notify employers that their payroll information is due. Describe the
  2      Input/Audit         Business       available methods of notification.
                                            Employers can submit their payroll information online using an online form
  3      Input/Audit         Business       that will automatically integrate the information into the system.
                                            Generate custom payroll reports based on employers' legal entity
  4      Input/Audit         Business       classification.
  5      Input/Audit         Business       Generate duplicate payroll reports upon request.
  6      Input/Audit         Business       Barcode payroll reports for tracking and receipt.
  7      Input/Audit         Business       Track or monitor the status of a payroll report.
                                            Identify, track and process employers who are delinquent in filing periodic
   8     Input/Audit         Business       payroll information.
   9     Input/Audit         Business       Automatically assess penalties based on WSI business rules.
  10     Input/Audit         Business       Audit payroll information based on WSI business rules.
                                            Automatically identify accounts for a potential field audit based on WSI
  11     Input/Audit         Business       business rules.                                                             Field audit
                                            Ability to capture gross and taxable payroll at the employee level based on
  12     Input               Business       WSI business rules.
                                                                                                                        Gross
  13     Audit               Business       Ability to adjust gross and taxable wages at the employee level.            wages




                                                               17 of 57
                                                     Employer - Premium Billing




Number   Subject Matter Area Type           Requirement                                                                 Glossary Link
                             (Business or
                             Technical)
                                            Ability to calculate and bill premium for policy periods to include wages,
                                            classifications, rates, premium discounts, experience modification,
  1      Billing             Business       applicable rating plan factors, minimum premium.                               Premium
                                            Ability to bill multiple types of optional coverage based on factors such as
  2      Optional Coverage   Business       rate classification, age and wage cap.                                         Wage cap
                                            Ability on a fiscal year basis, to update, apply and maintain history of
                                            premium calculation parameters such as manual rates, premium dividend
                                            credits, experience modification, loss rates, safety discounts, and wage
  3      Billing             Business       cap.                                                                           Dividend
                                            Ability to apply different interest rates by fiscal year based on WSI business
  4      Billing             Business       rules.
                                            Ability to provide alternative payment schedules and terms based on WSI
   5     Billing             Business       business rules.
   6     Billing             Business       Ability to apply discounts for early payment of premium.
   7     Billing             Business       Ability to provide electronic billing notification.
   8     Billing             Business       Ability to present billing statements online or electronically.
   9     Billing             Business       Ability to generate customized premium statements.
  10     Billing             Business       Ability to customize messages to premium statements.
  11     Billing             Business       Ability to attach correspondence to premium statements.
                                            Ability to show calculation details on all billing statements including any
  12     Billing             Business       adjustments.
  13     Audit               Business       Ability to calculate and generate a revised premium bill.
  14     Billing             Business       Ability to bill differences in estimated and audited payroll.
                                            Ability to complete premium adjustments resulting from changes.
                                            Examples of changes include; volunteer roster information, changes in
                                            wages, experience modification factor, safety discounts, optional coverage,
  15     Billing             Business       rate classification.
         Experience                         Ability to calculate experience modification factors based on WSI business
  16     Modification        Business       rules.




                                                               18 of 57
                                         Employer - Premium Billing


     Experience                Ability to adjust experience modification factors for multiple policy periods
17   Modification   Business   for all policies within a group.
     Experience                Ability to adjust experience modification factors for multiple policy periods
18   Modification   Business   resulting from subrogation orders.                                              Subrogation
19   Billing        Business   Ability to establish and maintain retrospective rated policies.
20   Billing        Business   Ability to establish and maintain deductible rated policies.
                               Ability to calculate and bill premium, interest, and penalty charges on
21   Billing        Business   accounts that are deemed uninsured.
                               Ability to generate premium charges based on alternative units of
22   Billing        Business   exposure, such as number per capita, dollar per volunteer, per hour.
23   Audits         Business   Ability to maintain historical information of completed premium audits.

24   Audits         Business   Ability to query and track premium audits based on WSI business rules.
25   Audits         Business   Ability to generate audit work papers on demand.
                               Ability to automatically generate a revised premium billing based on a field
26   Audits         Business   audit.
                               Ability to update employer profile information based on WSI business
27   Audits         Business   rules.




                                                   19 of 57
                                                    Employer - Payments & Certs




                                                                                                                             Glossary
Number   Subject Matter Area Type           Requirement                                                                      Link
                             (Business or
                             Technical)
                                            Ability to receive payments by various forms, such as: EFT, check, credit
  1      Cash Receipts       Business       card, cash.
  2      Cash Receipts       Business       Ability to receive payments online.
  3      Cash Receipts       Business       Ability to apply cash receipts based on WSI business rules.
                                            Simple view of a specific account's balances, such as: claim loss,
  4      Cash Receipts       Business       deductible, premium, etc.
  5      Payments            Business       Ability to view notes at a glance pertaining to a specific transaction.
                                            Ability to trigger a notification when a payment is applied based on WSI
                                            business rules, such as: write-offs, closed accounts, collections, credit
  6      Cash Receipts       Business       balances.
                                            Ability to make transaction corrections, such as: credits, refunds, balance
  7      Cash Receipts       Business       transfers, transposition of numbers, voiding a payment.
  8      Cash Receipts       Business       Describe standard reports available that are related to Payments.
  9      Cash Receipts       Business       Ability to process an NSF (Non Sufficient Funds) transaction.
                                            Ability to customize a certificate template. Include a copy of the certificate
  10     Certificates        Business       here.
  11     Certificates        Business       Ability to manually generate a certificate on demand.

  12     Certificates        Business       Ability to automatically generate certificates based on WSI business rules.
  13     Certificates        Business       Ability to access and print a certificate online.
  14     Certificates        Business       Ability to generate proof of coverage card in wallet size.
                                            Ability to issue and void refunds, individually and in batches, based on WSI
  15     Refunds             Business       business rules.

  16     Refunds             Business       Ability to automatically generate correspondence based on refund type.




                                                                20 of 57
                                                       Employer - Assesments




Number   Subject Matter Area Type           Requirement                                                                    Glossary Link
                             (Business or
                             Technical)
         Deductible                         Ability to automatically assess policyholders for costs associated with each
  1      Assessments         Business       claim based on WSI business rules.
         Deductible
  2      Assessments         Business       Ability to bill premium and claim loss deductibles on a single statement.
                                            Ability to automatically adjust claim loss deductible charges based on WSI
         Deductible                         business rules. Examples include subrogation, transfers, consolidations,
  3      Assessments           Business     denials.                                                                   Subrogation
         Deductible                         Ability to manually adjust claim loss deductible charges based on
  4      Assessments           Business     appropriate security levels.                                               Deductible
         Deductible                         Ability to apply different interest rates by fiscal year based on WSI
  5      Assessments           Business     business rules.                                                            Rate
         Deductible
  6      Assessments           Business     Ability to generate customized claim loss deductible statements.
         Deductible                         Ability to add global and/or individual messages to claim loss deductible
  7      Assessments           Business     statements.
         Deductible
  8      Assessments           Business     Ability to provide electronic billing notification.
         Deductible                         Ability to attach correspondence to claim loss deductible statements based
  9      Assessments           Business     on WSI business rules.
         Deductible
  10     Assessments           Business     Ability to apply discounts for early payments based on business rules.
         Deductible                         Ability to establish alternative payment schedules and terms based on WSI
  11     Assessments           Business     business rules.
         Deductible                         Ability to show detailed calculation on all claim loss deductible statements
  12     Assessments           Business     including any adjustments.

  13     Online Incident Report Business    Ability for employers to submit an online incident report.
                                            Ability to send confirmation to employer once they have submitted their
  14     Online Incident Report Business    incident report online.




                                                               21 of 57
                                                        Employer - Underwritting




Number    Subject Matter Area Type           Requirement                                                                      Glossary Link
                              (Business or
                              Technical)
                                             Ability to underwrite, cancel and reinstate mandatory coverage based on          Mandatory
         1 Canceling Coverage   Business     WSI business rules.                                                              Coverage
                                             Ability to underwrite, cancel and reinstate multiple types of optional
                                             coverage, such as: owner officers, self employed, family members and
                                             type of entity.                                                                  Optional
         2 Optional Coverage    Business                                                                                      coverage

         3 Underwriting Process Business     Ability to generate a customized application for insurance form.
                                             Ability to track the underwriting process from the receipt of application to
         4 Underwriting Process Business     when it is processed for billing.

         5 Underwriting Process Business     Ability to underwrite using a custom set of rate classification codes.
                                             Ability to automatically assign accounts to underwriters based on a set of
                                             parameters. Parameters may include alphabetical, size, industry and
         6 Underwriting Process Business     employer location.
                                             Ability for employers to submit their application online and integrate this
         7 Underwriting Process Business     information into the system automatically.
                                             Ability to underwrite uninsured period of exposure for work activity
         8 Uninsured            Business     occurring prior to inception of policy based on WSI business rules.

                                             Ability to identify and track individuals or businesses who are not required
                                             to carry workers' compensation coverage through an issuance of an                Affidavit of non-
         9 Underwriting Process Business     affidavit of non-employment.                                                     employment
                                             Ability to categorize employers, such as: size, industry, Professional           Professional
                                             Employer Organization (PEO), Preferred worker, Foreign farm worker,              Employer
     10 Underwriting Process Business        NAICS (North American Industrial Classification System).                         Organization
                                             When a new application is received, ability to automatically identify and flag
                                             duplicate or similar information, already in the system, based on WSI
     11 Underwriting Process Business        business rules.
                                             Ability to automatically underwrite an application based on WSI business
     12 Underwriting Process Business        rules.



                                                                 22 of 57
                                               Employer - Underwritting


                                    Ability to assign or change a rate classification sub-class description by
13 Rate Classification   Business   employer.
14 Canceling Coverage    Business   Ability to cancel a policy and generate a final payroll report.

15 Underwriting Process Business    Ability to flag an account for a potential field audit.
                                    Ability to underwrite, cancel and reinstate reciprocal coverage with other     Reciprocal
16 Reciprocal Coverage Business     states.                                                                        coverage
                                    Ability to calculate an aggregate experience rate for an identified group of
17 Consolidation         Business   policyholders based on WSI business rules.
18 Consolidation         Business   Ability to consolidate policy information based on WSI business rules.
19 Consolidation         Business   Ability to separate a single policy into multiple policies.

20 Underwriting Process Business    Ability to barcode applications for tracking and receipt.
                                    Ability to provide the employer the ability to establish an account using an
21 Underwriting Process Business    online application wizard based on WSI business rules.
                                                                                                                   All states
                                                                                                                   incidental
22 Underwriting Process Business    Ability to underwrite, cancel and reinstate all states incidental coverage.    coverage

23 Underwriting Process Business    Ability to underwrite, cancel and reinstate AG Excess coverage.




                                                        23 of 57
                                                          Other - Communications




                                                                                                                             Glossary
Number       Subject Matter Area Type           Requirement                                                                  Link
                                 (Business or
                                 Technical)
             Internet Online                    Online services should be accessible to the user through WSI's Internet
         1   Services            Business       site.
             Internet Online                    WSI should have the ability to control the overall look and feel of online
         2   Services            Business       services.
             Internet Online                    Online services provided should have the ability to have the same look and
         3   Services            Business       feel as the WSI internet site.
             Internet Online                    Online services provided should be Americans with Disabilities Act (ADA)
         4   Services            Business       compliant.
         5   Web Portal          Business       Describe the web portal capabilities (if any) of your product.




                                                                   24 of 57
                                                        Other - Executive Staff




                                                                                                                           Glossary
Number   Subject Matter Area Type           Requirement                                                                    Link
                             (Business or
                             Technical)
  1      Reports             Business       A system reporting tool must be supplied. Describe your system's
                                            reporting capabilities including but not limited to; standard reports,
                                            automated scheduling capabilities, customizable features to your standard
                                            reports, drill down capability through report results, exportable formats,
                                            report distribution features (e.g. e-mail scheduled reports to predetermined
                                            recipients), report viewing features (e.g. dashboards, scorecards), security
                                            structure, capability to design new reports in a user friendly environment,
                                            etc.

  2      Query               Business       A system query tool must be supplied. Describe your system query
                                            capabilities.




                                                               25 of 57
                                                       Other - Independent Review




                                                                                                                          Glossary
Number     Subject Matter Area Type           Requirement                                                                 Link
                               (Business or
                               Technical)
           Dispute Resolution
           and Constituency                   Ability to view claims and legal information based on appropriate
         1 Services            Business       authorization level.

           Dispute Resolution ,
           Binding Dispute
           Resolution, and                    Ability to automate the OIR dispute resolution registration process, such
         2 Constituency Services Business     as: populating forms, generating letters and sending events.                OIR




                                                                 26 of 57
                                                               Other - Legal




                                                                                                                             Glossary
Number     Subject Matter Area Type           Requirement                                                                    Link
                               (Business or
                               Technical)
           Litigation                         Describe the standard list of reports and queries that pertain to litigation
         1 Management          Business       and subrogation.                                                               Litigation
           Litigation                         Ability to create, modify, and track history of information throughout the
         2 Management          Business       notice of decision process based on WSI business rules.
           Litigation
           Management and
           Subrogation
         3 Processing          Business       Ability to autopay legal billings based on WSI business rules.
                                              Provide a subrogation calculator tool with the ability to perform and save
           Subrogation                        automatic subrogation settlement calculations, with the option to manually
         4 Processing          Business       override, based on WSI business rules.




                                                                  27 of 57
              Other - Legal




Subrogation




                28 of 57
                                                            Other - Finance




                                                                                                                              Glossary
Number   Subject Matter Area Type           Requirement                                                                       Link
                             (Business or
                             Technical)
  1      Tax Tables          Business       Ability to update and maintain history of Federal tax tables.
  2      Tax Tables          Business       Ability to update and maintain history of the State average weekly wage
                                            tables.
  3      1099 Processing     Business       Ability to issue 1099's to the payee and an electronic file to the IRS as well
                                            as maintain history.
  4      Financial Package   Business       If a financial package exists in your system, it should process and report
                                            on all activity/transactions, on a daily basis, related to workers
                                            compensation insurance needs, including General Ledger, Track reserve
                                            changes, Losses, Loss payments, Ceded Loss Reserves, Effect of
                                            reinsurance on losses, Subrogation, Claim overpayment adjustments, write-
                                            offs and recoveries, Apply cash receipts, Reserves, Claim payments,
                                            Premium billing, Premium adjustments, Premium credits, Premium
                                            dividends, Premium bad debt/write-offs, Advance premium billings and
                                            reconciliations, Customizable account list, Track overpayments, Track
                                            subrogation, Accurately record journal entries for all daily transactions (e.g.
                                            reserves, premium billing) and activity (e.g. subrogation, overpayments,
                                            reinsurance).
  5      Financial Package   Business       If your system does not have a financial package included then provide
                                            journal (General Ledger) entries for all types of transactions in a summary
                                            format and update appropriate General Ledger accounts on a daily basis
                                            and upload to our Great Plains financial system.
                                            The integration needs would be Payment number, List cleared checks from
                                            Great Plains to the new system, Post all daily activities in the new system
                                            to Great Plains General Ledger, Maintain its own EFT records in
                                            conjunction with its vendor maintenance responsibilities, Administer vendor
                                            maintenance for all its claimants, medical providers and policyholders.

  6      Payments            Business       Ability to issue payments automatically in a batch and individually on
                                            demand. Such as Claims Payments, Premium Refunds/Payments,
                                            Administrative Payments.
  7      Payments            Business       Ability to void and reissue payments.



                                                                29 of 57
                                          Other - Finance


8    Payments   Business   Ability to provide payments via check and EFT.
9    Payments   Business   Ability to receive and process a cleared check file from a financial
                           institution and automatically update the status of a check based on WSI
                           business rules.
10   Payments   Business   Ability to allow an employee to view the check status (ie: issued, cleared,
                           voided) of a payment, based on WSI business rules.




                                              30 of 57
                                                          Other - Global - Legal Entity




    Number   Subject Matter Area Type           Requirement                                                                      Glossary Link
                                 (Business or
                                 Technical)

             Legal entity                       Ability to establish Legal Entities for providers, injured workers, employers,
1            requirements        Business       etc. and manage attributes of those entities based on WSI business rules. Legal entity
             Legal entity
2            requirements        Business       Provide us your list of legal entity attributes for injured worker.
             Legal entity
3            requirements        Business       Provide us your list of legal entity attributes for providers.
             Legal entity
4            requirements        Business       Provide us your list of legal entity attributes for employers.
             Legal entity                       Ability to automatically/manually enter and maintain addresses based on
5            requirements        Business       United States Postal Service (USPS) information.

                                                Ability to view and search all information relating to Legal Entities such as;
             Legal entity                       attribute history, claim history, employment, provider relationship,
6            requirements        Business       dependant, beneficiary, etc based on WSI business rules.
             Legal entity
7            requirements        Business       Ability to link a Legal Entity with one or more other Legal Entities.
             Legal entity                       Describe your system's ability to use Legal Entity attributes in
8            requirements        Business       correspondence/payments/billing/etc.
             Legal entity                       Ability to identify the origin of WSI mailings by unique department code to
9            requirements        Business       be included in the address block.
             Legal entity                       Describe your ability to manage multiple addresses for a Legal entity such
10           requirements        Business       as physical, payment, and mailing/correspondence addresses.
             Legal entity
11           requirements        Business       Ability to indicate if a vendor is a 1099 recipient.
             Legal entity
12           requirements                       Ability to indicate 1099 payment type. Such as box 6 - medical payments.
             Legal entity                       Ability to record a Doing Business As (DBA) name in addition to a Legal
13           requirements        Business       business name, on a legal entity type of provider and employer.
             Legal entity
14           requirements        Business       Ability to record an alias on a legal entity type of injured worker.



                                                                     31 of 57
                             Other - Global - Legal Entity


     Legal entity   Ability to automatically identify duplicate legal entities and allow for manual
15   requirements   combination.




                                        32 of 57
                                                          Other - Global - Workflow




                                                                                                                               Glossary
    Number   Subject Matter Area Type           Requirement                                                                    Link
                                 (Business or
                                 Technical)
                                                Work Flow must have specific information required for processing, such as
1            Work Flow           Business       the priority, target completion date, origin of workflow.                 Work flow

2            Work Flow           Business       Ability to assign workflow activity to one or more users or group of users.
                                                Ability for user to add note text to a workflow activity at any point in the
3            Work Flow           Business       workflow process.
                                                Ability to manage and/or view any workflow activity and status for, an
                                                individual user or defined group at any point in the workflow process,
4            Work Flow           Business       based on WSI business rules.
5            Work Flow           Business       Ability to retain a history of all workflow activity.
6            Work Flow           Business       Ability to search workflow activity history by predefined parameters.
                                                Ability to temporarily alter workflow assignment based on WSI business
7            Work Flow           Business       rules.
                                                Ability to automatically or manually assign workflow activities based on
8            Work Flow           Business       WSI business rules.
9            Work Flow           Business       Ability to alter workflow, based on WSI business rules.
                                                Ability to trigger workflow activity by external applications such as web
10           Work Flow           Business       service.
                                                Ability to generate electronic forms by automatically populating information
11           Work Flow           Business       and produce workflow for referrals or procedures.
12           Work Flow           Business       Ability to electronically authorize workflow activity.
                                                Ability to provide electronic proof of processing for routing of workflow
13           Work Flow           Business       activity.

14           Work Flow           Business       Describe the ability to select and execute a work task from a master list.
                                                Ability for system to interface with state agencies utilizing enterprise
15           Work Flow           Technical      service transactions.
                                                Ability to send correspondence to multiple recipients utilizing multiple
16           Correspondence      Business       methods such as email, fax, paper.




                                                                   33 of 57
                                            Other - Global - Workflow


                                 Ability for a user to manually trigger the generation of a specific letter to be
17   Correspondence   Business   mailed.




                                                     34 of 57
                                                            Other - Global - Forms




                                                                                                                                 Glossary
    Number   Subject Matter Area Type           Requirement                                                                      Link
                                 (Business or
                                 Technical)
1            Forms Tools         Business       Describe your forms tools capabilities.
                                                Ability to automatically and manually select existing documents, forms and
                                                images and attach them to outgoing correspondence based on WSI
2            Forms Tools         Business       business rules.
                                                Automated capability for attaching images and documents to outgoing
3            Forms Tools         Business       correspondence.
                                                Ability to create, test, update, maintain and produce forms and envelopes
4            Forms Tools         Business       in one system.

5            Forms Tools         Business       Ability to auto fill forms and outgoing correspondence with required data.
                                                Ability to identify multiple outgoing correspondence to a single recipient
                                                and automatically or manually combine correspondence to one mailing
6            Forms Tools         Business       based on USPS regulations.
7            Forms Tools         Business       Ability to cancel or hold a form at any given time before printing.
                                                Ability to override the legal entity address and print alternate addresses for
8            Forms Tools         Business       forms and envelopes.
                                                Ability to automatically create and store an image of all outgoing
9            Forms Tools         Business       correspondence based on WSI business rules.




                                                                    35 of 57
                                                            Other - Global - Notes




                                                                                                                              Glossary
    Number   Subject Matter Area Type           Requirement                                                                   Link
                                 (Business or
                                 Technical)

                                                Ability to create and attach notes to any specific document or any legal
1            Notes               Business       entity. Please describe the process by which you will accomplish this.
                                                Ability to search, sort and access notes, by category, content, sub-
2            Notes               Business       category, header, etc.
                                                Describe all the features of your systems notepad functionality such as
3            Notes               Business       spell-check, category, captions.
                                                Describe your process for displaying notes attached to a specific item such
4            Notes               Business       as address, transaction, policyholder, remittance advice.
5            Notes               Business       Ability to attach a note to multiple claims or a legal entity.

6            Notes               Business       Ability to attach notes to items in an image/content management system.
                                                             Other - Global - Misc




                                                                                                                               Glossary
    Number   Subject Matter Area Type           Requirement                                                                    Link
                                 (Business or
                                 Technical)
             General Claim                      Ability to link to third party sites to reference their information such as
1            Management          Business       CareMC, Merck, ODG, etc.
                                                Ability to enter, modify and track history of approved contacts for the
             General Claim                      "authorization to release information." This capability should be able to be
2            Management          Business       linked to a specific claim, account and/or legal entity.
             General Claim
3            Management          Business       Ability to use a "calendar assist" to select or input dates or date ranges.
             Global / Voice
4            activation          Business       Ability to interact with third party voice activation software.
             Globals / Visual                   Ability to display, a claim or policy status on every page based on WSI
5            Indicators          Business       business rules.
6            GUI                 Business       Describe your system error reporting and notification capability.
7            Integration         Business       Ability for WSI to customize the look and feel of the application.
8            GUI                 Business       Ability to maintain user preferences.
9            Integration         Business       Describe your ability to integrate with other COTS products.
                                                Describe your system's spell checking, grammar checking and content
10           Spell Checking      Business       filtering capabilities.
             Web and mobile
11           access              Business       Describe all mobile capabilities that your product may offer.
             Web and mobile                     Describe all online service capabilities for injured workers, providers and
12           access              Business       employers.
                                                Describe your system's ability to provide off-line data access, usage, and
13           Field reps          Business       synchronization.




                                                                    37 of 57
                                                       Other - Global - Imaging & Tech




                                                                                                                              Glossary
    Number   Subject Matter Area Type           Requirement                                                                   Link
                                 (Business or
                                 Technical)
                                                Describe your ability to search, sort, view and print by categories and
1            Imaging                Business    document types.
2            Imaging                Business    Ability to accept, store, and access imaged documents.
                                                Describe the systems' ability to markup an electronic document, such as
                                                add annotations, highlight, watermarks, layer of redaction from mail to any
3            Imaging (Desktop       Business    appropriate artifact, WITHOUT altering the original artifact.
             Imaging (Desktop and
4            Web)                   Business    Describe your systems' features and capability for viewing an image.
             Imaging (Desktop and
5            Web)                   Business    Ability to retrieve electronic records via the desktop.
             Imaging (Desktop and
6            Web)                   Business    Ability to publish records to the web.
             Imaging (Desktop and
7            Web)                   Technical   Describe your systems' storage options.
                                                List all formats that are supported by the content storage system such as
8            Imaging                Technical   audio files, office documents, video files.




                                                                    38 of 57
                                                            Other - Global - Other




                                                                                                                            Glossary
    Number   Subject Matter Area Type           Requirement                                                                 Link
                                 (Business or
                                 Technical)
                                                Capability to Accept ANSI 837 format for claims aka. Medical Billings
1            Other               Business       transactions.
2            Other               Business       ANSI 835 Remittance compliant.

3            Other               Business       Describe your system's ability to allow WSI to manage its business rules.
                                                Describe your procedure for implementing and integrating WSI business
4            Other               Business       rules.




                                                                   39 of 57
                                                              Other - SIU




                                                                                                                        Glossary
Number   Subject Matter Area Type           Requirement                                                                 Link
                             (Business or
                             Technical)
  1      Field and Fraud     Business       Ability to track and reference case assignment and reassignment capability
         Investigation                      of the following information: name of investigator, internal or external
                                            investigator, agency name, address of investigator, e-mail address,
                                            contract dates of investigator, phone number of investigator and date
                                            investigator was assigned.
  2      Field and Fraud     Business       Ability to provide historical tracking and reporting of all prior
         Investigation                      investigations/surveillance on claimant, provider, and/or employer.
  3      Field and Fraud     Business       Ability to track and report case activity per each investigator and
         Investigation                      engagement on a claim, a specific employer, and/or specific provider
                                            based on WSI business rules.
  4      Field and Fraud     Business       Ability to track and reference post-investigation activity based on WSI
         Investigation                      business rules.
  5      Field and Fraud     Technical /    Ability to interface with outside sources through the use of a quick link to
         Investigation       Business       their sites/services. Examples include: state Motor Vehicle office,
                                            Corrections offices, ND Job Service, ND Private Investigation Board,          Outside
                                            Secretary of State, etc.                                                      sources
  6      Field and Fraud     Business       Ability to cross reference investigation history with Employer, Injured
         Investigation                      Worker, and Provider.
  7      Field and Fraud     Business       Ability to integrate bar-coding to track and search all evidence items in a
         Investigation                      'library' style system that would keep track of evidence information by using
                                            security levels incorporating access to a specific legal entity.

  8      Field and Fraud     Business       Ability to enter, modify and track Hotline information that is accessed     Hotline
         Investigation                      according to appropriate security roles for all tips received.              Information




                                                               40 of 57
                                                            Technical - SOA




Number   Subject Matter Area Type           Requirement                                                                     Glossary Link
                             (Business or
                             Technical)
                                            Service-Oriented Architecture (SOA) expresses a business-driven
                                            approach to software architecture that supports integrating the business as
                                            a set of linked, repeatable business tasks, or “services”. Services are self-
                                            contained, reusable software modules with well-defined interfaces and are
                                            independent of applications and the computing platforms on which they run.
                                            SOA will help WSI innovate its business by ensuring that IT systems can
                                            adapt quickly, easily, and economically to support rapidly changing
                                            business needs. Please describe how your solution supports SOA,
                                            including any architecture diagrams or other documentation that explain
                                            your SOA implementation. If the system does not currently support SAO or
                                            has limited SOA capability, explain your strategy to transition your system
  1      SOA                 Technical      towards SOA.




                                                                41 of 57
                                                      Technical - Adminstration




                                                                                                                           Glossary
Number   Subject Matter Area Type           Requirement                                                                    Link
                             (Business or
                             Technical)
  1      Project Management Technical       Vendor must supply project manager for system implementation as part of
                                            this bid. Please describe the credentials and prior experience of this
                                            project manager.

                                            Activities must abide by the North Dakota State Large Project Oversight
                                            Standard. Please see the following websites for these standards:
                                            - STD009-05 Standard for the Project Management of Large
                                            Information Technology Projects:
                                            http://www.nd.gov/ea/standards/standards/approved/std009-05.pdf
                                            - ND Century Code:
                                            http://www.legis.nd.gov/cencode/T54C35.pdf
  2      Project Management   Technical     http://www.legis.nd.gov/cencode/t54c59.pdf
                                            Activities must abide by the North Dakota State Project Management
                                            Guide Book. Please refer to the following websites:
  3      Project Management   Technical     http://www.nd.gov/epm/training/guidebook/index.html
                                            Describe the online tutorials and/or help tools that are embedded within
  4      Training             Technical     your solution.
                                            Describe in detail the training plan for train the trainer(s) and end users.
                                            The description should include a narrative on the training curriculum and a
                                            commitment of the number of days of training that will be provided.
                                            Descriptions should include details on training in all the application
  5      Training             Business      modules.
  6      Training             Technical     Describe in detail the training materials given to end users.
                                            Describe how you would provide WSI with defined use case scenarios with
  7      Training             Technical     a prepopulated training database.
  8      Training             Technical     Training should be held at a WSI approved training facility(s).
                                            Describe any training available to WSI IT staff for system customization
  9      Training             Technical     capabilities.
                                            Describe in detail the training plan for administration such as Security
                                            administration, System administration, Report administration, Database
  10     Training             Technical     administration, etc.


                                                               42 of 57
                                           Technical - Adminstration


                                 Describe your process of transferring knowledge to WSI leading to self-
11   Training        Technical   sufficiency.
                                 Ability to have WSI's procedure guides/manuals as an interactive
                                 electronic help tool that is fully searchable and contains wizards. These
12   Documentation   Business    guides/manuals will be updated by WSI.
                                 Describe how you would provide the following types of documentation:
                                 technical documentation, database documentation, application
13   Documentation   Technical   documentation.




                                                    43 of 57
                                                    Technical - Post Implementation




                                                                                                                         Glossary
Number    Subject Matter Area Type           Requirement                                                                 Link
                              (Business or
                              Technical)
                                             A maintenance contract is required. Describe both the base maintenance
                                             contract and optional maintenance contract. (The percentage of licensing
                                             costs for maintenance should be based on the negotiated discount price
         1 Maintenance        Technical      and not the current list price).
                                             Describe software maintenance operations related to corrective
                                             maintenance, adaptive maintenance, perfective maintenance, and
         2 Maintenance        Technical      preventive maintenance.
                                             Describe the software "End of Life" version support and notification
         3 Maintenance        Technical      process.
                                             Describe your software release procedures. Include descriptions of
         4 Maintenance        Technical      frequency, process, and reasons for release.
                                             Vendor proposals shall contain a narrative of the proposed service level
                                             agreement through which the vendor shall provide on-going support and
                                             maintenance after conclusion of the warranty period. The narrative shall
                                             include response times and the nature of the response that the contractor
         5 Software Support   Technical      shall provide.
         6 Software Support   Technical      Describe in detail your warranty and warranty period.
                                             Describe your software patch procedures. Include descriptions of
                                             frequency, process, and reasons for release, impact of vulnerability,
         7 Maintenance        Technical      maximum severity rating, etc.




                                                                44 of 57
                                       Technical - Post Implementation



                                The vendor should provide to WSI, as part of the Transition-Out Plan:
                                -Technical and functional overviews of the system
                                -System data dictionary
                                -Where applicable, current copies of the application source code.
                                -Documentation as specified in the Documentation Requirements Section.
                                -Detailed documentation of all application modifications, including all
                                changes in progress, in electronic format.
                                -Overviews of all procedures, tools and administrative services provided
                                under the contract.
                                -Listings and details regarding all known system defects.
 8 Transition-Out   Technical   -Entity Relationship Diagrams.
                                Describe how and when vendor staff will transition-out after system
 9 Transition-Out   Technical   implementation.
                                The vendor shall work closely with WSI staff to continue normal
                                maintenance and operations activities until completion of all Transition-Out
10 Transition-Out   Technical   Plan activities.




                                                   45 of 57
                                                            Technical - System




Number     Subject Matter Area Type           Requirement                                                                     Glossary Link
                               (Business or
                               Technical)

                                              Please describe the software license options that are included with your
         1 Licensing           Technical      product. Please state any other software products not included but needed.
                                              Using diagrams or other media describe your software solution's
                                              architectural blueprint. Describe the frameworks and patterns used by
         2 Architecture        Technical      your application.

         3 Architecture        Technical      Describe your business rules engine capabilities.                               Business rules engine

         4 Architecture        Technical      Describe your ability to integrate with other software products and services.
                                              Describe methods you have for bridging the gap between your solution and
         5 Architecture        Technical      WSI application requirements.
                                              Describe the capabilities of your product to standardize inputs from any
                                              media into a single, uniform format so that they are available to the
                                              document management and workflow management components for
                                              routing, processing and storing in a manner that is independent of the input
         6 Architecture        Technical      media.
                                              Describe the web services and application programming interface (API)
         7 Web Services        Technical      capabilities your solution provides.
                                              The solution shall operate within the existing North Dakota Enterprise
                                              Architecture for Web Development Standard (STANDARD EGT003-04.5,
                                              STANDARD EGT004-04. STANDARD AST001-04.3 and Best Practice
         8 Web Services        Technical      EGT-BP001 ).
                                              System data must be housed in an industry standard relational database
                                              management system (RDBMS), with Oracle being preferred due to WSI's
      9 DBMS                   Technical      current investment in Oracle.
     10 DBMS                   Technical      Data should be available 24 hours a day, 7 days a week.




                                                                 46 of 57
                                                Technical - System


                                   The Relational Database Management System (RDBMS) must provide the
                                   following

                                   -The ability to access the RDBMS for Online or Hot backups (Backups
                                   which are taken while data is still accessible to users).
                                   -The ability to access the RDBMS for Export of data (A picture of the data
                                   which is taken while data is still accessible to users).
                                   -The ability to access the RDBMS for an archiving of the entire RDBMS.
                                   (Archives are backups of the entire database with the RDBMS inaccessible
                                   to users).
                                   -The ability to restore the RDBMS using a point-in-time recovery feature
                                   which would allow WSI to simply provide a date or time up to which they
11 Disaster Recovery   Technical   wish the RDBMS to be restored.
12 DBMS                Technical   Describe methods and/or tools used to guarantee data integrity.
                                   Describe the software languages and development skills needed to
13 Development Tools   Technical   interface with and maintain application.
                                   The solution shall operate within the existing North Dakota Enterprise
                                   Architecture Standards for Network Environment 100Base T Ethernet
                                   (POLICY N003-96). Refer to Section 2.02 - State of North Dakota
14 Hardware            Technical   Technical Architecture - State Standards.
                                   The solution shall operate within the existing North Dakota ITD Standard
                                   Inter-LAN Communication Protocol Policy (Policy N001-95). Refer to
                                   Section 2.02 - State of North Dakota Technical Architecture - State
15 Hardware            Technical   Standards.
                                   The solution shall operate within the existing North Dakota Enterprise
                                   Architecture for Operating Systems and Platform Standard (Standard
                                   STD001-98). Refer to Section 2.02 - State of North Dakota Technical
16 Hardware            Technical   Architecture - State Standards.
                                   The solution shall operate within the existing North Dakota Enterprise
                                   Architecture for Desktop Operating Systems Standard (Standard DT003-
                                   06.1). Refer to Section 2.02 - State of North Dakota Technical Architecture -
17 Hardware            Technical   State Standards.




                                                      47 of 57
                                                   Business Technical - Implement




                                                                                                                            Glossary
Number   Subject Matter Area Type           Requirement                                                                     Link
                             (Business or
                             Technical)
                                            The vendor must provide its proposed transition approach for system
                                            implementation. The vendor's proposal must provide information that can
                                            be used by WSI to evaluate the vendor's knowledge of, and intended
                                            approach to, system transition and cutover. This information must include
                                            at least the following: Technical Transition Plan (transitioning of hardware,
                                            software, networks, data and operations to the new system.) and a
                                            Business Transition Plan (transitioning of WSI staff and business
  1      Implementation      Technical      processes to the new system).
                                            Hardware Requirements--Describe the site-specific hardware
  2      Implementation      Technical      requirements necessary to support implementation.
                                            Software Requirements--Describe any software required to implement the
                                            system (such as, software specifically designed for automating the
  3      Implementation      Technical      installation process).
                                            Network Requirements--Describe any network requirements required to
  4      Implementation      Technical      implement the system.
                                            Data Requirements--Describe specific data preparation and conversion
  5      Implementation      Technical      requirements that must be available for the system implementation.

                                            Facilities Requirements--Describe the site-specific physical facilities and
  6      Implementation      Technical      accomodations required during the system implementation period.
                                            Team--Describe the composition of the proposed implementation team
                                            (including credentials and relevant prior work experience) and the tasks to
  7      Implementation      Technical      be performed by each member of the implementation team.

                                            Schedule--Provide a detailed transition schedule that clearly defines key
  8      Implementation      Technical      milestones, deliverables, tasks, and responsibilities during implementation.
                                            Procedures--Describe any operational procedures that are used during
  9      Implementation      Technical      implementation such as a checklist, operations guide, etc.
                                            Describe vendor(s) experience related to the proposed system
  10     Implementation      Technical      implementation.




                                                                48 of 57
                                         Business Technical - Implement


                                  Describe the process for assuring that the system implementation was
                                  successful. (Please list all relevant references and clients with successful
11   Implementation   Technical   implementations).




                                                     49 of 57
                                                    Business Technical - Testing




                                                                                                                         Glossary
Number   Subject Matter Area Type           Requirement                                                                  Link
                             (Business or
                             Technical)
  1      System support      Technical      Describe how, on what schedule, and by whom your product will be tested
                                            to assure proper installation has been completed, before any WSI
                                            modifications have been incorporated. (get a baseline of the application
                                            functionality).
  2      System support      Technical      Describe how, on what schedule, and by whom your product will be tested
                                            after WSI business rule modifications.
  3      System support      Technical      Describe how your clients have successfully accomplished testing of your
                                            product after an upgrade to a new version and applying service upgrades.

  4      System support      Technical      Describe any tools available or bundled with your product that could be
                                            used for testing purposes to include automated functional testing tool
                                            scripts.
  5      System support      Technical      Describe what preprogrammed tests within your test plan are made
                                            available to your customers as part of the purchased product price.
  6      System support      Technical      Describe any support forums you provide for your customers to seek
                                            assistance and technical material?
  7      System Support      Technical      Describe features that your product has in order to support/monitor system
                                            performance. (e.g.audit logs, error logs, system notifications, etc.).

  8      Product Quality     Technical      Describe your company’s prior to release: test plan, manual and
                                            automated, to include functional, load and regression testing with the
                                            priority and pass/fail requirements of individual function points.
   9     Product Quality     Technical      Describe your load testing procedures.
  10     Product Quality     Technical      Describe how you communicate any and all unresolved issues to your
                                            customers prior to the release of the product?




                                                               50 of 57
                                                    Business Technical - Security




                                                                                                                        Glossary
Number   Subject Matter Area Type           Requirement                                                                 Link
                             (Business or
                             Technical)
                                            Ability for application to provide for secure user authentication. Please
  1      Security            Technical      describe.
                                            Describe how your application administers and applies security in each of
  2      Security            Business       its modules/areas.




                                                               51 of 57
                                                       Safety - Loss Prevention




                                                                                                                        Glossary
Number   Subject Matter Area Type           Requirement                                                                 Link
                             (Business or
                             Technical)
         Loss
  1      Prevention/Control  Business       Ability to integrate WSI's calendar system, such as: Microsoft Outlook.
         Loss
  2      Prevention/Control  Business       Ability to document customer visits/contacts based on WSI business rules.
         Loss                               Ability to automatically or manually assign employer services
  3      Prevention/Control  Business       representatives to an account based on WSI business rules.

                                            Ability for the customer to fully manage their account online and receive
                                            electronic notices for items such as Loss Runs, request services,
  4      Online               Business      experience rate wizard, and safety, grant and/or discount programs.
         Loss
  5      Prevention/Control   Business      Ability to associate policyholders based on WSI business rules.
         Loss                               Ability to administer and track safety, grant and/or discount programs
  6      Prevention/Control   Business      based on WSI business rules.
         Loss
  7      Prevention/Control   Business      Ability to integrate with WSI's Learning Management System.
         Loss                               Ability to identify policyholders eligible for premium discounts based on
  8      Prevention/Control   Business      WSI business rules.




                                                               52 of 57
               Term                Definition
                                   Data that are a deviation of the HIPPA norm on patients who do
"Captured" Pharmacy Transactions   not have an active claim with WSI.
                                   The process involved in investigating claims. This process is
                                   performed on all disability claims and can be carried out on
                                   claims of unusual filing (exposure claims, heart attack, etc...).
                                   Upon point of receipt, the adjustor initiates the following:
                                   1. Contact with Injured Worker
                                   2. Contact with Employer
                                   3. Contact with Medical Provider
                                   The purpose of the 3 point contact is to gain preliminary info on
                                   disability, Return to Work(RTW) and claim details

3pt Contact
                                   The processing and managing of claims, making the
                                   compensability and claims management decisions on a claim; to
                                   review the submitted claim and all pertinent information in the
                                   claim file and make a decision as to WSI's liability.
Adjudication
                                   When an independent contractor and/or owner of a business is
                                   applying for a contractor's license, this form is signed to state he
                                   or she does not have any employees and is not applying for
Affidavit of Non-employment        optional coverage.
                                   Provides North Dakota employers with multiple state workers'
                                   compensation coverage for employees who work temporarily
All State Incidental Coverage      outside the state.
                                   Calculation to determine a regular-interval payment plan to pay
Amortization Schedule              principal and interest
                                   System is set up so claims are automatically processed (based
                                   on pre-defined criteria) without adjuster involvement
Auto Adjudication
                                   Average Weekly Wage - The base from which disability
                                   payments at WSI are calculated. AWW is the weekly wage the
                                   employee was receiving from all employments at the date of first
AWW                                disability.
                                   The condition in which a business or individual cannot meet its
                                   debt obligations and petitions a federal court either for
                                   reorganization of its debts or liquidation of its assets. If a debt is
                                   owed for a period before the bankruptcy filing this is a pre-petition
                                   debt. If a debt is owed for a period after the bankruptcy filing this
Bankruptcy                         is a post-petition debt
                                   A Rule Base Engine that allows clients to separate business rules
Business Rules Engine              from application code.
                                   Correct Coding Initiative - CCI edits identify procedure codes
                                   (CPT codes) routinely bundled together. Codes that should be
CCI                                bundled together can not be billed separately.
                                   The status of an employer account when default occurs on a
                                   premium or medical expense assessment payment or when a
Collections                        required payment is not received on a claims overpayment.
                              The process of merging two existing claims into one.
                              Consolidation typically occurs when two claims for the same
                              injury are filed in error or a new claim is filed for an injury and it is
                              apparent the current problems stem from an injury on an already
                              existing (prior) claim.
Consolidation
                              An active account entity that enters into a merger, acquisition, or
Consolidations                purchase of the ownership rights of another account entity.
                              Current Procedural Terminology - Codes used to describe the
CPT                           procedure being performed by the medical provider.
Deductible                    A portion of covered loss not paid by the insurer.

                              This is the medical provider that an employer designates for all of
                              their employees to see in the instance of a work related injury.
Designated Medical Provider
                              A partial return of premium to the insured based on the insurer's
                              financial performance or the insured's loss experience.
Dividends
                              Durable Medical Equipment - This is a term used to indicate any
                              supplies or hardware a person would need i.e brace, cane,
DME                           guaze, etc.
                              The process by which experience rating data are applied to the
Experience Modification       premium of the insured.
                              A financial record survey of a person or organization that
Field Audit                   determines exposures, limits, premium, etc…
                              Global Packaging edits refers to the bundling of CPT codes. An
                              example would be the use of the CPT code for a specific
                              chemistry panel instead of using the CPT codes for each
                              individual test (glucose, potassium, chloride, BUN, etc). The new
                              system must recognize when a bundled code would be the
Global Packaging              appropriate billing mechanism.
                              An amount of money before deductions, usually associated with
Gross Wages                   salaries and wages.
                              Healthcare Common Procedure Coding System - These codes
                              include supplies and equipment provided as well as procedures
                              being performed. These codes are also used to indicate the
                              nature of an injury (location) as well as track preventative
HCPCS                         services being provided.
                              Information received regarding possible claimant, employer, or
Hotline Information           provider fraud.
                              International Classification of Diseases version 9 - These
                              diagnositic codes are used to descripe the injury or illness a
                              person has. These codes establish what is wrong with the
ICD-9                         individual.
                              A compensation payment including disability payments,
                              permanent partial impairment (PPI) awards, or a lump sum
Indemnity Payment             settlement payment.
                                     Ability to update and track overall demographics specific to an
                                     injured worker separate from a claim: such as name, alias,
                                     address, address history, phone, SSN, sex, date of birth, marital
                                     status, marital history dependant information, overpayments, prior
                                     injuries, previous WSI claims,special investigations history,
                                     vendor tax ID #, 1099 recipent, employment history, etc… This
                                     information should be readily accessible to the adjuster when
                                     managing a claim and customizable for additional categories to
Legal Entity                         be added.
Litigation                           Disputes pending before WSI or the courts.
                                     The date at which the injured worker first lost wages as a result of
Loss of Earnings(LOE)                the work injury.
                                     Workers' compensation insurance is mandatory for most
Mandatory Coverage                   employment. This coverage is required by law.
                                     The least amount of premium to be charged for providing a
Minimum Premium                      particular insurance coverage.
                                     Maximum Medical Improvement - Further recovery from, or
                                     lasting improvement to, an injury or disease can no longer
                                     reasonably be anticipated based upon reasonable medical
MMI                                  probability.
                                     Workforce Safety & Insurance is the sole provider and
                                     administrator of workers' compensation insurance in North
Monopolistic State                   Dakota.
                                     National Council on Prescription Drug Program - This is the
                                     standard transaction data format all pharmacies use when
NCPDP                                submitting data electronically.
                                     National Provider Identification Number - An assigned number a
                                     provider must obtain from the government. This number will be
                                     the number they will now need to use when providing service to
                                     any individual, regardless of payer. There will no longer be
                                     different numbers assigned from different insurance carriers,
                                     Medicare or Federal agencies. In addition to physicians, all
                                     medical providers and facilities will now need to have an assigned
                                     number submitted with any billed charge.
NPIN
                                     Orthopedic and Chiropractic Consultants (of North Dakota) - This
                                     contracted company reviews all of the chiropractic care being
                                     performed that is beyond the established window period.
OCC
                                     Provides assistance workers who have filed a claim, which may
                                     also include acting on behalf of workers aggrieved by a decision.
                                     Provides education to workers regarding the effect of a decision
Office of Independent Review (OIR)   made by the organization.
                                     Automatic deductions from an injured worker’s disability payment.
                                     When the full disability payment is calculated, the system will
                                     deduct the offsets that are set up on a particular claim from that
                                     disability amount. The offsets are set up by WSI business rules.
                                     Examples of offsets include: Social Security Disability,
                                     aggravations(WSI is only liable for a certain percent on the
                                     claim), overpayments, Social Security Retirement, etc.
Offsets
                                     Coverage for the owners, partners or corporate officers of a
                                     business corporation is optional. An employer may elect to
                                     purchase optional coverage for themselves, their spouse, and
                                     children under the age of 22. This coverage is not required by
Optional Coverage                    law.
                                     These are resources or agencies that WSI's Special Investigation
                                     Unit (SIU) utilizes in the course of an investigation. Outside
                                     sources include, but are not limited to, the Motor Vehicle
                                     Department, Job Service, and the Secretary of State's Office.
Outside Sources
                                     Pharmacy Benefit Administrator - WSI has contracted with a
                                     Pharmacy Benefit Administrator to assist in the processing of
PBA                                  pharmacy charges in a point-of-sale enviroment.
                                     Permanent Partial Impairment - This impariment award is
                                     provided to injured workers who have received a permanent
                                     impairment due to their injury and met the state requlations for
PPI                                  rating impairments.
                                     A worker who has incurred a compensible injury that resulted in a
                                     disability that poses a substantional obstacle to employment. In
                                     addition, employers who apply for and are approved as a
                                     preferred worker employer may not be assessed premiums on a
                                     preferred worker's salary for 3 years from the date of hiring.
Preferred Worker
                                     The amount of money an insurer charges to provide the coverage
Premium                              described in the policy or bond.
                                     A business entity that provides or leases employees or maintains
                                     a co-employment relationship with employers in North Dakota.
Professional Employer Organization
                                     A unit of cost that is multiplied by an exposure base to determine
                                     an insurance premium. An insurance rate is the amount of
                                     money necessary to cover losses, expenses, and provide a profit
Rate                                 to the insurer for a single unit of exposure.
                                     A calculating device in which data can be inputed to determine
                                     payment information for a given period of time, based on an
                                     Average Weekly Wage, a post injury wage, the marital and
                                     dependency status, etc... This information does not become a
Rate Calculator                      part of the permanent record of the claim
                                     Extends to incidental operations lasting fewer than 30
                                     consecutive days in a state where the employer has no other
                                     significant contacts with that state and those operations do not
                                     require the employer to purchase workers compensation
Reciprocal Coverage                  insurance under the laws of that state.
                                     This is the date, associated with a reapplication for disability
                                     benefits, when an Injured Worker has had a recurrence in losing
                                     wages due to the work injury, after an initial period of disability
                                     has already been paid. The recurrent loss of earnings is set up
                                     when it has been more than one year since WSI last paid
                                     disability benefits to the Injured Worker in question, and if the
                                     Injured Worker’s current wages at the time of reapplication are
                                     greater than the first Loss of Earnings date.
Recurrent Loss of Earnings(RLOE)
                       Dollar amounts set aside for the cost of the claim. Estimating the
                       total probable cost that will be incurred on a claim during its
Reserves               lifetime (See Total Cost Exposure definition).
                       A rating plan that adjusts the premium, subject to a certain
                       minimum and maximum to reflect the current loss experience of
                       the insured. Retrospective rating combines actual losses with the
                       graded expenses to produce a premium which more accurately
                       reflects the current experience of the insured. Adjustments are
                       performed periodically, after the policy has expired.
Retrospective Rating
                       The legal right to recover damages against a third party
                       (someone other than an employee or co-employee) who is at fault
                       for an employee's injury. This right may be brought by the injured
                       employee, the injured employee's dependents or WSI.
Subrogation
                       A monetary amount suspended on a claim when the injured
                       worker has been successful in a third-party lawsuit. Suspended
                       benefits are the dollar amount over which WSI has expended
                       monies on a claim. Payments on this claim are suspended until
                       the injured worker has absorbed this amount through his own
Suspended Benefits     payments.
                       The amount of payroll per employee used to bill premium, which
Taxable Wages          is based on 70% of the state's average annual wage.
                       This is the same as a reserve in which the total probable cost that
                       will be incurred on a claim during its lifetime. These funds are set
                       aside for the total cost of the claim (See Reserves definition).
Total Cost Exposures
                       A system designed to prioritize injuries/claims that demand the
                       most attention or pose the greatest potential for a high cost
Triage Risk Score      exposures.
                       Utilization Review - Utilzation Review provides for pre-service,
                       concurrent & retro-prosective reviews of services requiring prior
                       authorization from the medical providers in order to be performed.
UR
                       The maximum taxable payroll for each employee calculated by
                       establishing a wage cap of 70% of the state's average annual
Wage Cap               wage.
                       Weekly Compensation Rate - The rate at which an injured worker
WCR                    is paid disability based on WSI business rules.
                       Activities that include, but are not limited to diary events, system
                       events, calendar tasks, automated form creation, escalation,
Work Flow              document events, bill events, and user events.

				
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