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					PERSONNEL MANAGEMENT
  INFORMATION SYSTEM



ACCIDENT/INJURY
       &
   WORKERS’
 COMPENSATION
    SYSTEM



   OFFICE OF STATE PERSONNEL


      REVISED DECEMBER, 1997
                                                        TABLE OF CONTENTS


INTRODUCTION ................................ ................................ ........... .................. .................... .............1 -1
ACCIDENT/INJURY & WORKERS’COMPENSATION SYSTEM OVERVIEW ................................ ......... ............1 -1
FORMAT OF THIS MANUAL ................................ ................................ ...... ...............................................1 -1


GETTING INTO AND AROUND THE SYSTEM ................................ ................................ ............ 2-1
IMS ACCESS ................................ ................................ ................................ ................................ .......... 2-1
  Access to IMS Through a PC ............................................................................................................ 2-1
  Access to IMS Through a “Dumb” Terminal .................................................................................... 2-1
SECURITY - RACF SIGNON................................ ................................ ................................ ..................... 2-2
CHANGING YOUR PASSWORD................................ ................................ ................................ .................. 2-3
KEYBOARD TIPS ................................ ................................ ................................ ................................ ..... 2-3
PAGING ................................ ................................ ................................ ................................ ................. 2-4
  Standard PMIS Paging ..................................................................................................................... 2-4
  Getting Stuck in “Response Mode” .................................................................................................. 2-4
  Alternate IMS Paging Method ......................................................................................................... 2-5
TRANSACTION “ABENDS”................................ ................................ ................................ ....................... 2-6
LEAVING THE SYSTEM ................................ ................................ ................................ ............................ 2-6
THE ACCIDENT/INJURY & WC SYSTEM MAIN MENU ................................ ................................ ............... 2-7
THE OPTION LINE................................ ................................ ................................ ................................ ... 2-8
ENTERING “NON-PMIS EMPLOYEE”
DATA.......................................................................... ............................2 -9


FIGURE 2.1 - “RACF SECURITY SIGNON” SCREEN SAMPLE................................ ................................ ....... 2-2
FIGURE 2.2 - “ACCIDENT/INJURY AND WORKERS’COMPENSATION SYSTEM MAIN MENU” SCREEN ........... 2-7
FIGURE 2.3 - “EMPLOYEE DATA SCREEN” (Requirements For Incidents/Old Accounting System Format).............2-9
FIGURE 2.4 - “EMPLOYEE DATA SCREEN” (Requirements For Claims/New Accounting System Format)..............2-
10
FIGURE 2.5      - “EMPLOYEE DATA SCREEN” (All Fields Used/University Accounting System Format)....................2-10


OPTION 1 - ADD OR UPDATE AN INCIDENT REPORT.. ................................ ........... ................3 -1
FIGURE 3.1 - “INCIDENT REPORT” SCREEN SAMPLE ................................ ................................ ................ .3-1
FIGURE 3.2 - “TYPE OF ACCIDENT” SCREEN SAMPLE................................ ................................ ............... 3-5
FIGURE 3.3 - “NATURE OF INJURY” SCREEN SAMPLE ................................ ................................ .............. 3-6
FIGURE 3.4 - “PART OF BODY” SCREEN SAMPLE ................................ ................................ ..................... 3-7


OPTION 2 - UPDATE CLAIM/POST ACTION TO ACTIVITY LOG..... ............................ ..........4 -1
RECORDING FORMS SENT TO AND RECEIVED FROM THE INDUSTRIAL COMMISSION ................................ ... 4-8
ENTERING PROVIDER VISIT AND/OR BILL INFORMATION ................................ ................................ ........ 4-10
ENTERING PRESCRIPTION/EQUIPMENT BILL INFORMATION................................ ................................ ..... 4-16
RECORDING INDEMNITY PAYMENTS ................................ ................................ ................................ ...... 4-19
RECORDING OTHER EXPENSES ................................ ................................ ................................ .............. 4-23
SUBROGATION......................................................................... ................................ ....................... 4-26
SETTLEMENTS ................................ ................................ ................................ ................................ ...... 4-27

FIGURE 4.1 - “UPDATE CLAIM/ACTIVITY LOG” SCREEN SAMPLE ................................ .............................. 4-1
FIGURE 4.2 - “FORMS TO/FROM IC SCREEN SAMPLE................................ ................................ ................ 4-8
FIGURE 4.3 - “PROVIDER VISIT/BILL” SCREEN SAMPLE................................ ................................ ..........                         4-10
FIGURE 4.4 - “PRESCRIP/EQUIP BILL” SCREEN SAMPLE ................................ ................................ ..........                        4-16
FIGURE 4.5 - “INDEMNITY” SCREEN SAMPLE ................................ ................................ .........................                   4-19
FIGURE 4.6 - “OTHER EXPENSES” SCREEN SAMPLE................................ ................................ ................                        4-23
FIGURE 4.7 - “SUBROGATION” SCREEN SAMPLE ................................ ................................ ...............                           4-26
FIGURE 4.8 - “SETTLEMENT” SCREEN SAMPLE ................................ ................................ ......................                     4-27



OPTION 3- WC CLAIM INFORMATION/ACTIVITY LOG................................ .......................... 5-1
CLAIM STATUS ................................ ................................ ................................ ................................ ....... 5-1
PROVIDER VISITS/BILLS ON THE LOG ................................ ................................ ................................ ...... 5-3
UPDATING INFORMATION ON THE LOG ................................ ................................ ................................ .... 5-3
BREAKDOWN OF CLAIM EXPENDITURES ................................ ................................ ................................ .. 5-4

FIGURE 5.1 - “CLAIM ACTIVITY LOG” SCREEN SAMPLE (PAGE 1)................................ .............................. 5-1
FIGURE 5.2 - “CLAIM ACTIVITY LOG” SCREEN SAMPLE (PAGE 2)................................ .............................. 5-2
FIGURE 5.3 - “CLAIM ACTIVITY LOG - BREAKDOWN OF EXPENDITURES” SCREEN SAMPLE ........................ 5-4


OPTION 4- CLAIM INQUIRIES AND STATISTICS. ................................ ................................ ..... 6-1
THE AIWC INQUIRIES AND STATISTICS MENU ................................ ................................ ............ 6.1
ACCIDENT/INJURY AND WC CLAIMS EXTRACT................................... ................................ ....... 6-2
WC CLAIM ACTIVITY/EXPENDITURES EXTRACT.. ................................ ................................ ... 6-11
AIWC QUARTERLY REPORT REQUEST SCREEN.... ................................ ................................ .... 6-16

FIGURE 6.1- “AIWC INQUIRIES AND STATISTICS MENU......... ................................ ...................... 6-1
FIGURE 6.2 - “ACCIDENT/INJURY & WC CLAIMS EXTRACT FORMATTED SCREEN ................. 6-2
FIGURE 6.3 - “ACCIDENT/INJURY & WC CLAIMS EXTRACT - WC CLAIM LISTING................... 6-7
FIGURE 6.4 - “ACCIDENT/INJURY & WC CLAIMS EXTRACT - INCIDENT LISTING .................... 6-8
FIGURE 6.5 - “ACCIDENT/INJURY & WC CLAIMS EXTRACT - CLAIM TOTALS..... ..................... 6-9
FIGURE 6.6 - “ACCIDENT/INJURY & WC CLAIMS EXTRACT - INCIDENT TOTALS. ................... 6-9
FIGURE 6.7 - “WC CLAIM ACTIVITY/EXPENDITURES EXTRACT FORMATTED SCREEN...... .. 6-11
FIGURE 6.8 - “WC CLAIM ACTIVITY/EXPENDITURES LISTING....................... ........................... 6-14
FIGURE 6.9 - “WC CLAIM ACTIVITY TOTALS...................................... ................................ .......... 6-14
FIGURE 6.10 - “WC CLAIM EXPENDITURES TOTALS.................................. ................................ .. 6-15
FIGURE 6.11 - “AIWC QUARTERLY REPORT REQUEST FORMATTED SCREEN................ ......... 6-16


PROVIDER TYPE CODES/FACILITY CODES ................................ ............................ APPENDIX A

EDUCATIONAL LEVEL CODES........... ................................ ................................ ........ APPENDIX B

HANDICAP STATUS CODES............. ................................ ................................ ............ APPENDIX B

VETERAN STATUS CODES.............. ................................ ................................ ............. APPENDIX B

TYPE OF ACCIDENT CODES............ ................................ ................................ ............ APPENDIX C

NATURE OF INJURY CODES............ ................................ ................................ ............. APPENDIXC

PART OF BODY CODES................ ................................ ................................ ................ APPENDIX C
               1.      INTRODUCTION

Accident/Injury & Workers’Compensation System Overview

The purpose of the Accident/Injury and Workers’Compensation System (AIWCS) is to
enable on-line entry and tracking of safety & health incidents, and resulting workers’
compensation claims, through the Personnel Management Information System (PMIS).
This data will fulfill the statistical quarterly and annual reporting requirements for
Accidents/Injuries and Workers’Compensation Expenditures.

Questions concerning the data to be entered or Workers’Compensation Program Policy
should be directed to Lou Kost of Employee Risk Control Services Division at
(919) 733-6316. For system and database problems (particularly when instructed by a
screen message), contact Anita Newell of PMIS at (919) 733-2992. For these types of
problems, providing as much detail about what you were doing at the time the problem
occurred is extremely helpful. Screen prints and exact keying sequences are invaluable to
the error detection and correction process.

The goal of the AIWC System is to automate and thereby simplify the collection and
tracking of workers’compensation expenditures and safety & health incident information.

Format of this Manual

Interpreting the information in this manual will be easier by remembering that:

References to keyboard keys are capitalized
(ENTER KEY)

Words capitalized in BOLDFACE are actual keystrokes to be entered.
(/FOR SIGNON)

Screen field names are underlined and capitalized.
(DATE PAID)

Chapter titles are numbered, centered, capitalized and in boldface.
(1. INTRODUCTION)

Section titles within a chapter are in boldface on the left margin.
(AIWC System Overview)

Sub-sections within a section are underlined on the left margin.
(Access to IMS Through a PC)




                                             1-1
              2.      GETTING INTO AND AROUND THE SYSTEM


IMS (Information Management System) Access

The AIWC System, like the Personnel Management Information System as a whole, is an
on-line Information Management system housed on the mainframe at State Information
Processing Services (SIPS). However, with the proper connections, users may access it
through a variety of other computers.


Access To IMS Through a PC
If you are accessing PMIS through a PC, there are a variety of ways that the SIPS IMS
connection may be made. A computer systems person in your agency will assist you in
making that connection. Depending on the type of software your agency uses to make the
connection, you may have the following panel to fill in:

Enter Your Userid:
Password:                              New password:
Application:
Application required. No Installation Default

If you have a screen like this, fill in your User ID and Password, then type IMS in the
Application and press ENTER. Complete the new password only if you wish to change
your password.

If your screen does not look like this, you will probably specify IMS as the application
through some other means, such as choosing IMS or SIPS from a menu or clicking on an
                                                 s
IMS or SIPS icon, depending on your agency’ set-up.


Access To IMS Through a “Dumb” Terminal
For access to PMIS through a “dumb” terminal, you will begin at the point where the
following message is visible on the screen:

PMT123X IS CONNECTED TO THE STATE NETWORK -- HELP: 872-8841
/ 1-800-772-3946

When this screen is visible type IMS and press the ENTER key.




                                           2-1
RACF (Resource Access Control Facility) Signon
Whether accessing SIPS via “dumb” terminal or a PC, once you have successfully
connected to SIPS and specified IMS as the application, the following should appear:

  DFS3649A /SIGN COMMAND REQUIRED FOR IMS IMSA

    DATE:     06/04/96    TIME: 17:13:05

    NODE NAME: PMXI002A

    USERID:

    PASSWORD:

    USER DESCRIPTOR:
    GROUP NAME:
    NEW PASSWORD:

       OUTPUT SECURITY AVAILABLE


                                           Figure 2.1


If this screen does not appear, contact the State Network Help Desk at 872-8841 or
1-800-772-3946, to check the status of IMS. If it is not operational , the Help Desk will
provide an estimate of when IMS will become operational. Notice that your node name,
which identifies your SIPS connection, appears on this screen. It is important to know
your node name if you need to call the Help Desk concerning problems with your
session/connection.

The above screen is part of the Resource Access Control Facility (RACF) security system
that governs access to the SIPS mainframe. Unless you are changing your password, the
only information you need to enter is your user ID (also called RACF ID) and your
password. Key in the USERID and tab to PASSWORD (NOTE: if you press ENTER
instead of tabbing, you will get an error message and will need to key the USERID again).
After keying in your password, press ENTER. When you successfully pass through this
security check, this message will appear:

 DFS3650I SESSION READY FOR INPUT

If any other message appears, a RACF security problem has occurred. Without this
security approval, you will not be able to key in any IMS transactions and access to the
AIWC System will be denied. If you are not sure what your user ID is, or if you have
forgotten your password, contact your agency RACF Security Administrator for
                                                                 s
assistance. PMIS has no control over the assignment of user ID’ or passwords for users
outside of the Office of State Personnel.




                                              2-2
Changing Your Password

If you are changing your password, key in USERID, tab to PASSWORD and key in your
current password, then tab to NEW PASSWORD and key in your new password. Now
press ENTER and you should be asked to key the new password one more time for
verification.


Keyboard Tips

There are mainframe keys you will need to locate on your keyboard in order to
successfully use the AIWC System, other PMIS transactions, or any mainframe system. If
you are using a “dumb” terminal the keys will be clearly marked on the keyboard.
However, if you are using a PC, the keyboard will not have the mainframe keys. Not to
worry!! The software that enables you to access mainframe systems through a PC also
provides a way to substitute existing keys on your keyboard for use as the mainframe
                                s
keys. Check with your agency’ computer staff for the translation, more commonly
known as the “keyboard mapping”.

Below is a list of the keys you will need to locate, along with the more common PC
Keyboard equivalents. If the PC equivalents listed do not work on your PC keyboard,
     t
don’ panic. There are many different ways the keyboards are mapped and it depends on
the software your agency is using. Once you have determined where your mainframe keys
are, you are home free!

Mainframe Key                       Common PC Keyboard Equivalent

PA1 (used for paging)               PAGE UP Key or sometimes Ctrl + F1
CLEAR                               PAUSE
RESET                               ESC or ALT
ENTER                               CTRL or ENTER

PF1 thru PF12                       F1 thru F12
PF13 thru PF24                      SHIFT + F1 thru SHIFT + F12




                                         2-3
Standard PMIS Paging

Many PMIS transactions, as well as a few AIWC System transactions, display multiple
screen pages of output. Standard forward (and revolving) paging when using PMIS
transactions is by use of the PA1 key (or the equivalent on a PC Keyboard -see p. 2-4,
“Keyboard Tips”). After the last page of data is displayed, you will see the following
message:

DFS223 09:56:11 PAGE REQUESTED NOT CONTAINED IN CURRENT
MESSAGE

Continue to page forward using the PA1 key and the system will revolve back to the first
page of screen output. (For backward paging or advancing to a specific page, see p. 2-6,
“Alternate IMS Paging Method”).


Getting Stuck in “Response Mode”

At the end of a multiple page PMIS transaction (as described in “Standard PMIS Paging”,
above), you will get a screen with the following message:

DFS223 09:56:11 PAGE REQUESTED NOT CONTAINED IN CURRENT
MESSAGE

If you press the paging (PA1) key when you see this message, it will return you to the first
page sent in the transaction. If, however, you press the CLEAR key on this screen you
will become stuck in “response mode” and all further IMS activity will give you the
following message:

DFS2162 09:52:27 TERMINAL IN RESPONSE MODE - ENTER PA1 OR
PA2 THEN AWAIT REPLY

To exit the “response mode”, press the PA1 key, as the message indicates. The last screen
of data that you were viewing before you went into response mode should then appear.
Now it will be okay to press the CLEAR key and key in your next transaction.




                                            2-4
Alternate IMS Paging Method

Standard forward paging in PMIS transactions is by use of the PA1 key, however an
alternate IMS method is available. The built-in IMS method of paging allows the user to
go directly to a specific page in the group of output pages displayed. This can be
accomplished by using the following procedure:

       1) Overlay the PM in the transaction name in the top left corner of the screen
          with the desired paging command (listed below).

       2) Press the SPACE BAR

       3) Press ENTER.


       Paging Commands (enter everything in the quotes)
       “=L” Takes you to the last page in the group of pages displayed
       “=n” Takes you to the page specified by n (forward or backward)
       “=+n” Advances n pages
       “=-n” Goes back n pages


       Example:

       PMXCLAIM 333224444            (Transaction name and SSN in top left corner)

       =3    CLAIM 333224444         (Overlaying the transaction name with “=3” will
                                     cause the system to advance to the 3rd page in
                                     the group of pages currently displayed)




                                          2-5
Transaction “Abends”

Occasionally, when you are working in PMIS, instead of getting a normal screen response
from pressing ENTER or one of the PF (Program Function) keys, you may see a string of
data that looks like this:

  DFS55S1 TRAN PMXCLAIM ABEND SOC7,UG000 ; MSG IN PROCESS:
                     PMXCLAIM 2238350474
                       92/260 11:49:57

.
When you see two lines of data that look similar to this, the transaction you have just tried
has “abended” (abnormal ending). This abnormal ending is caused by a programming
failure.

When you get an “abend” on your screen, you should call PMIS and describe what you
were doing. This helps us more quickly determine the nature of the problem and informs
us that the transaction needs to be restarted. You should not try the same transaction
again before calling PMIS! Until the program is fixed, you will just generate another
“abend”.

Until the transaction is restarted, everyone in the system who tries to use the same
transaction will receive this message:

                                TRAN/LTERM STOPPED

For instance, the “abend” pictured above, was on a PMXCLAIM Transaction (Option 03-
View Claim Activity Log). Until the PMXCLAIM transaction is restarted by the PMIS
staff, no PMXCLAIM processing can take place by anyone in the system.


Leaving the System

When you are finished with the system, you need to “sign off” IMS. To do this, type
/RCL and press ENTER. The system should then return you to the screen you were on
when you specified IMS as the application.




                                            2-6
The Accident/Injury & WC System Main Menu

The starting point for the AIWC System is its main menu which is accessed by keying in
PMXWCMNU (space) (all IMS transaction names must be followed by a space - use the
SPACE BAR). The menu screen will appear (see figure 2.2). From this screen you will
                                                     s
choose the appropriate option and type the employee’ SSN, if required.
The following outlines the available options. A more detailed explanation of the screens
are in the chapters that follow.

OPTION

01               Screen used when adding a new Incident Report or updating previously
                 entered information.
02               Screen used to post new entries (activity) to the WC Claim
                 Information/Activity Log
03               View or revise a previous entry to the Claim Activity Log, which is a claim
                 information screen, displaying a line-by-line account of the activity that
                 has been posted on a claim.
04               Produce an on-line report of claims and incidents and agency totals
24               Return to the PMIS Main Menu

      PMXWCMNU            PPPPPPPPP     MMMMM MMMMM IIIIIIIII      SSSSSS
                        PP      PP     MM MM MM MM       II     SS    SS    *----------------*
                       PP      PP     MM MM MM MM      II      SS           | DATE: 10/01/96 |
                     PPPPPPPPP       MM MMMM MM       II       SS           | TIME: 12:26 PM |
                    PP             MM         MM    II            SS        | USER: OSP LEK |
                  PP              MM         MM    II       SS     SS       | RACF: SPWR009 |
                 PP             MM          MM IIIIIIII      SSSSS          *----------------*

                           PERSONNEL MANAGEMENT INFORMATION SYSTEM
                  ACCIDENT/INJURY AND WORKERS’ COMPENSATION SYSTEM MAIN MENU

                    01   ADD OR UPDATE AN INCIDENT REPORT
                    02   UPDATE CLAIM/POST ACTION TO ACTIVITY LOG
                    03   VIEW OR REVISE ACTIVITY LOG
                    04   CLAIM INQUIRIES AND STATISTICS
                    24   PMIS MAIN MENU




     CHOOSE OPTION:      __   SSN:   ___ __ ____ #___ NAME:______________________

     CHOOSE OPTION BY NUMBER OR USE FUNCTION KEY.

                                             Figure 2.2




                                                2-7
The Option Line

At the bottom of all Accident/Injury and Workers’Compensation System screens, you will
find the following line displayed:

CHOOSE OPTION: __ SSN: ___ __ ____ NAME:_________________
The purpose of this line is to facilitate movement around the system. In order to move
from one screen in the system to another, type the option number and the SSN, if
required. Program function keys (i.e., F1 - F24) may be used instead of typing the option
number. For example, to add a workers’compensation claim, you could type the
           s
employee’ SSN on the line and type 02 in OPTION or press the F2 key. For switching to
other screens when working with the same SSN, it is not necessary to key the SSN as long
as it appears somewhere on the screen you are currently working from. For example, if
you had just completed option 02 to add a claim and wished to view the WC Claim
Information/Activity Log for the claim just added, you could simply press the F3 key,
without typing the SSN.

Two options listed on the Accident/Injury and WC System Main Menu may also be
accessed from a clear screen, without going through the menu. These are the Incident
Report and Claim Activity Log screens. The transaction names associated with each
option and the format of the entry are described in more detail in subsequent chapters.




                                           2-8
                   ENTERING “NON-PMIS EMPLOYEE” DATA

The first time you select Option 1 and enter the social security number to record an
incident on an employee who is not on the PMIS system, such as a temporary or EPA
employee, you will get a message instructing you to check the social security number
entered, and if correct press F7 or enter 07 on the Choose Option line to enter employee
data. The PMXEMP screen (see figures 2.3 - 2.5) will display a screen through which
basic information about the employee must be entered before you will be able to add the
incident. The boldtype items in figure 2.3 are those items which are required in order to
enter an incident. The boldtype items in figure 2.4 are those items which will be required
to be completed in order to enter a claim. The screen in figure 2.5 is an example of a
screen with all fields completed. The fields which do not require data to be entered have
been provided to allow each agency flexibility for recording information for internal
tracking of activity and allocation of expenditures. The Employee Salary Funding
Information fields illustrated in figure 2.3 are an example of the format used by agencies
who have not converted to the new Statewide Accounting System (NCAS). This
information is displayed in figure 2.4 in the format used by agencies who have converted
to NCAS, and figure 2.5 is in the format used by universities.



    PMXEMP 111-22-3333,01           EMPLOYEE DATA

    EMPL SSN: 111-22-3333 INCID NO: 01       EMPL TYPE: _ EPA     _ INMATE X OTHER
    AGENCY: ADMIN - INDIAN AFFAIRS                      _ TEACHER _ STUDENT

       LAST NAME       FIRST NAME   INIT      AGE       RACE       SEX   EDUC   HANDICAP   VET
    DOE_______________ JON_________ J          45        W          M      _       __       _

    POSITION NUMBER      WORK COUNTY SCHEM    CLASSIFICATION TITLE    SALARY               GRADE
    1234 ____ ____ ___                                                  ___
                         ____________ _____ _________________________ ___                  ___

    APPT TYPE: _ PERM _ PROB _ TEMP _ TRNE                                    -TIME: _ (F/P)
                                                                   FULL OR PART

                     ***** EMPLOYEE SALARY FUNDING INFORMATION *****
                          BCODE    FUND     RCC/FRC   SALARY    PCT
                    01    14100    1311     311400     21000   100
                    02    _____    ____     ______    ______    ___
                    03    _____    ____     ______    ______    ___
                    04    _____    ____     ______    ______    ___
                    05    _____    ____     ______    ______    ___
                                             TOTAL    ______
     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
    ENTER=SAVE, OPTIONS:   01=INCIDENT REPORT 02=POST ACTIVITY      03=CLAIM LOG
    04=INQUIRIES 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJURY 11=PART OF BODY

                                            Figure 2.3
                                    (Requirements for Incidents/
                                      Old Accounting System)




                                               2-9
   PMXEMP 111-22-3333,01            EMPLOYEE DATA

   EMPL SSN: 111-22-3333 INCID NO: 01        EMPL TYPE: _ EPA     _ INMATE X OTHER
     AGENCY: OFFICE OF STE PERSN                        _ TEACHER _ STUDENT

      LAST NAME       FIRST NAME   INIT       AGE      RACE        SEX   EDUC   HANDICAP    VET
   DOE_______________ JON_________ J           45       W           M      _       _        _

   POSITION NUMBER      WORK COUNTY SCHEM    CLASSIFICATION TITLE                SALARY    GRADE
   4000 9999 9999 999   WAKE________ 01601 ADMINISTRATIVE ASST I                 021000     63

   APPT TYPE: _ PERM _ PROB X TEMP _ TRNE                          FULL OR PART-TIME: F (F/P)

                    ***** EMPLOYEE SALARY FUNDING INFORMATION *****
                         COMP     FUND     CENTER     SALARY   PCT
                   01    1301     1311     311400    _21000   100
                   02    ____     ____     ______     ______   ___
                   03    ____     ____     ______     ______   ___
                   04    ____     ____     ______     ______   ___
                   05    ____     ____     ______     ______   ___
                                            TOTAL      21000   100
    CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
   ** UPDATE COMPLETE ** 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
   04=CLAIM INQ 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJ 11=PART OF BODY

                                           Figure 2.4
                                    (Requirements for Claims/
                                    New Accounting System))




   PMXEMP 111-22-3333,01            EMPLOYEE DATA

   EMPL SSN: 111-22-3333 INCID NO: 01        EMPL TYPE: _ EPA     _ INMATE X OTHER
     AGENCY: UNC HOSPITALS                              _ TEACHER _ STUDENT

      LAST NAME       FIRST NAME   INIT        AGE      RACE       SEX   EDUC   HANDICAP    VET
   DOE_______________ JON_________ J            45       W         M      4       NO        N

   POSITION NUMBER      WORK COUNTY SCHEM    CLASSIFICATION TITLE                 SALARY   GRADE
   6095 1234 5678 910   WAKE________ 01601 ADMINISTRATIVE ASST I                 021000    63

   APPT TYPE: _ PERM _ PROB X TEMP _ TRNE                          FULL OR PART-TIME: F (F/P)

                    ***** EMPLOYEE SALARY FUNDING INFORMATION *****
                         BCODE    FUND    ACCT/DEPT SALARY      PCT
                   01    56096    0600     005231    011000     52
                   02    56096    0502     002805    010000     48
                   03    ____     ____     ______     ______    ___
                   04    ____     ____     ______     ______    ___
                   05    ____     ____     ______     ______    ___
                                            TOTAL     21000    100
    CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
   ** UPDATE COMPLETE ** 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
   04=CLAIM INQ 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJ 11=PART OF BODY

                                             Figure 2.5
                                         (All fields used/
                                   University accounting system)




Posting Employee Data is accomplished by entering the required information, as well as
any other information you wish to record in the provided fields, and pressing ENTER.


                                              2-10
Upon initial selection of the screen, the social security number (SSN), incident number
(INCID NO) and agency name will be displayed. The first time you are entering the data,
the incident number will be 01. Following is a list of the fields on the Employee Data
screen, and a brief description of each item. The system will automatically tab you to the
next item, from left to right. You may move around the screen either by tabbing, using the
arrow keys, or pointing and clicking with the mouse.

EMPL TYPE                                    Employee Type is a required field and may
                                             be recorded by selecting the appropriate field
                                             and typing an X on the line. Options are:
                                             EPA, Inmate, Other, Teacher, Student.

LAST NAME                                    This is a required field. Type the last name
                                             of the employee (up to 18 characters). No
                                             special characters are allowed except for
                                             hyphens or commas. Since you probably
                                                  t
                                             won’ be using the full line, tab to the next
                                             selection upon completion.

FIRST NAME                                   This is a required field. Type the first name
                                             of the employee (up to 11 characters). Since
                                                                 t
                                             you probably won’ be using the full line, tab
                                             to the next selection.

INIT                                         Type the middle initial of the employee, if
                                             known. This is an optional field.

AGE                                          This is a required field. Type the age of the
                                             employee at the time of the incident.

RACE                                         This is a required field. Type the appropriate
                                                                          s
                                             code to enter the employee’ race. Valid
                                             codes are: A = Asian;
                                              B = Black; H = Hispanic; I = American
                                             Indian/Alaskan Native; W = White
                                             U = Unknown

SEX                                          This is a required field. Type the appropriate
                                                                                 s
                                             code (M/F) to enter the employee’ gender.




                                          2-11
EDUC               This is an optional field. Type the
                   appropriate code to enter the employee’s
                   educational level. Refer to Appendix B for a
                   listing of valid codes.

HANDICAP           This is an optional field. Type the
                   appropriate code to enter the employee’   s
                   handicap status (at the time of the incident).
                   Refer to Appendix B for a listing of valid
                   codes.

VET                This is an optional field. Type the
                   appropriate code to enter the employee’s
                   veteran status. Refer to Appendix B for a
                   listing of valid codes.

POSITION NUMBER    The minimum requirement for data entry in
                   this field is the first four digits of the
                               s
                   employee’ position number which identifies
                   the department of division in which the
                   employee works. If desired, the entire 15
                   digit number may be keyed. The position
                   number may be obtained from your
                   Personnel Office. If only the first four digits
                   are used, tab to the next field.

WORK COUNTY        This is a required field once a claim is filed,
                   but is an optional field when only entering an
                   incident. Type the name of the county in
                   which the employee is based. If the entire
                   line is not used, tab to the next field.

SCHEM              This is a required field once a claim is filed,
                   but is an optional field when only entering an
                                                    s
                   incident. Type the employee’ (not the
                             s)
                   position’ 5 digit schematic code as printed
                                s
                   in the State’ Salary Plan Book which
                   includes schematic codes for all SPA
                   classification titles. A listing of EPA faculty
                   schematic codes is available by hard copy
                   report from PMIS. If the schematic is less
                                                        s
                   than 5 digits fill with leading zero’ (e.g.,
                   521 should be entered as 00521). If there is
                   no code available enter all nines (9).


                  2-12
CLASSIFICATION TITLE            Do not key anything in this field. After all of
                                the necessary information has been added to
                                the screen and you hit enter, the
                                Classification Title for the schematic code
                                previously entered will be displayed on the
                                screen and become a part of the record.

SALARY                          This is a required field once a claim is filed,
                                but is an optional field when only entering an
                                                                s
                                incident. Enter the employee’ salary in
                                whole dollars. Do not key the dollar sign ($)
                                or commas. For salaried employees key the
                                annual salary. For hourly employees key in
                                dollars and two decimal places. For
                                example, $12.50/hour would be keyed 12.50.

GRADE                           This is a required field once a claim is filed,
                                but is an optional field when only entering an
                                                                 s
                                incident. Key in the employee’ salary grade.
                                On T-grades, type a T after the number; on
                                X grades, put an X after the number. Type
                                FR for Flat Rate and NG for No Grade
                                (trainees).

APPT TYPE                       This is a required field once a claim is filed,
                                but is an optional field when only entering an
                                incident. Select the appropriate
                                Appointment Type by typing an X in the
                                blank preceding the field. Options are
                                PERM (Permanent), PROB (Probationary),
                                TEMP (Temporary) and TRNE (Trainee).

FULL OR PART TIME               This is a required field once a claim is filed,
                                but is an optional field when only entering an
                                incident. Type an F if the employee was full-
                                time or P if the employee was part-time at
                                the time of the incident.

EMPLOYEE SALARY FUNDING INFO    These are optional fields, however if you
                                wish to enter information under one or more
                                of the SALARY fields in this section, you
                                will be required to complete at least one of
                                the preceding three fields. Since the first
                                three fields will differ depending on the
                                accounting system utilized by


                               2-13
                                               agencies/universities, descriptions will not be
                                               provided here. Contact your Personnel or
                                               Accounting Office to determine what you
                                               should enter.

SALARY                                         Key in the annual salary paid under the
                                               accounting information entered in one or all
                                               of the first three fields on the line. For
                                               example if the employee was paid $20,000
                                               per year, but $5,000 was from a different
                                               source than the rest, key in the $5000 which
                                               is associated with the accounting codes
                                               relating to those wages. On the next line,
                                               key in the remaining $15,000 which is
                                               associated with the accounting codes for
                                               those wages. Do not key in the dollar sign
                                               or commas.

PCT                                            You do not need to enter anything in this
                                               field, as the system will calculate the
                                               percentage from the salary information
                                               entered on each line. The percentage for
                                               each source will be displayed after you hit
                                               the enter key (see figure 2.5).

Pressing ENTER upon completion of all required and desired fields will save the
information to the system, which will be reflected by the Update Complete message on the
bottom left corner of the screen. You are now ready to add an incident, which may be
accomplished by hitting the F1 key or typing 01 on the Choose Option line.

If you are adding a second incident for an employee whose records were previously
entered using the Employee Data screen, you will be instructed to hit F7 from the Incident
Report screen, which will bring you back to the screen displaying the employment
information entered at the time of the first incident. The information may be revised to
reflect current information at the time of the second incident, and the system will retain the
data previously entered which applied to the first incident.




                                            2-14
       3.      OPTION 1 - ADD OR UPDATE AN INCIDENT REPORT

Option 1 or PMXINCID is the screen used for adding an Incident Report to the AIWC
System (see figure 3.1). You may access this screen from the Option Line by choosing
                                  s
option 01 and typing the employee’ SSN; or you may access this transaction from a blank
screen by keying PMXINCID XXXXXXXXX (where X=SSN) or
PMXINCID NNNNNNNNNNNNNN (where N=Last Name).

This Incident Report screen enables the user to record all pertinent information about an
accident, injury or illness. The entries may be subsequently reviewed or revised by
selecting option 01 and entering the employee Social Security Number or Name. To add
an incident report, enter the appropriate information, key any necessary comments, and
press ENTER. For actions requiring additional information, the system will prompt you
to make the appropriate selections or key more data. Two lines are available for entering
comments about the action. Incident information will not be posted to the Claim Activity
Log (or claim history) unless a workers’compensation claim is actually filed. However,
you may view a previously entered Incident Report by selecting option 01 and entering the
name or SSN of the individual.
   PMXINCID 111-22-3333          INCIDENT REPORT
    EMPL NAME: DOE, MARY                  AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN: 987-65-4321 INCID NO: 01    EMPL TITLE: SOCIAL RESEARCH ASST II
         RACE: BLACK       SEX: FEMALE   AGE: 48 DOB: 02/26/48 CLAIM? Y IC REPT? N

     DATE OF INCIDENT:   07 12 96    TYPE OF ACCIDENT:   STRUCK AGAINST OBJECT
     TIME OF INCIDENT:   10 00 PM    NATURE OF INJURY:   FRACTURE
      DAY OF THE WEEK:   WEDNESDAY       PART OF BODY:   LOWER EXTREM, MULT PARTS
    DATE RPTD TO SUPV:   07 12 96     SUPERVISOR NAME:    LOU KOST
        DATE REPORTED:   07 20 96         REPORTED TO:    CARL GOODWIN
     ACCIDENT ON-SITE:   Y (Y/N)              WITNESS:   MARY FULMER

     TYPE OF CASE:    INITIAL INVESTIG:   ASSAULT STATUS:
     _ REPORT ONLY    X SUPERVISOR        _ CLIENT CAUSED     OSHA RECORDABLE: Y (Y/N)
     _ FIRST AID      _ SAFETY OFFICER    _ CLIENT ASSAULT         NO. DEPEND: _
     X INJURY         _ WCA               X NON-RELATED          MARITAL STAT: M (M/S)
     _ ILLNESS        _ OUTSIDE THE AGN
     _ FATALITY
    COMMENTS ______________________________________________________________________
              ______________________________________________________________________

     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
    ENTER=SAVE, OPTIONS:  A=ADD NEW INCIDENT D=DELETE INCIDENT   03=CLAIM LOG
    07=EMPL DATA 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJURY 11=PART OF BODY

                                          Figure 3.1

                                                              s
When this screen appears you will notice that the employee’ Name, Social Security
Number, Agency, Title, Race, Sex, Age and Date of Birth will display for verification - if
               s
the employee’ records are already on the PMIS Employee History database. This
information will be current at the time of the incident, and will be displayed on other
screens throughout the life of a workers’compensation claim, in the event one is filed. If
              s
the employee’ records are not on the PMIS database (e.g., EPA, Temporaries) refer to
page 2-10 to add employee data for these individuals.




                                             3-1
You will also notice a field called INCID NO. In the event of multiple incidents for the
same employee, the system will automatically number each new incident entered. The
example in Figure 3.1, shows that this is the first incident reported by this employee.
Also, for informational purposes, in the event you are revising or reviewing an Incident
Report previously entered, the screen will display a Y or N to indicate whether a claim has
been filed and whether it was IC Reportable.

The system will automatically tab you to the next data item, from left to right, however
you may move around the screen by tabbing or using the arrow keys.

DATE OF INCIDENT                             Enter the date of the accident, injury, or
                                             diagnosis of the illness in the MM DD YY
                                             format. (i.e., 07 12 96). In the event a WC
                                             claim is filed, this date will be displayed as
                                             the Date of Injury.

TIME OF INCIDENT                             Enter the time of day in which the incident
                                                                 0’
                                             occurred. Insert a ‘ if the time includes a
                                             single digit. Do not insert a colon, and type
                                             am or pm after the time.
                                             (i.e., 10 05 pm)

DAY OF WEEK                                  Enter the day of the week on which the
                                             incident occurred. You may type the full
                                             name of the day - or its abbrevation (Mon,
                                             Tues, Wed, Thurs, Fri, Sat, or Sun).

DATE REPTD TO SUPV                           Enter the date on which the employee first
                                             reported the incident to his/her immediate
                                             supervisor, or other person in authority (the
                                             Industrial Commission would consider this
                                             the “supervisor” for purposes of the
                                                        s
                                             employee’ reporting of the incident).

SUPERVISOR NAME                              Enter the name of the immediate supervisor
                                             or other person in authority to whom the
                                             employee first reported the incident.

DATE REPORTED                                Enter the date the incident was first reported
                                             to either the agency Safety Officer or WC
                                             Administrator (MM DD YY). In the event a
                                             WC claim is filed, the claim log will display
                                             the date the incident was reported as the first
                                             entry on the log.




                                            3-2
REPORTED TO                                   Enter the name of the Safety Officer or WC
                                              Administrator to whom the incident was first
                                              reported.

ACCIDENT ON-SITE                              Enter a Y if the incident occurred on the
                                              agency premises or work-site. If the incident
                                              occurred in a place other than the premises
                                              or work-site, an N should be entered, and
                                              you should enter the accident site in the
                                              COMMENTS section provided at the
                                              bottom of the screen.

WITNESS                                       Enter the name of any primary witness to the
                                              incident, or NA if there was no witness. If
                                              there were additional witnesses you wish to
                                              note, you may use the COMMENTS section
                                              at the bottom of the screen to name them.

After completing the information above, you will be prompted to select the appropriate
data field for the categories on the lower half of the screen. The system will automatically
tab you to the next section, from left to right, beginning with the TYPE OF CASE fields.
You may move around the screen to mark the proper selection either by tabbing or using
the arrow keys. The selection will be made by entering an X on the line next to the proper
answer.

TYPE OF CASE                                  Select whether the incident was report only,
                                              first aid or if it resulted in an injury, illness or
                                              fatality. NOTE: If a case was initially
                                              entered as report only or first aid and there is
                                              a subsequent entry indicating a Workers’
                                              Compensation claim has been filed due to
                                              lost work time or medical bills, the system
                                              will display a message to update the Incident
                                              Report by selecting injury or illness.

INITIAL INVESTIG                              Select the person who conducted the primary
                                              investigation of the incident.

ASSAULT STATUS                                This item is used only by agencies whose
                                              employees are subject to the statute relating
                                              to salary continuation for employees injured
                                              during acts of violence. The selection is
                                              based on whether the injury was caused by
                                              an action of the client, a direct assault by the
                                              client, or not related to the client at all.


                                            3-3
OSHA RECORDABLE                             Enter Y (Yes) if the incident is OSHA
                                            recordable and N (No) if not. The system
                                            will store this information for reporting
                                            purposes.

NO.DEPEND                                   You will be required to enter Number of
MARITAL STATUS                              Dependents and Marital Status (M =
                                            Married/ S = Single) in fatality cases only,
                                            and will be prompted to do so after checking
                                            FATALITY in the TYPE OF CASE
                                            category. You may enter the information on
                                            other type cases if you choose to do so.

COMMENTS                                    Use the COMMENTS section for a brief
                                            description of the incident, or for any
                                            notations you wish to make which you
                                            would like to appear on the claim log.

When you have finished entering the above information and have pressed ENTER to save
it, you will be prompted to complete the Type of Accident, Nature of Injury and Part of
Body fields. This information will be entered from other screens, as shown on the
following pages.




                                          3-4
TYPE OF ACCIDENT                                 Press F8 or enter 08 on the Option Line to
                                                 branch to the selections for this category.
                                                 The following screen will appear:


         PMXACCID 111-22-3333,01      INCIDENT REPORT

                                   SELECT TYPE OF ACCIDENT

     EMPL NAME: DOE, MARY                     AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
      EMPL SSN: 111-22-3333 INCID NO: 01 DATE OF INCIDENT: 07/12/96

     _   STRUCK AGAINST OBJECT                       _   ELECTRICAL SHOCK
     _   STRUCK BY FLYING OBJECT                     _   TOXIC MATERIAL EXPOSURE
     _   STRUCK BY OTHER OBJ OR PERSON               _   NOISE EXPOSURE
     _   FALLS (ALL TYPES)                           _   DISEASE EXPOSURE/NEEDLE STICK
     _   CAUGHT IN, UNDER OR BETWEEN                 _   REPETITIVE MOTION
     _   RUBBED OR ABRADED BY OBJECT                 _   VEHICLE OR EQUIPMENT ACCIDENT
     _   BODILY REACTION (SPRAIN, ETC.)              _   ACCIDENT TYPE, OTHER
     _   CONTACT W/ TEMPERATURE EXTREME




     CHOOSE OPTION: __    SSN: ___ __ ____
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY           03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJ          11=PART OF BODY

                                            Figure 3.2


The screen in Figure 3.2 displays a list from which you will select the Type of Accident.
The employee Name, Social Security number, Incident Number, Agency and Date of
Incident will appear on the top of the screen. Select one data field describing the accident
type by entering an X on the appropriate line. Press ENTER to save. From this screen
press F10 or enter 10 on the Option Line to branch to the Nature of Injury screen.




                                               3-5
NATURE OF INJURY

         PMXACCID 111-22-3333,01       INCIDENT REPORT

                                   SELECT NATURE OF INJURY

     EMPL NAME: DOE, MARY                     AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
      EMPL SSN: 111-22-3333 INCID NO: 01 DATE OF INCIDENT: 07/12/96

     _    AMPUTATION OR ENUCLEATION                   _   HEAT EXHAUSTION, SUNSTROKE
     _    BURN OR SCALD                               _   HERNIA OR RUPTURE
     _    CONTUSIONS, BRUISES                         _   SCRATCHES, ABRASIONS
     _    CUT (PUNCTURE)                              _   SPRAINS, STRAINS
     _    RASH FROM PLANTS                            _   FRACTURE
     _    RASH NOT FROM PLANTS                        _   MULTIPLE INJURIES
     _    ELECTRIC SHOCK                              _   INSECT/ANIMAL BITES
     _    INHALATION INJURY - TOXIC                   _   NEEDLE PUNCTURES
     _    FREEZING, FROSTBITE                         _   NON-CLASSIFIABLE
     _    HEARING LOSS OR IMPAIRMENT




     CHOOSE OPTION: __    SSN: ___ __ ____
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY            03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJ           11=PART OF BODY


                                            Figure 3.3


The screen in Figure 3.3 displays a list from which you will select the Nature of Injury.
Again, the employee Name, Social Security Number, Incident Number, Agency and Date
of Incident will appear on the top of the screen. Select one data field describing the nature
of the injury by entering an X on the appropriate line. Press ENTER to save. From this
screen press F11 or enter 11 on the Option Line to branch to the Part of Body screen.




                                                3-6
PART OF BODY

         PMXACCID 111-22-3333,01      INCIDENT REPORT

                                     SELECT PART OF BODY

     EMPL NAME: DOE, MARY                     AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
      EMPL SSN: 111-22-3333 INCID NO: 01 DATE OF INCIDENT: 07/12/96

     _   HEAD                                        _   LEGS (ABOVE ANKLE)
     _   EYES (INC. VISION)                          _   FOOT
     _   ARMS (ABOVE WRIST)                          _   TOES
     _   HAND                                        _   LOW EXTREM. MULT PARTS
     _   FINGERS                                     _   LOW EXTREM. NEC
     _   UP. EXTREM. MULT. PARTS                     _   MULTIPLE PARTS OF BODY
     _   ABDOMEN (INC. INT. ORG.)                    _   DIGESTIVE SYSTEM
     _   BACK (INC. MUSCLE SPRAIN)                   _   RESPIRATORY SYSTEM
     _   CHEST (INC. INT. ORGANS)                    _   CIRCULATORY SYSTEM
     _   HIPS (INC. PELVIC ORGANS)                   _   SKIN
     _   SHOULDERS                                   _   NON-CLASSIFIABLE
     _   TRUNK, MULT. PARTS


     CHOOSE OPTION: __    SSN: ___ __ ____
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY           03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU 08=TYPE OF ACCIDENT 10=NATURE OF INJ          11=PART OF BODY


                                            Figure 3.4


The screen in Figure 3.4 displays a list from which you will select the Part of Body. Once
again, the employee Name, Social Security Number, Incident Number, Agency and Date
of Incident will appear on the top of the screen. Select one data field describing the part
of body by entering an X on the appropriate line. Press ENTER to save. Press F1 or
enter 01 on the Option Line to return to the Incident Report screen, which should display
all information entered. Successful completion of this transaction will post an “Incident
Reported” line as the first entry on the Claim Activity Log in the event a claim is filed.

If you wish to add another Incident Report after completing one, press F1 or enter A in
the CHOOSE OPTION field on your current screen, followed by the Social Security
Number (SSN) or NAME for the next report. If you are finished, press F9 or choose
option 09 to return to the AIWCS Menu, or enter 24 on the Option Line to exit to the
PMIS Main Menu. Or, to exit PMIS completely, type /RCL after clearing the screen.




                                               3-7
4.      OPTION 2 - UPDATE CLAIM/POST ACTION TO ACTIVITY LOG

Option 02, or PMXCLACT,allows you to post new entries to the Claim Activity Log.
You may also access this transaction from a clear screen by typing
PMXCLACT XXXXXXXXX (X = SSN), or PMXCLACT NNNNNNNNNNNNN
(where N = Last Name). Once you choose option 02 and enter the SSN or Name, the
Update Claim/Activity Log screen will be displayed (see figure 4.1). You will use this
option after you have added an Incident Report (Option 1 Add or Update an Incident
Report). If an Incident Report has not yet been entered, you will not be able to add a
claim.

       PMXCLACT 111-22-3333,01   UPDATE CLAIM/ACTIVITY LOG

     EMPL NAME: DOE, MARY                       AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
      EMPL SSN: 111-22-3333    DOI: 07/12/96   CLAIM STATUS: OPEN/ACTIVE
      CLAIM NO: 241705370-01 IC NO: 123456   EFFECTIVE DATE: __ __ __

                 ****** ENTER EFFECTIVE DATE AND SELECT AN ACTION ******

          _   CLAIM FILED                      _     LOST DAY(S) IN WAITING PERIOD
          _   CONTACTED EMPLOYEE               _     UPDATE IC FILE NUMBER
          _   EMPLOYEE WENT ON WC LEAVE        _     OTHER EXPENSE
          _   EMPL RET TO WORK W/OUT RESTR     _     RESTRICTED DAYS FOR QUARTER
          _   EMPL RET TO WORK WITH RESTR      _     SUBROGATION RECOVERY
          _   FORMS SENT TO/RECEIVED FROM IC   _     SETTLEMENT
          _   PROVIDER VISIT/BILL              _     CLOSE CLAIM
          _   PRESCRIPTION BILL                _     RE-OPEN CLAIM
          _   INDEMNITY PAYMENT                _     COMMENTS ONLY


     COMMENTS ______________________________________________________________________
              ______________________________________________________________________
     CHOOSE OPTION: __    SSN: ___ __ ____ #__ NAME: __________________
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU


                                        Figure 4.1


Posting new entries to the Claim Activity Log (or claim history) is accomplished by
entering the effective date, choosing the appropriate action, keying any necessary
comments, and pressing ENTER. Two lines are available for entering comments about
the action. Only one action should be chosen for each transaction. You will be able to
continue entering additional information to the claim, if needed, by displaying a new
screen after posting each action. The way you can display a new screen is by hitting F2 or
entering 02 in the Choose Option line after you have received the Update Complete
message for the previous transaction. Each entry posted causes a line and any associated
comments to be added to the Claim Activity Log (see figure 5.1). For actions requiring
additional information, the system will branch to other screens. Actions which will branch
to other screens are: FORMS TO/FROM THE IC, PROVIDER VISIT/BILL,
PRESCRIP/EQUIP BILL, INDEMNITY PAYMENT, RECORD OTHER EXPENSE,
SUBROGATION RECOVERY (other screen available 7/97, however entries may be
made on this screen now; see page 4-21), and SETTLEMENT.




                                            4-1
Upon initial selection of the Update Claim/Activity Log screen from the PMXWCMNU
screen, the screen in figure 4.1 will appear. The Name, Social Security Number (SSN),
Agency and Date of Injury (obtained from the Incident Report data already entered) will
be displayed at the top of the screen. This information is what was current as of the date
of the incident and will be displayed throughout the life of the claim. The Claim Status
will be displayed by the System after initial entry of the claim, based on other information
entered about the claim.

The Claim Number will also be displayed by the System, and will consist of the
           s
employee’ Social Security Number with a number following it to identify the correct
claim in cases where employees have multiple claims. The first claim entered will be
numbered 01, and so on. When multiple claims exist for an employee, the System will
provide a list for selection purposes. The claim number will correspond with the Incident
Number. In most cases, 01 for the first claim. However, if there were multiple incidents
before a claim was filed, the System will provide a list from which you may choose the
Incident to which the claim applies. If the claim is associated with the Incident 03, the
claim number assigned will be 03. This will keep the Claim and Incident information
connected. Once the system assigns a Claim Number, you will never have to enter it - you
will simply choose from a list when there are multiple claims.

Following is a list of the data fields on the Update Claim/Activity Log screen, and a brief
description of each action. The system will automatically tab you to the next item, from
left to right, beginning with the Claim Filed field. You may move around the screen to
mark the proper selection either by tabbing or using the arrow keys. The appropriate
action may be selected by entering an X on the line to the left of the action.

EFFECTIVE DATE                                After selecting an action, enter the effective
                                              date of any action which does not branch to
                                              another screen. This will be the effective
                                              date reflected on the Claim Activity Log.
                                              For example, if the action being selected is
                                              Claim Filed, use the arrow keys to go to the
                                              effective date and type in the date the claim
                                              was filed. The date entered will show on the
                                              Log as the date on which the claim was filed.
                                              The date format is MM DD YY.




                                             4-2
CLAIM FILED                  The selection of this action, in combination
                             with the effective date entered, will record
                             on the Claim Activity Log the date on which
                             a claim was filed. The effective date entered
                             for injuries may be the date the Form 19 was
                             completed, as long as it is within 5 days of
                             the date of injury. If not, the date reported
                             to the supervisor should be the claim filing
                             date. For illnesses, the date of diagnosis is
                             always the claim filing date. NOTE: The
                             System will automatically identify the claim
                             as IC Reportable or Medical Only, for
                             reporting purposes, based on other
                             information recorded, regarding lost work
                             days and medical expenditures. The System
                             will also automatically record the Claim
                             Status as Open/Active until a Form 61 is
                             entered, indicating the claim was denied.

CONTACTED EMPLOYEE           The selection of this action, in combination
                             with the effective date entered, will record
                             on the Log dates of all employee contact.
                             Use the COMMENTS section to note the
                             main points from the conversation.

EMPLOYEE WENT ON WC LEAVE    The selection of this action, in combination
                             with the effective date entered, will record
                             on the Log the most recent date an employee
                             was removed from regular payroll and put on
                             workers’compensation leave. If a previous
                             entry indicated the employee had returned to
                             work with restrictions, after you ENTER this
                             action, you will be prompted to enter the
                             number of restricted workdays for which the
                             employee was paid full salary. (If there were
                             none, enter 0.) The figure entered at this
                             time will be added to any restricted workday
                             accumulation for which Indemnity was paid
                             (these restricted work days will be entered
                             on the Indemnity Screen.




                            4-3
EMPL RET TO WORK W/OUT RESTR          The selection of this action, in combination
                                      with the effective date entered, will record
                                      on the Log the most recent date the
                                      employee returned to work without
                                      restrictions. If a previous entry indicated the
                                      employee had returned to work with
                                      restrictions, after you ENTER this action,
                                      you will be prompted to enter the number of
                                      restricted workdays for which the employee
                                      was paid full salary. (If there were none,
                                      enter 0.) The figure entered at this time will
                                      be added to any restrictd workday
                                      accumulation for which Indemnity was paid
                                      (these restricted work days will be entered
                                      on the Indemnity Screen. NOTE: If the
                                      employee was on Salary Continuation,
                                      enter the lost and restricted workday
                                      information through the Other Expenses
                                      screen.

EMPL RET TO WORK WITH RESTR           The selection of this action, in combination
                                      with the effective date entered, will record
                                      on the Log the most recent date the
                                      employee returned to work with restrictions.
                                      Use the COMMENTS section to note the
                                      restrictions. It is important to update the
                                      claim as soon as the employee either returns
                                      to WC leave or returns to work without
                                      restricitions, in order to accumulate total
                                      lost/restricted workdays.

FORMS SENT TO/RECEIVED FROM IC Selection of this action will branch you to the
                               screen in Figure 4.2, which will record to the
                               Log the dates forms were sent to or received
                               from the Industrial Commission.

PROVIDER VISIT/BILL                   Selection of this action will branch you to the
                                      screen in Figure 4.3, which will record to the
                                      Log the dates of doctor visits, additional
                                      information about the visit, and medical
                                      expenditures and payment information to the
                                      physician or facility, as well as associated
                                      travel expenses.




                                     4-4
PRESCRIP/EQUIP BILL            Selection of this action will branch you to the
                               screen in Figure 4.4, which will record to the
                               Log the dates and payment information
                               relating to medicinal and equipment
                               prescriptions.

INDEMNITY PAYMENT              Selection of this action will branch you to the
                               screen in Figure 4.5, which will record to the
                               Log the dates, types and amounts of
                               indemnity payments. Lost and Restricted
                               Work Day information where Indemnity was
                               paid will also be recorded via this screen.

LOST DAYS IN WAITING PERIOD    Enter the number of lost work days in the
                               waiting period only up to 7. Then use the
                               arrow keys to go to the EFFECTIVE DATE
                               and press ENTER. The purpose of this entry
                               is to allow the System to count and
                               accumulate lost workdays - as of the
                               effective date entered - for claims which are
                               IC Reportable but do not result in an
                               indemnity payment. Once the payments
                               begin to be entered on the Indemnity screen,
                               the System will automatically begin with 7
                               lost work days in the count which
                               accumulates in the system.

UPDATE IC FILE NUMBER          Enter the IC File number provided by the
                               Industrial Commission, tab to the
                               EFFECTIVE DATE, type the date and press
                               ENTER. The IC number must only be
                               entered once, and the System will display the
                               number each time the claim file is opened for
                               updating or viewing.

OTHER EXPENSE                  Selection of this action will branch you to the
                               screen in Figure 4.6, which will record to the
                               Log the dates, types and amounts of
                               payments for other costs associated with the
                               claim, such as contracted Rehab Services,
                               Private Investigations, Equipment and Other
                               Property, as well as Salary Continuation.




                              4-5
RESTRICTED DAYS FOR QUARTER    This action will allow you to enter the
                               number of restricted workdays with full pay
                               when the employee continues in this status
                               beyond a quarter. Upon selection of this
                               action, you will be prompted to enter the
                               number of restricted workdays with full pay,
                               and the system will include this count in the
                               calculations for the Quarterly Statistical
                               Report. (Note: A full time employee typically
                               works 65 days per quarter.) If you need to
                               determine which employees are in this status
                               at the end of a quarter, use Option 6 on the
                               AIWC Inquiries and Statistics Menu to
                               extract a listing of these employees, using the
                               necessary parameters.

SUBROGATION RECOVERY           Selection of this action will branch you to
                               another screen which is currently under
                               development. In the meantime, you may use
                               the COMMENTS section to record
                               information you wish to appear on the Log.

SETTLEMENT                     Selection of this action will branch you to the
                               screen in Figure 4.7, which will record to the
                               Log the types and amounts of indemnity
                               payments, medical expenses, and attorney
                               costs associated with a settlement.

CLOSE CLAIM                    The selection of this action, in combination
                               with the effective date entered, will record
                               on the Log the date on which a claim was
                               closed. The System will automatically
                               record the Claim Status as Closed/Active
                               until the 2 year statute of limitations expires
                               or the claim is re-opened.

RE-OPEN CLAIM                  The selection of this action, in combination
                               with the effective date entered, will record
                               on the Log the date on which a claim was re-
                               opened. The System will automatically
                               record the Claim Status as Open/Active.

COMMENTS ONLY                  The selection of this action, in combination
                               with the effective date, will record on the
                               Log the effective date of what you are simply


                              4-6
                                            noting to the claim record using the
                                            COMMENTS section. This is not tied to
                                            any specific action.

COMMENTS                                    Use the COMMENTS section for any short
                                            notations you wish to make, which you
                                            would like to see upon viewing the claim log.

Press ENTER after completing the entry for each action. If you wish to post another
action to the Log after completing one, press F2 or enter 02 on the Option Line on your
current screen. If you are adding more information to the same claim, you do not need to
enter the Social Security Number (SSN) or NAME again; if you are entering information
for another claim, you must enter either the SSN or the NAME of the next individual. If
you wish to view the information entered on the Claim Activity Log, press F3 or enter 03
on the Option Line. If you are finished, press F9 or choose option 09 to return to the
AIWCS Menu, or enter 24 on the Option Line to exit to the PMIS Main Menu. Or, to exit
PMIS completely, type /RCL after clearing the screen.




                                          4-7
Recording Forms Sent To and Received From the Industrial Commission

You may get to this transaction by choosing the Forms Sent To/Received From IC action
from the screen displayed by Option 02 - Update Claim/Activity Log (See p. 4-17).


    PMXICF 111-22-3333             FORMS TO/FROM IC

    EMPL NAME: DOE, MARY                          AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN: 111-22-3333      DOI: 07/12/96    CLAIM STATUS: OPEN/ACTIVE
     CLAIM NO: 987654321-01   IC NO: 123456

        FORM NUMBER               SENT OR REC?           DATE SENT/REC
           26                          S                    12 01 96
        ______________________________________________________________________
        ______________________________________________________________________
           28T                         S                     12 01 96
        EMPLOYEE BEGAN TRIAL RTW - 4 HRS. DAY_________________________________
        ______________________________________________________________________
           26                          R                     12 15 96
        APPROVED BY IC________________________________________________________
        ______________________________________________________________________
           XXXX                        X                     MM DD YY
        ______________________________________________________________________
        ______________________________________________________________________


    CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
     ** UPDATE COMPLETE ** 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU     *** HIT F8 TO POST ANOTHER ACTION OF THIS TYPE ***


                                         Figure 4.2


The screen displayed in Figure 4.2 will be used to enter information on Forms sent to and
received from the Industrial Commission. The Employee Name, Social Security Number,
Agency, Date of Injury, Claim Number and IC Number (if one has been assigned) will be
displayed, based on information already entered on the Update Claim/Activity Log screen.
You will be prompted to enter the first form number and may tab or use the arrow keys to
move around the screen as needed. Up to four forms may be entered at a time on one
screen. A separate line will appear on the Log for each form. Comments may be entered
for each form sent or received. Certain forms entered on this screen will result in System
actions affecting the Claim Status, which are:
• Entering that a Form 61 was sent (S) will cause the Claim Status to show as Denied,
    as of the date the form was sent.
• When a Form 63 is entered, as sent (S), it will cause the Claim Status to show as
    Payment Without Prejudice. This status will remain for 90 days from the Date of
    Injury unless one of the following three actions are taken: 1) If a Form 61 is filed, the
    status will change to Denied; 2) If a Form 60 or 21 is sent, the status will change to
    Open/Active; 3) If no form has been completed, but medical or indemnity payments
    are being made after 90 days, the status will change to Open/Active.

FORM NUMBER                                     Enter the number of the form. Up to four
                                                digits are available. Simply type the form



                                             4-8
                                             number, omitting the ‘NCIC’which precedes
                                             the numbers on the actual forms.

SENT OR REC?                                 Answer the question by entering an S if the
                                             form was sent to the IC, and an R if the form
                                             was received from the IC. Use the Comment
                                             line provided below each form entry to note
                                             whether the form was approved,
                                             disapproved, revised, etc.

DATE SENT/REC                                Enter the date the form was sent or received
                                             in the MM DD YY format.


When you have finished entering the form(s) information, press ENTER to save. Select
an option listed at the bottom of the screen to go to the next desired screen:
• If you wish to enter more forms information, press F8 or enter 08 on the CHOOSE
    OPTION line, enter the Social Security Number or Name and press ENTER. (You
    must enter the SSN even if you are adding more information to the same claim, as a
    precaution against accidentally entering information which applies to another claim.)
• If you wish to go back to the Update Claim/Activity Log screen to post additional
    actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
    wish to continue entering information on the same claim, you do not need to enter the
    SSN (Social Security Number) again. If you wish to add or update another claim,
    enter the new SSN or the Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
    enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
    Menu, or enter 24 to exit to the PMIS Main Menu.




                                           4-9
Entering Provider Visit and/or Bill Information

You may get to this transaction by choosing the Provider Visit/Bill action from the screen
displayed by Option 02 - Update Claim/Activity Log (See p. 4-17).


    PMXDOCTR 111-22-3333,01      PROVIDER VISIT/BILL
    EMPL NAME: DOE, MARY                         AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN: 111-22-3333      DOI: 07/12/96   CLAIM STATUS: OPEN/ACTIVE
     CLAIM NO: 111-22-3333-01 IC NO: 123456    DATE PYMT REQ: 08 10 96

     DATE OF SERVICE:   07 12 96 SENT TO IC: 08 10 96
         PROVIDER ID:   44 4444444   PROV TYPE CODE: 11      PRIMARY TREATING: Y   (Y/N)
      PHYSICIAN NAME:   DR. SMITH                          SECOND OPINION/IME: _   (Y/N)
           TREATMENT/   SUTURES IN ARM AND LEG
           DIAGNOSIS:
                                                           PHYSICIAN FEES:      500. 00
       FACILITY NAME:   THE DOCTOR'S GROUP                  FACILITY FEES:         . 00
    FACILITY ADDRESS:   3300 BROWNING PLACE                    TRAVEL EXP:           00
          (OPTIONAL):   SUITE 2101                                  OTHER:         . 00
    CITY, STATE, ZIP:   RALEIGH         NC 27604 0000                      ------------
        PHONE NUMBER:   919 238 3504                                TOTAL:       500 .00

     EMPL CHOICE: Y (Y/N)    IN HOUSE: N (Y/N)    PAID: 02 15 97

    COMMENTS ______________________________________________________________________
             ______________________________________________________________________
    CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
     04=CLAIM INQ 09=MENU


                                         Figure 4.3


The purpose of the screen in Figure 4.3 is to enter information to the Log to track the
following: bill payment requests and payments by provider or facility; travel expenses
related to medical treatment; physician information relating to treatment or diagnosis, any
statements regarding prognosis, the type of visit and provider type. You will also be able
to record whether the physician is the current primary treating physician, whether the
                             s              s
physician was the employer’ or employee’ choice and whether or not it was In-house
treatment.

The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number (if one has been assigned and entered) will be displayed,
based on information already entered on the Update Claim/Activity Log screen. The
system will automatically tab you to each data field, from left to right, beginning with the
DATE PYMT REQ field. You may move around the screen either by tabbing or using the
arrow keys. Following are descriptions of the data fields:

DATE PYMT REQ:                                   The Date Payment Requested field should be
                                                 completed when a bill received by the WCA
                                                 has been forwarded to the appropriate
                                                 agency fiscal department for payment.




                                            4-10
DATE OF SERVICE    The Date of Service is the key field which
                   will be used to reference payment activity, as
                   well as any information which you wish to
                   note to the LOG regarding the provider’    s
                   comments. If the bill covers several diferent
                   dates of service, for example, 3 different
                   physical therapy treatments, you may just
                   enter the date of the last treatment and note
                   on the COMMENT line the dates of PT the
                   bill covered. Enter the date using the
                   MM DD YY format.


SENT TO IC         Enter the date a bill was sent to the Industrial
                   Commission for reduction approval, in the
                   MM DD YY format.


PROVIDER ID                       s
                   The Provider’ Federal ID Number MUST
                   be entered. Name and address information
                   for the provider is stored under this number
                   upon the first entry by any user in any agency
                   of the particular ID number. This
                   information will then automatically be
                   displayed each time thereafter when the same
                   Provider ID number is entered and the F10
                   key is pressed (or option 10 is chosen). This
                   will omit the need to re-type the address of
                   frequently used providers.


PROV TYPE CODE     Enter the Provider Type Code here to
                   identify the type of provider or facility to
                   which this transaction relates. To complete
                   this information you will need to refer to the
                   Provider/Facility Code List in Appendix A
                   (p. 5-47). Enter the appropriate two digit
                   code from the list to identify the Provider
                   Type.




                  4-11
Next you must select the type of visit for which the information being recorded relates.
You will choose between the following three scenarios:

PRIMARY TREATING                             Enter a Y if the information being recorded
                                             relates to the Primary Treating Physician.
                                             The name of the primary treating physician
                                             will be displayed in the top portion of the
                                             Log. You will be prompted to answer the
                                             question any time the Provider ID code is
                                             different than that which was originally
                                             identifed as the Primary Treating Physician.

SECOND OPINION/IME                           Enter a Y if the information being recorded
                                             relates to a visit for a Second Opinion or
                                             Independent Medical Examination.

After choosing the visit type, use the tab or arrow keys to move to the next field you wish
to complete.

PHYSICIAN NAME                               Enter the name of the physician to which all
                                             entries on the screen refer. If you are
                                             entering data for payment of a Facility bill,
                                             enter the name of the referring physician. By
                                             entering the appropriate Provider Code and
                                             related Federal ID number, the information
                                             being recorded will indicate payment to the
                                             facility.

TREATMENT/                                   You may enter comments on these lines,
DIAGNOSIS                                    regarding either the Treatment or Diagnosis,
                                             or both, based on statements from the
                                             Physician.

Fees

You can not enter fees for the Physician and the Facility in one transaction, when they
each have a separate Provider ID, as the charge will relate to only the Provider ID
Number entered above. If you wish to enter charges for a second bill with a different ID
Number, press ENTER at the end of the first transaction and enter 08 on the Option Line,
which will allow you to post another, separate provider visit/bill action.

PHYSICIAN FEES                               Enter the amount charged on the bill for
                                             services rendered on the DATE OF


                                           4-12
                    SERVICE by the Provider associated with
                    the referenced Provider ID number. (Be sure
                    the DATE PYMT REQ field is completed.)
                    However, if the bill is over the Fee Schedule
                    for a Medical Only case and must be sent to
                    the Industrial Commission for reduction
                    approval before a payment request can be
                    made, the SENT TO IC field must be
                    completed instead.

FACILITY FEES       Enter the amount charged on the bill for
                    services rendered on the DATE OF
                    SERVICE by the Facility associated with the
                    referenced Provider ID number. (Be sure the
                    DATE PYMT REQ field is completed.)
                    However, if the bill is over the fee schedule
                    and must be sent to the Industrial
                    Commission for reduction approval before a
                    payment request can be made, the SENT TO
                    IC field must be completed instead.

TRAVEL EXP          Enter the amount of travel expenses, relating
                    to medical treatment, which are being paid to
                    the employee. Then tab or arrow up to the
                    DATE PYMT REQ field and complete it as
                    described above.

OTHER               Enter amount of medical expenditure for
                    something not covered above or on the
                    Prescrip/Equip or Other Expenses screens
                    (See p. 4-31 and p. 4-38). Note the reason
                    for the expenditure in the COMMENTS
                    section.

TOTAL               You may enter the total amount of the
                    expenditures entered during this session, or
                    the System will total it for you when you
                    press ENTER.

FACILITY NAME       The first time the Provider ID number for a
FACILITY ADDRESS    facility is entered, the Facility name and
                    address must be entered in this field by the
                    user. Thereafter, any time the Provider ID
                    number is entered and the F10 key is pressed
                    (or 10 is entered on the Option Line), the


                   4-13
                                              name and address will automatically be
                                              displayed and will not require re-entry. The
                                              “facility” will be the name of a physician in
                                              private practice, or the name of a physician
                                              group or HMO which is associated with the
                                              Federal ID number. If the ID number has
                                              never been entered, type in the NAME and
                                              ADDRESS, tabbing to the next line; after
                                              typing the CITY you must tab to the STATE
                                              field (i.e., NC), from where you will
                                              automatically be tabbed to the ZIP.

PHONE NUMBER                                  Enter the telephone number of the Provider,
                                              including the area code; enter it for the
                                              facility if desired.

EMPL CHOICE                                   Enter Y (Yes) if the Provider was chosen by
                                              the employee. Enter N (No) if the medical
                                              care was directed by the agency WC
                                              Administrator.

IN-HOUSE                                      Enter Y (Yes) if the medical care was
                                              provided by an in-house medical facility of
                                              the agency. Otherwise, enter N for no.

PAID                                          This field will record the date the referenced
                                              expenditure was actually paid. If the date
                                              paid is not known at this time, you may
                                              come back to this screen from the Log to
                                              enter the information at a later time.

COMMENTS                                      Use the COMMENTS section for any other
                                              notations you wish to make which you
                                              would like to see upon viewing the claim log.


When you have finished entering the Provider Visit/Bill information, press ENTER to
save. Select an option listed at the bottom of the screen to go to the next desired screen:


• If you wish to enter more Provider Visit/Bill information, press F8 or enter 08 on the
  Option Line, enter the Social Security Number or Name, and press ENTER. (You
  must enter the SSN even if you are adding more information to the same claim, as a
  precaution against accidentally entering information which applies to another claim.)



                                            4-14
• If you wish to go back to the Update Claim/Activity Log screen to post additional
  actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
  wish to continue entering information on the same claim, you do not need to enter the
  SSN (Social Security Number) again. If you wish to add or update another claim,
  enter the new SSN or Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
  enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
  Menu, or enter 24 to exit to the PMIS Main Menu.




                                         4-15
Entering Prescription/Equipment Bill Information

You may get to this transaction by choosing the Prescription Bill action from the screen
displayed by Option 02 - Update Claim/Activity Log (See p. 4-17).


      PMXBILL    111-22-3333      PRESCRIP/EQUIP BILL
    EMPL NAME:   DOE, MARY                          AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN:   111-22-3333      DOI: 07/12/96    CLAIM STATUS: OPEN /ACTIVE
     CLAIM NO:   111-22-3333-01 IC NO: 000000     DATE PYMT REQ: __ __ __


       DATE INCURRED: __ __ __                               DATE PAID: __ __ __

       FEDERAL ID NO: __ _______                               PAID TO: _ EMPLOYEE
                                                                        _ COMPANY
        COMPANY NAME:   SUPPLY THE FEDERAL ID NO AND
     COMPANY ADDRESS:   CHOOSE OPTION 10 (OR F10)            MEDICINAL: 0000000 . 00
          (OPTIONAL):   FOR COMPANY ADDRESS                  EQUIPMENT: 0000000 . 00
    CITY, STATE, ZIP:   __________________ __ _____ ____               ------------
        PHONE NUMBER:   ___ ___ ____                             TOTAL: _______ . __



    COMMENTS ______________________________________________________________________
                                                                          ________
             ______________________________________________________________

    CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
    ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
    04=CLAIM INQ 09=MENU


                                          Figure 4.4


The purpose of the screen in Figure 4.4 is to enter information to the Log, to track
expenditures relating to prescribed medicine as well as equipment. You will also be able
to track the dates payments were requested and actually paid.

The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number (if one has been assigned and entered) will be displayed,
based on information already entered on the Update Claim/Activity Log screen. You may
tab or use the arrow keys to move around the screen as needed.

DATE PYMT REQ:                                 The Date Payment Requested field should be
                                               completed when a bill received by the WCA
                                               has been forwarded to the appropriate
                                               agency fiscal department for payment. Enter
                                               the date in the MM DD YY format.

DATE INCURRED                                  The date the expenditure was incurred would
                                               be the date the prescription was filled,
                                               whether it covers medicine or equipment
                                               provided. Enter the date in the MM DD YY
                                               format.




                                            4-16
DATE PAID          This field will record the date the referenced
                   expenditure was actually paid.

PROVIDER ID        Do not enter anything here if the payment
                   was made to the employee. The Federal ID
                   Number of the pharmacy or company
                   supplying the prescriptives MUST be
                   entered. Press F10, or enter 10 on the
                   Option Line, to cause the System to display
                   any previously stored address information for
                   this pharmacy/company. The System will
                   store the related name and address upon the
                   first entry by any user in any agency of the
                   particular ID number. This information will
                   then automatically be displayed each time
                   thereafter, when the same Provider ID
                   number is entered and the F10 key is
                   pressed. This will omit the need to re-type
                   the address of frequently used pharmacies or
                   companies.

Paid To:
EMPLOYEE           To indicate whether the payment has or will
COMPANY            be paid to reimburse the employee or will be
                   paid directly to the pharmacy or company,
                   enter an X on the appropriate line.

COMPANY NAME       The first time the Federal ID number for a
COMPANY ADDRESS    company ( or pharmacy) is entered, the name
                   and address must be entered in this field.
                   Thereafter, any time the Federal ID number
                   is entered and the F10 key is pressed (or 10
                   is entered on the OptionLine), the name and
                   address will automatically be displayed and
                   will not require re-entry. Do not enter
                   anything here if the payment is being made to
                   reimburse the employee.

PHONE NUMBER       Enter the telephone number of the pharmacy
                   or company, including the area code.




                  4-17
MEDICINAL                                   Enter the cost of any prescription for drugs,
                                            or anything used for medicinal purposes,
                                            relating to the injury or illness.

EQUIPMENT                                   Enter the cost of any prescribed equipment,
                                            such as crutches, wheel-chair, tens unit, etc.

TOTAL                                       You may total the amount of expenditures
                                            which has been entered during this session,
                                            or the System will total it for you when you
                                            press ENTER.

COMMENTS                                    Use the COMMENTS section for any other
                                            notations you wish to make which you
                                            would like to see upon viewing the claim log.

When you have finished entering the Prescription/Equipment Bill information, press
ENTER to save. Select an option listed at the bottom of the screen to go to the next
desired screen:
• If you wish to enter more Prescription/Equipment information, press F8 or enter 08 on
    the Option Line, enter the Social Security Number or Name, and press ENTER. (You
    must enter the SSN even if you are adding more information to the same claim, as a
    precaution against accidentally entering information which applies to another claim.)
• If you wish to go back to the Update Claim/Activity Log screen to post additional
    actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
    wish to continue entering information on the same claim, you do not need to enter the
    SSN (Social Security Number) again. If you wish to add or update another claim,
    enter the new SSN or Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
    enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
    Menu, or enter 24 to exit to the PMIS Main Menu.




                                          4-18
Recording Indemnity Payments

You may get to this transaction by choosing the Indemnity Payment action from the
screen displayed by Option 02 - Update Claim/Activity Log (See p. 4-17).


      PMXCOMP    111-22-3333           INDEMNITY
    EMPL NAME:   DOE, MARY                        AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN:   111-22-3333    DOI: 07/12/96    CLAIM STATUS: OPEN/ACTIVE
     CLAIM NO:   111223333-01 IC NO: 123456         DATE PAID: __ __ __

                                         ACCUM          PYMT INCL WAITING PERIOD? _ (Y/N)
      PERIOD: __ __ __ THRU __ __ __    TO DATE        (IF YES, DO NOT COUNT THOSE
         FOR: ____ LOST WORK DAYS           49         SEVEN LOST WORK DAYS - THE
              ____ RESTRICTED WORK DAYS     76         SYSTEM HAS COUNTED THEM)

      AVG. WEEKLY WAGE: 0000 . 00                             AMT. PAID AS OF LAST
     COMPENSATION RATE: 0000 . 00           THIS PAYMENT      PAYMENT ON 05/30/97
       DAILY COMP RATE: 0000 . 00       TTD: 0000000 . 00              600.00
                                        TPD: 0000000 . 00              600.00
       EMPLOYEE SALARY:   $21510        PPD: 0000000 . 00              300.00
         LAST WORK DAY: 08/09/96        PTD: 0000000 . 00              400.00
         DATE RETURNED: 12/01/96      DEATH: 0000000 . 00            1000.00

   COMMENTS ______________________________________________________________________
            ______________________________________________________________________

   CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
   ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
   04=CLAIM INQ 09=MENU


                                          Figure 4.5




The purpose of the screen in Figure 4.5 is to enter information to the Claim Activity Log
for tracking Indemnity expenditures relating to lost or restricted work days. You will be
able to track the period covered by the payments, the type of payments, and the dates
payments were actually paid. This screen will be used to record lost and restricted
workdays for which Indemnity was paid, which the system will accumulate and summarize
on the last page of the Log.

The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number will be displayed, based on information already entered on
the Update Claim/Activity Log screen. The system will automatically tab you to each data
field, from left to right, beginning with the DATE PAID field. You may move around the
screen by tabbing or using the arrow keys. Following are descriptions of the data fields:


DATE PAID                                      This field will record the date the referenced
                                               expenditure was actually paid. Enter the
                                               date in the MM DD YY format.




                                             4-19
PAYMENT INCL WAITING PERIOD    If the first Indemnity payment was not paid
                               until after the employee missed 21 days, the
                               payment probably includes compensation for
                               the seven day waiting period. If the answer
                               is Yes (Y), do not count the 7 day waiting
                               period when completing the Lost and
                               Restricted Workdays field on this screen.
                               The system will automatically add the first 7
                               lost workdays to the count.

PERIOD...THRU                  Enter the dates (MM DD YY) covered by
                               the indemnity payment being recorded. It is
                               recommended that you enter this information
                               on a monthly basis. This will allow clean
                               reporting of the quarterly statistics, by
                               summarizing statistics for each month in the
                               quarter. This will also keep you up-to-date
                                                               s
                               on the status of the employee’ recovery.

LOST WORK DAYS                 Enter the number of lost or restricted
RESTRICTED WORK DAYS           work days that this payment covers. Do not
                               count the 7 day waiting period, as the system
                               knows that the waiting period has passed
                               upon the first entry of an indemnity payment,
                               and the 7 days will automatically be added to
                               the total accumulation.

ACCUM TO DATE                  The system will keep running totals of lost
                               and restricted workdays for which Indemnity
                               was paid, including the 7 day waiting period,
                               which will be displayed in this section. The
                               amount displayed will be the total as of the
                               previous Indemnity transaction entered.




                              4-20
AVERAGE WEEKLY WAGE          The first time you are entering Indemnity
COMPENSATION RATE            information on a claim, you must enter the
DAILY COMP RATE              Average Weekly Wage, Compensation Rate
                             and Daily Compensation Rate. Thereafter
                             when you enter new Indemnity information,
                             these three fields will display the information
                             and need not be re-typed.

This Payment
TTD                           Enter the amount covered by the payment,
TPD                           relative to the date entered in the DATE
PPD                           PAID field, in the blank next to the type of
PTD                           payment. Only one payment type may be
DEATH                        entered per transaction. If one check
                             included payments for a few days of
                             Temporary Total Disability (TTD), as well as
                             a period of Temporary Partial Disability
                             (TPD), each must be broken out and entered
                             separately. Permanent Partial Disability
                             (PPD), Permanent Total Disability (PTD)
                             and Death payments would also be entered
                             using separate transactions.

AMT LAST PAID ON MM/DD/YY                 s
                             The System’ running totals of Indemnity
                             payments will be displayed in this section.
                             The amount displayed will be the total as of
                             the previous Indemnity payment made on the
                             date indicated.

EMPLOYEE SALARY              The System will display the employee’   s
                             annual salary as of the date of the Incident.
                             This may be used in calculating the
                             Compensation Rate.

LAST DAY WORKED              The system will display the most recent last
                             day worked, based on the information
                             entered with the EMPLOYEE WENT ON
                             WC LEAVE action on the Update Claim/
                             Activity Log




                            4-21
DATE RETURNED                               The system will display the most recent
                                            return to work effective date, based on the
                                            information entered with the EMPLOYEE
                                            RET TO WORK WITH (OR W/OUT)
                                            RESTR action on the Update Claim/
                                            Activity Log.

COMMENTS                                    Use the COMMENTS section for any other
                                            notations which you would like to see upon
                                            viewing the claim log.



When you have finished entering the Indemnity information, press ENTER to save. Select
an option listed at the bottom of the screen to go to the next desired screen:
• If you wish to enter more Indemnity information, press F8 or enter 08 on the Option
    Line, enter the Social Security Number or Name and press ENTER. (You must enter
    the SSN even if you are adding more information to the same claim, as a precaution
    against accidentally entering information which applies to another claim.)
• If you wish to go back to the Update Claim/Activity Log screen to post additional
    actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
    wish to continue entering information on the same claim, you do not need to enter the
    SSN (Social Security Number) again. If you wish to add or update another claim,
    enter the new SSN or the Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
    enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
    Menu, or enter 24 to exit to the PMIS Main Menu.




                                          4-22
Recording Other Expenses

You may get to this transaction by choosing the Other Expense action from the screen
displayed by Option 02 - Update Claim/Activity Log (See p. 4-17).

      PMXBILL    111-22-3333,01        OTHER EXPENSES
    EMPL NAME:   Doe, Mary                       AGENCY/UNIV: ADMIN/GOV CNCL/YOUTH
     EMPL SSN:   111-22-3333    DOI: 07/12/96    CLAIM STATUS: OPEN /ACTIVE
     CLAIM NO:   111223333-01 IC NO: 123456        DATE PAID: __ __ __

       TYPE OF EXPENSE:                    AMOUNT OF EXPENSE: 0000000 . 00

       _   REHAB COMPANY (VOC REHAB, REHAB NURSE, ETC)      CURRENT SALARY: $17717
       _   CASE MANAGEMENT
       _   INVESTIGATION                                  _ SALARY CONTINUATION
       _   FUNERAL EXPENSES
       _   RE-EMPL ASSISTANCE                             FROM __ __ __ TO __ __ __
       _   EQUIP & OTHER PROPERTY
       _   AMBULANCE                                      ____ LOST WORK DAYS
       _   MEDICAL BILL REVIEW                            ____ RESTR WORK DAYS
       _   OTHER


    COMMENTS ______________________________________________________________________
             ______________________________________________________________________

     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
    ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
    04=CLAIM INQ 09=MENU


                                          Figure 4.6




The purpose of the screen in Figure 4.6 is to enter information to the Claim Activity Log
to track workers’compensation expenditures which are not true medical or indemnity
payments. You will be able to track costs for contracted Managed Care services, Rehab
services (such as Vocational Rehabilitation, Rehab Nurse), contracted Re-employment
Assistance, as well as the cost of damage to State equipment and property and Salary
Continuation. The system will accumulate and summarize these costs on the last page of
the Log. The applicable expenses entered here may be combined, if desired, with the
Medical expenditures for reporting purposes, in order to do comparisons with historical
costs.

The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number will be displayed, based on information already entered on
the Update Claim/Activity Log screen. The current salary will also be displayed, for use
when entering Salary Continuation The system will automatically tab you to each data
field, from left to right, beginning with the DATE PAID field. You may move around the
screen to mark the proper selection either by tabbing or using the arrow keys. The
appropriate expense type may be selected by entering an X on the line to the left of the
description. Use the COMMENTS section to enter the name of the company being paid.
Following are descriptions of the data fields:




                                            4-23
DATE PAID                   Enter the date the expenditure was paid, in
                            the MM DD YY format.

AMOUNT OF EXPENSE           Enter the amount of the expenditure.


Type Of Expense:
REHAB COMPANY               Mark this field if a rehab company has been
                                                            s
                            hired to assist in the employee’ recovery.
                            This may include vocational rehabilitation, or
                            a contract with a Rehab Nurse.

CASE MANAGEMENT             Mark this field if a vendor has been hired to
                            assist with case management.

INVESTIGATION               Mark this field if a private investigation
                            company has been hired on the case.

FUNERAL EXPENSES            Mark this field to denote that the payment
                            was for funeral services.

RE-EMPLOYMENT ASSISTANCE    Mark this field if a company has been hired
                            to assist the employee in finding other
                            employment.

EQUIP & OTHER PROPERTY      Mark this field to denote that the payment
                            was for damages to equipment or other
                            property, for which the state was liable.

AMBULANCE                   Mark this field to denote that the payment
                            was for ambulance service.

MEDICAL BILL REVIEW         Mark this field if the payment is for
                            contracted services to review medical bills
                            for Fee Schedule compliance.

OTHER                       Enter amount of medical expenditure for
                            something not covered above. Note the
                            reason for the expenditure in the
                            COMMENTS section.




                           4-24
SALARY CONTINUATION                          Mark this field and enter the beginning and
                                             ending dates of the period the payment
                                             covered. You must enter the ending date in
                                             order for the amounts to be summarized and
                                             captured in the quarterly report statistics for
                                             the proper quarter. You may cover a period
                                             of up to three months which correspond to
                                             a calendar quarter with one transaction and
                                             enter the DATE PAID as the last day of the
                                             quarter; or you may enter the information
                                             monthly.


LOST WORK DAYS                               Enter the number of lost and/or restricted
RESTRICTED WORK DAYS                         work days during the period this payment
                                             covers. These lost days should only be those
                                             covered by Salary Continuation. If the two
                                             year period expires and the employee begins
                                             workers’compensation, lost time should be
                                             entered elsewhere, as described in the
                                             Update Claim/Acticity Log screen section.

COMMENTS                                     Use the COMMENTS section for any other
                                             notations you wish to make, which you
                                             would like to see upon viewing the claim log.

When you have finished entering the Other Expenses information, press ENTER to save.
Select an option listed at the bottom of the screen to go to the next desired screen:
• If you wish to enter more Other Expenses information, press F8 or enter 08 on the
    Option Line, enter the Social Security Number or Name and press ENTER. (You
    must enter the SSN even if you are adding more information to the same claim, as a
    precaution against accidentally entering information which applies to another claim.)
• If you wish to go back to the Update Claim/Activity Log screen to post additional
    actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
    wish to continue entering information on the same claim you do not need to enter the
    SSN (Social Security Number) again. If you wish to add or update another claim,
    enter the new SSN or Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
    enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
    Menu, or enter 24 to exit to the PMIS Main Menu.




                                           4-25
Subrogation Recovery

You may get to this transaction by choosing the Subrogation Recovery action from the
screen displayed by Option 02 - Update Claim/Activity Log. The purpose of the screen
in Figure 4.7 is to enter information to the Claim Activity Log and to track subrogation
recovery.
    PMXSUBR   111-22-3333,01     SUBROGATION INFORMATION             2

    EMPL NAME: DOE, MARY                      AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN: 111-22-3333    DOI: 07/12/96   CLAIM STATUS: OPEN/ACTIVE
     CLAIM NO: 111223333-01 IC NO: 123456   EFFECTIVE DATE: __ __ __


                    THIRD PARTY NAME:   ______________________________
                             ADDRESS:   _________________________
                          (OPTIONAL):   _________________________
                    CITY, STATE, ZIP:   _______________ __ _____ ____
                        PHONE NUMBER:   ___ ___ ____
                DATE OF LAST CONTACT:   __ __ __
                     AMOUNT RECEIVED:   00000000 . 00
                              REASON:   ______________________________


    COMMENTS ______________________________________________________________________
             ______________________________________________________________________


     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
     04=CLAIM INQUIRIES   09=WC MAIN MENU    24=PMIS MENU

                                          Figure 4.7


The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number will be displayed, based on information already entered on
the Update Claim/Activity Log screen. Following are descriptions of the data fields:

THIRD PARTY NAME                               Enter the name of the party from which the
                                               subrogation is being recieved.

ADDRESS                                        Enter the fulladdress and telephone number
CITY, STATE, ZIP                               of the third party.
PHONE NUMBER

DATE OF LAST CONTACT                           Enter the date of the last communication
                                               with the third party.

AMOUNT RECEIVED                                Enter the dollar amount of the subrogation.

REASON                                         If desired, enter the reason for the
                                               subrogation.
When you have finished entering the Settlement information, press ENTER to save.
Select an option listed at the bottom of the screen to go to the next desired screen:




                                             4-26
Settlements

You may get to this transaction by choosing the Settlement action from the screen
displayed by Option 02 - Update Claim/Activity Log.


      PMXCOMP    111-22-3333          SETTLEMENT
    EMPL NAME:   DOE, MARY                        AGENCY/UNIV: ADMIN-GOV CNCL/YOUTH
     EMPL SSN:   111-22-3333    DOI: 07/12/96    CLAIM STATUS: OPEN/ACTIVE
     CLAIM NO:   111223333-01 IC NO: 123456   EFFECTIVE DATE: 09 01 97


                                      TTD:  00000 . 00
                                      TPD:0000000 . 00
                                      PPD:0000000 . 00
                                      PTD:  20000 . 00
                                   DEATH: 0000000 . 00
                                 MEDICAL:  500000 . 00
                                ATTORNEY: 0000000 . 00
                                   OTHER:   32000 . 00
                                         ------------
                                   TOTAL: 552000 . 00


    COMMENTS OTHER FOR MODIFICATIONS TO EMPLOYEE RESIDENCE_________________________
             ______________________________________________________________________

    CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
    ENTER=SAVE, OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 03=VIEW ACTVTY LOG
        04=CLAIM INQ 09=MENU


                                             Figure 4.8


The purpose of the screen in Figure 4.8is to enter information to the Claim Activity Log
and to track expenditures associated with settlements, by the type of payment. A
summary of the expenditures will be displayed on the last page of the Log, under the
appropriate category for payment type.

The employee Name, Social Security Number, Agency, Date of Injury, Claim Number,
Claim Status and IC Number will be displayed, based on information already entered on
the Update Claim/Activity Log screen. The system will automatically tab you to each data
field, from left to right, beginning with the DATE PAID field. You may move around the
screen either by tabbing or using the arrow keys. Following are descriptions of the data
fields:

DATE PAID                                        Enter the date the expenditure was paid, in
                                                 the MM DD YY format.

TTD                                              Enter the amount of the settlement which
                                                 covers Temporary Total Disability payment.

TPD                                              Enter the amount of the settlement which
                                                 covers Temporary Partial Disability payment.




                                               4-27
PPD                                         Enter the amount of the settlement which
                                            covers Permanent Partial Disability payment.

PTD                                         Enter the amount of the settlement which
                                            covers Permanent Total Disability payment.

DEATH                                       Enter the amount of the settlement which
                                            covers Death benefit payment.

MEDICAL                                     Enter the amount of the settlement which
                                            covers Medical payments.

ATTORNEY                                    Enter the amount of the settlement which
                                            covers Attorney payments upon an Order to
                                            pay.

OTHER                                       Enter the amount of the settlement which
                                            covers a payment for an item not covered
                                            above. Note the reason for the expenditure
                                            in the COMMENTS section.

TOTAL                                       You may enter the total amount of the
                                            settlement, or the System will total it for you
                                            when you press ENTER.

COMMENTS                                    Use the COMMENTS section for any other
                                            notations you wish to make, which you
                                            would like to see upon viewing the claim log.

When you have finished entering the Settlement information, press ENTER to save.
Select an option listed at the bottom of the screen to go to the next desired screen:
• If you wish to enter more Settlement information, press F8 or enter 08 on the Option
    Line, enter the Social Security Number or Name and press ENTER. (You must enter
    the SSN even if you are adding more information to the same claim, as a precaution
    against accidentally entering information which applies to another claim.)
• If you wish to go back to the Update Claim/Activity Log screen to post additional
    actions to the Claim Activity Log, press F2 or enter 02 on the Option Line. If you
    wish to continue entering information on the same claim you do not need to enter the
    SSN (Social Security Number) again. If you wish to add or update another claim,
    enter the new SSN or the Name.
• If you wish to view the information entered on the Claim Activity Log, press F3 or
    enter 03 on the Option Line.
• If you are finished posting new actions, press F9 or enter 09 to return to the AIWCS
    Menu, or enter 24 to exit to the PMIS Main Menu.



                                          4-28
       5.      OPTION 3. - WC CLAIM INFORMATION/ACTIVITY LOG

You may view the history of a claim by choosing Option 03 and providing the SSN or by
typing PMXCLAIM XXXXXXXXX (where X = SSN) or PMXCLAIM
NNNNNNNNNNNNNN (where N=Name). This option allows you to view all the
current information on an individual claim, as well as a history of activity relating to the
claim (See Figures 5.1 and 5.2). The employee information displayed at the top is that
which was current at the time of the incident that caused the injury or illness; the claim
history appears below it, and will be listed in date order (this may require several screens).
When multiple pages of output have been displayed, use the PA1 key (or PC keyboard
equivalent) to page through the screens. To get back to previous screens of the Claim
Activity Log, continue paging (using PA1) and the system will wrap back around to the
first page. (See p. 2-6, “Alternate IMS Paging Method”, for more information about
paging).


Claim Status

The Claim status appears in the upper portion of the Claim Log. The values that may
appear there are:

   Payment Without Prejudice                   This will be the status of the claim when an
                                               action on the Forms To/From IC screen
                                               indicates that a form 63 has been submitted
                                               to the Industrial Commission, beginning
                                               payments under the Payment Without
                                               Prejudice statute. This status continues to be
                                               displayed until the claim is denied or a Form
                                               60 or 21 is submitted to the IC. If no
                                               activity occurs after 90 days from the date of
                                               injury, the status will automatically change to
                                               Open/Active.

   Denied                                      The claim status will display as Denied when
                                               an action on the Forms To/From IC screen
                                               indicates that a form 61 has been submitted
                                               to the Industrial Commission.

   Open/Active                                 This claim status will be displayed when an
                                               action is taken on either the Incident Report
                                               screen or the Update Claim/Activity Log
                                               screen, indicating a claim has been filed.




                                             5-1
Closed/Active                                 This claim status will be displayed when the
                                              claim is closed, but is still within the 2 year
                                              statute of limitations.

Closed/Inactive                               This claim status will be displayed when the
                                              claim is closed with the 2 year statute of
                                              limitations completed.

    PMXCLAIM   111-22-3333       CLAIM ACTIVITY LOG                        PAGE: 001
   CLAIM NO:   111-22-3333-01 IC NO: 123456     STATUS:    OPEN /ACTIVE
  EMPL NAME:   DOE, MARY                    EMPL TITLE:    SOCIAL RESEARCH ASST II
     AGENCY:   ADMIN-GOV CNCL/YOUTH            SECTION:    SECTION TITLE UNAVAIl
  PRIM TRTG:   DONNA SMITH          DOI: 07/12/96 RACE:    BLACK      SEX: F AGE: 48

    DATE       ACTION DESCR.   ACTION INFO.          PMT REQ   DATE PD     AMOUNT

 * 07-12-96 DOCTOR VISIT-IT DR. SMITH             08-10-96            500.00
   ** DR. EXPECTS HER TO BE OUT OF WORK SIX WEEKS
 * 07-20-96 INCIDENT RPTD   STRUCK AGAINST OBJ
   ** SLIPPED ON WATER CAUSED BY OVERFLOW FROM ICE MACHINE IN CAFETERIA
 * 07-20-96 CLAIM FILED
 * 07-20-96 CONTACTED EMPL
   ** EMPLOYEE STATED WENT TO OWN DR.;SUPV. DIDN'T TELL HER TO GO TO PPO.
      SHE TOLD DR. TO SEND BILL TO AGENCY
 * 07-20-96 LOST DAYS-WTG     7 DAYS
 * 07-20-96 WENT ON WC LVE
 * 07-21-96 SENT FORM 19    NOTICE OF CLAIM
 * 07-27-96 UPDATE IC NO

CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 04=CLAIM INQUIRIES 09=MENU
REPLACE * WITH Y & HIT ENTER TO VIEW/UPDATE ACTION. REPLACE * WITH D TO DELETE
                                    Figure 5.1


PMXCLAIM 111-22-3333       CLAIM ACTIVITY LOG                            PAGE: 002
   CLAIM NO: 111-22-3333-01 IC NO: 123456      STATUS:     OPEN /ACTIVE
  EMPL NAME: DOE, MARY                    EMPL TITLE:      SOCIAL RESEARCH ASST II
     AGENCY: ADMIN-GOV CNCL/YOUTH             SECTION:     SECTION TITLE UNAVAI
  PRIM TRTG: DONNA SMITH          DOI: 07/12/96 RACE:      BLACK      SEX: F AGE: 48

    DATE       ACTION DESCR.   ACTION INFO.          PMT REQ   DATE PD     AMOUNT

 * 07-24-96 SENT FORM 21    COMP AGREEMENT
 * 07-29-96 RECVD FORM 21   COMP AGREEMENT
   ** NOT APPROVED - MUST CORRECT AVERAGE WEEKLY WAGE
 * 07-30-96 SENT FORM 21    COMP AGREEMENT
 * 07-31-96 INDEMNITY PYMT TTD             DATES: 07-20-96 07-31-96         424.16
 * 07-31-96 RECVD FORM 21   COMP AGREEMENT
 * 08-31-96 INDEMNITY PYMT TTD             DATES: 08-01-96 08-31-96        1195.36
 * 09-02-96 RET W/ RESTR
   ** EMPLOYEE MAY ONLY WORK 4 HOURS/DAY FOR 2 WEEK PERIOD
 * 09-15-96 INDEMNITY PYMT TTD             DATES: 09-01-96 09-01-96          38.56
   ** TTD FOR 9/1;
   10-15-96 SUBR RECOVERY
   ACE ICE MACHINE COMPANY $500
            ** END OF LOG - SEE NEXT PAGE FOR COST BREAKDOWN **

CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 04=CLAIM INQUIRIES 09=MENU
REPLACE * WITH Y & HIT ENTER TO VIEW/UPDATE ACTION. REPLACE * WITH D TO DELETE

                                      Figure 5.2




                                          5-2
Provider Visits/Bills on the Log

When a Provider visit is indicated on the Claim Log, the two alpha characters preceding
the name of the Provider will indicate the Provider type. The following values may
appear:

   PT                                        Primary Treating

   2D                                        Second Opinion

   IM                                        Independent Medical Exam

   FA                                        Facility

   OT                                        Other



Updating Information on the Log

If you wish to update information appearing on the Claim Log, which was entered from
one of the screens that branched from the Update Claim/Activity Log screen, you can
choose the line displaying the action by replacing the asterisk with a Y and pressing
ENTER. This will take you to the actual screen where the information was originally
entered. You will then be able to make changes to the information previously entered. In
the event something was entered in error and you wish to delete it altogether, replace the
asterisk with the letter D and press enter to delete that line from the Claim Log.




                                            5-3
Breakdown of Claim Expenditures

A screen showing a breakdown of expenditures and the total lost and restricted work days
to-date, for the life of the claim, will be shown on the last page of the Log. (Figure 5.3).


      PMXCLAIM 111-22-3333       CLAIM ACTIVITY LOG                     PAGE: 005
      CLAIM NO: 111-22-3333-01 IC NO: 123456      STATUS: OPEN/ACTIVE
     EMPL NAME: DOE, MARY                   EMPL TITLE: SOCIAL RESEARCH ASST II
        AGENCY: ADMIN-GOV CNCL/YOUTH         SECTION: SECTION TITLE UNAVAI
     PRIM TRTG: DONNA SMITH        DOI: 07/12/96 RACE: BLACK       SEX: F AGE: 48

            INDEMNITY              MEDICAL                    OTHER EXPENSES

         TTD      $600.00    PHYSICIAN     $453.00       MANAGED CARE            $.00
         TPD      $600.00     FACILITY   $2,320.50     REHAB COMPANY             $.00
         PPD      $300.00       TRAVEL   $1,853.49     INVESTIGATION        $3,500.00
         PTD      $400.00       PRESCR      $28.50        FUNERAL EXP            $.00
       DEATH    $1,000.00    EQUIPMENT     $218.63    RE-EMPL ASSIST         $400.00
             ------------        OTHER   $1,395.18    EQUIP/PROPERTY             $.00
       TOTAL    $2,900.00             ------------        SALARY CONT     $11,900.00
                                TOTAL    $6,269.30          AMBULANCE         $250.00
        69 LOST WORK DAYS                                    ATTORNEY      $12,000.00
        87 RESTR WORK DAYS                                      OTHER         $618.95
                                                                        ------------
               *** OVERALL CLAIM COST    $37,838.25                        $28,668.95

    CHOOSE OPTION: __    SSN: ___ __ ____ NAME: __________________
    OPTIONS: 01=INCIDENT REPORT 02=POST ACTIVITY 04=CLAIM INQUIRIES 09=MENU
    REPLACE * WITH Y & HIT ENTER TO VIEW/UPDATE ACTION. REPLACE * WITH D TO DELETE


                                         Figure 5.3




                                             5-4
                6.         OPTION 4- CLAIM INQUIRIES AND STATISTICS

Upon selection of Option 4 from the AIWC Main Menu the AIWC Inquiries And Statistics
Menu (figure 6.1) will display; or you may access this screen from a blank screen by typing
PMXWCINQ (space) and pressing enter. From this screen you will choose the
appropriate option to extract the type of information desired by entering the
corresponding number on the CHOOSE OPTION line or press the corresponding function
key. For example, if you wish to extract information on expenditures, enter 07 or press
F7. Listed below is an outline of the available options. Detailed explanations of the
screens for each option follow.

OPTION

06              A formatted screen to report listings and summary totals of claims or
                incidents within specified parameters
07              A formatted screen to extract expenditure totals by type of expenditure and
                within specified parameters as well as claim activity by effective date or
                date posted.
08              The initial screen to request the quarterly Accident/Injury and WC
                Expenditures statistical report. This screen will request employee and
                manhour figures.

09              Return to the AIWCS Main Menu
24              Return to PMIS Main Menu

     PMXWCINQ         PPPPPPPPP     MMMMM MMMMM IIIIIIIII     SSSSSS
                       PP     PP     MM MM MM MM       II     SS    SS
                      PP     PP     MM MM MM MM      II      SS
                    PPPPPPPPP      MM MMMM MM       II       SS
                   PP            MM         MM    II            SS
                 PP             MM         MM    II       SS     SS
                PP            MM          MM IIIIIIII      SSSSS

                       PERSONNEL MANAGEMENT INFORMATION SYSTEM
                          AIWC INQUIRIES AND STATISTICS MENU

                     06    INCIDENT AND CLAIM EXTRACTS (PMXWCI)
                     07    EXPENDITURE/ACTIVITY EXTRACTS (PMXEXP)
                     08    QUARTERLY REPORT (PMXQTR)


                     09    RETURN TO AIWC SYSTEM MAIN MENU
                     24    RETURN TO PMIS MAIN MENU



      CHOOSE OPTION:      __   SSN:   ___ __ ____ # __   NAME:   __________________

 CHOOSE OPTION BY NUMBER OR USE FUNCTION KEY.
                                        Figure 6.1




                                                  6-1
Accident/Injury And WC Claims Extract

Selection of Option 6 will display the Accident/Injury And WC Claims extract screen
(Figure 6.2) which allows you to extract specific information about incidents or claims
filed in your agency, based on the criteria you select. You may also go directly to this
screen by typing PMXWCI (space) from a blank screen. You will have an opportunity to
specify criteria to pull out specific information or to extract all information entered to-
date. After you make your selections, the system will display a list of the desired incidents
or claims, followed by totals broken out by case type or by type and status of claim.

Selecting Criteria

                                                     s
To select specific information, simply overlay the X’ on the formatted extract screen with
the desired value(s). For example, if you want to report on all open active claims in your
agency you would enter “O” (open) and “A” (active) for STATUS. You may mix and
match any combination of the parameters to pull out the kind of information you need at a
given time.

    PMXWCI F                 ACCIDENT/INJURY & WC CLAIMS EXTRACT

       ***** FILL IN PARAMETERS TO EXTRACT SPECIFIC CLAIMS/INCIDENTS *****
     DEPT/DIV & SECTION (OR SECTION RANGE)       XX - XX    XXXXXX - XXXXXX
     RACE (W,B,H,A,I), SEX (M,F), AGE RANGE      X AND/OR X AGE XX - XX
                      ******CLAIMS EXTRACT PARAMETERS******
     DATE FILED OR DATE RANGE                    XX XX XX       XX XX XX - XX XX XX
     STATUS - OPEN (O OR C) / ACTIVE (A OR I) X / X
       OR D=DENIED, S=SETTLED, P=PYMT W/O PRED   X
     CLAIM TYPE (I=IC REPORTABLE, M=MED ONLY)    X
     TOTAL CLAIM COST (RANGE)                    XXXXXXX - XXXXXXX
                    ******INCIDENT EXTRACT PARAMETERS******
     DATE OF INJURY OR DATE RANGE                XX XX XX       XX XX XX - XX XX XX
     TYPE CASE (A=AID R=RPT I=INJ L=ILL F=FATL) X
     TYPE OF ACCID, NAT OF INJ, PART OF BODY     XXX XXX     XXX XXX    XXX XXX
     INVEST (W=WCA, F=SAFOFF, S=SUPV, O=OUT)     X
     CLAIM/ ON-SITE/ OSHA/ RESTR (Y/N ON ALL)   X / X / X / X
     CLIENT ASSUALT (C=CAUSED, A=ASSLT, N=NON) X
     LOST & RESTRICTED WORK DAYS RANGES          XXX - XXX (LOST)   XXX - XXX (RESTR)
     REPORT FORMAT (I=INCIDENT, C=CLAIM)         X

     CHOOSE OPTION: __   SSN: ___ __ ____ # __     NAME:   __________________
    04 = INQ MENU 09 = AIWC MAIN MENU

                                         Figure 6.2


Following is a list of parameters and a brief description of each. Wherever no parameter is
overlayed, the system will default to all information entered in that field.




                                            6-2
DEPARTMENT/DIVISION                               This screen automatically defaults to
                                                  your department/division number, as
                                                  this is usually the only area for which
                                                  you have security clearance. If you
                                                  have security clearance for other areas,
                                                  you can enter the department code here
                                                  to view the applicable information

SECTION (OR SECTION RANGE)                        If you are seeking information on one
                                                  particular section or a range including
                                                  several sections in a department or
                                                  division, enter the six-digit code for the
                                                  section or university department for
                                                  which you are requesting information.
                                                  (non-universities enter 00 and 4 digits.)

RACE AND/OR SEX, AGE                              To extract information on a certain
                                                  race or sex, or for a specific age, enter
                                                  the corresponding code.
                                                  W=White
                                                  B=Black
                                                  H=Hispanic
                                                  A=Asian
                                                  I=Indian
                                                  U= Unknown

                                                  M=Male
                                                  F=Female

CLAIMS EXTRACT PARAMETERS - Fill in the desired parameters in this section if
you are extracting information relating more to wc claims, such as the type of claim,
number of lost or restricted work days and payment information. Again, if no parameters
are entered in a field, the system will default to all information entered in that field.

CLAIM DATE FILED OR DATE RANGE                    If you are seeking information for
                                                  claims filed on a certain date, enter that
                                                  date in the single date portion (MM
                                                  DD YY). However, if you are seeking
                                                  information on claims filed within a
                                                  range of dates, bypass this entry and
                                                  overlay those dates in the range
                                                  portion.




                                           6-3
STATUS                                                For information on claims at a
                                                      particular status, enter the desired
                                                      status here.
                                                      O=Open             C=Closed
                                                      A=Active           I=Inactive
                                                      D=Denied           S=Settled
                                                      P=Payment Without Prejudice

CLAIM TYPE                                            If you would like the report to reflect
                                                      information only on IC Reportable
                                                      claims, replace the X with an I; if you
                                                      would like the report to reflect
                                                      information only on Medical Only
                                                      claims, replace the X with an M.

TOTAL CLAIM COST (RANGE)                              Choose this option if you wish to view
                                                      claims where the total cost was within
                                                      a specific range (e.g., all claims which
                                                      have costs from $50,000 to $100,000).

INCIDENT EXTRACT PARAMETERS - Fill in the desired parameters in this section
if you are extracting information more related to incidents, such as time of injury, type of
case, initial investigator, type of accident, nature of injury, etc. If no parameters are
entered in a given field, the system will default to all information in the system in that field.

DATE OF INJURY OR DATE RANGE                          If you are seeking information on
                                                      incidents occurring on a certain date,
                                                      enter that date in the single date
                                                      portion (MM DD YY). If you are
                                                      seeking information on incidents
                                                      occurring within a range of dates,
                                                      overlay those dates in the range
                                                      portion.

TYPE OF CASE                                          If you would like to view only incidents
                                                      of a certain type, enter the type here:
                                                      A=First Aid; R=Report Only; I= Injury
                                                      Cases; L=Illness Cases; F=Fatalities.

TYPE OF ACCIDENT, NAT OF INJ,
PART OF BODY                                          If you wish to view only by a particular
                                                      Type of Accident, Nature of Injury or
                                                      Part of Body, refer to Appendix C for a
                                                      listing of valid codes to enter here.



                                              6-4
INVEST                 If you would like to view only incidents
                       initially investigated at a specific level,
                       enter the type here:
                       W=WC Administrator S=Supervisor;
                       F=Safety Officer; O=Outside the
                       Agency.

CLAIM FILED            Choose this option if you wish to view
                       only incidents where a workers’
                       compensation claim was filed by
                       overlaying the X with a Y. Entering an
                       N will show only incidents where a
                       claim was not filed. If no parameter is
                       entered, the default will be all incidents.

ON-SITE                Choose this option if you wish to view
                       only incidents that occurred on-site by
                       overlaying the X with a Y. Entering an
                       N will show only incidents where the
                       incident did not occur on-site. If no
                       parameter is entered, the default will be
                       all incidents.

OSHA                   If you wish to view OSHA Recordable
                       incidents, overlay the X with a Y.
                       Enter an N if you wish to view
                       incidents which were not OSHA
                       recordable. If neither of these options
                       are entered, the default will be all
                       incidents, whetehr or not they were
                       OSHA recordable.

RESTR                  Choose this option to view cases where
                       employees are on restricted duty with
                       full pay at the end of a quarter. This
                       listing may then be used to post the
                       number of restricted workdays (on
                       Update Claim/Activity Log screen) for
                       quarterly statistical calculations.

CLIENT ASSAULT         If you would like to view only incidents
                       with a specific client assault status,
                       enter the type here: C=Client Caused;
                       A=Client Assault; N=Non-Related



                 6-5
LOST & RESTRICTED WORK DAYS
                       RANGES         If you wish to view only incidents
                                      where the number of lost or restricted
                                      work days was within a specific range
                                      enter the numbers in the range here.
                                      For example, if you only want to view
                                      all incidents which have had from 50 to
                                      100 lost work days overlay the X’  s
                                      with those numbers.

REPORT FORMAT                         You will be required to select one of
                                      these format options. If you would like
                                      the report format to reflect information
                                      on incidents, replace the X with an I; if
                                      you would like the report to reflect
                                      information on wc claims, replace the
                                      X with a C. Note: Any combination of
                                      extracts may be keyed. You may
                                      combine incident and wc claim criteria.
                                      For example, you may wish to list all
                                      claims filed and related costs, but only
                                      where the incident was the result of
                                      sprains and strains. The date range
                                      entered will control whether the extract
                                      will key on date of injury (Incident
                                      format) or date claim filed (Claim
                                      format).




                                6-6
Figure 6.3 is an example of a listing produced by selecting the Claim report format. This
extract shows detailed information about claims, using the parameters specified. In this
example the only parameter used was the DATE RANGE, which shows all claims filed
from 04-01-97 to 06-30-97 (the first page of the report is displayed). Note: The date
reported is the date the incident was reported to the WCA or Safety Officer; the
expenditure amounts show the total paid to-date in each category.




    PMXWCI                   ACCIDENT/INJURY & WC CLAIMS EXTRACT          PAGE   001
                                      WC CLAIM LISTING
        DEPT/DIV = ADMIN-GOV CNCL/YOUTH         DATE RANGE = 04/01/97 - 06/30/97

           DOI/       CLAIM   TYPE/   LOST/     LAST    MEDICAL/ OTHER EXP/   EMPLOYEE NAME/
         DATE RPT     FILED STATUS    RESTR    PAYMENT INDEMNITY TOTAL EXP    CLAIM NUMBER
    *    03-24-97   04-03-97 MD C/A           04-22-97   $103.56      $.00    POWELLS, DELORIS
         04-04-97                                           $.00   $103.56     111-22-3333-01
    *    04-02-97   04-03-97 MD O/A                         $.00      $.00    WELLS DONNA
         04-03-97                                           $.00       $.00    111-22-3333-02
    *    04-07-97   04-07-97 IC O/A   35/0               $820.59      $.00    CROWN, SHERRYL
         04-10-97                             06-09-97   $848.80 $1669.39     111-22-3333-01
    *    04-03-97   04-08-97 MD O/A           06-03-97   $173.63      $.00    GREENE, LISA
         04-03-97                                           $.00   $173.63     111-22-3333-01
    *    04-09-97   04-09-97 MD O/A           06-03-97   $478.37      $.00    BROWN, JOHN D.
         04-09-97                                           $.00   $478.37     111-22-3333-01
    *    04-04-97   04-10-97 MD O/A           05-23-97    $71.10      $.00    HOWELL BRENDA .
         04-08-97                                           $.00    $71.10     111-22-3333-01
    *    04-17-97   04-18-97 MD O/A           06-04-97 $1231.36       $.00    ANDREWS, DONALD
         04-17-97                                           $.00 $1231.36     111-22-3333-01

        CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
        10 = PMXWCI FORMATTED EXTRACT SCREEN, 04 = INQ MENU, 09 = AIWC MAIN MENU.
        REPLACE * WITH Y TO SELECT: 01=INCIDENT REPT, 02=POST ACTVTY, 03=CLAIM LOG

                                               Figure 6.3




                                                  6-7
Figure 6.4 is an example of a listing produced by selecting the Incident report format.
This report shows detailed information about incidents, using the parameters specified. In
this example the only parameter used was the DATE RANGE, which shows all incidents
occurring from 04-01-97 to 06-30-97 (the first page of the report is displayed). Note: the
Date Reported is the date the incident was reported to the WCA or Safety Officer; the
Demo shows the demographic information by race, sex and age.


    PMXWCI                   ACCIDENT/INJURY & WC CLAIMS EXTRACT          PAGE    001
                                      INCIDENT LISTING
        DEPT/DIV = ADMIN-GOV CNCL/YOUTH       DATE RANGE = 04/01/97 - 06/30/97

         DOI/    DTE RPTD/   TYPE CASE/   TYPE OF ACCIDENT/    DEMO     EMPLOYEE NAME/
         TIME    CLM FILED   INIT INVES   NATURE OF INJURY    OSHA, DAY SSN, INCID NO
    *   04-02-97 04-03-97    INJURY       BODILY REACT(SPRAIN) BF    35 WELLS DONNA
        06:10 AM 04-03-97    SUPERVISOR   SPRAINS, STRAINS      Y   WED 111-22-3333-02
    *   04-03-97 04-07-97    REPT ONLY    FALLS (ALL TYPES)     BF   46 DOE, MARY
        01:30 PM             SUPERVISOR   SPRAINS, STRAINS       N  FRI 111-22-3333-01
    *   04-03-97 04-03-97    INJURY       FALLS (ALL TYPES)     WF   35 GREENE, LISA
        09:30 AM 04-08-97    SUPERVISOR   SPRAINS, STRAINS      Y   THU 111-22-3333-01
    *   04-04-97 04-02-97    REPT ONLY    BODILY REACT(SPRAIN) WF    25 HARRISON, ANN O
        10:50 PM             SUPERVISOR   SPRAINS, STRAINS       N  WED 111-22-3333-01
    *   04-04-97 04-08-97    INJURY       BODILY REACT(SPRAIN) BF    51 HOWELL BRENDA .
        05:30 AM 04-10-97    SUPERVISOR   SPRAINS, STRAINS      Y   FRI 111-22-3333-01
    *   04-04-97 04-07-97    REPT ONLY    STRUCK BY OBJ/PERSON WF    32 FORTNER, BILLIE
        10:30 AM             SUPERVISOR   CONTUSIONS, BRUISES    N  FRI 111-22-3333-01
    *   04-07-97 04-10-97    INJURY       BODILY REACT(SPRAIN) WF    46 CROWN, SHERRYL
        09:00 AM 04-07-97    SUPERVISOR   SPRAINS, STRAINS      Y   TUE 111-22-3333-01

     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
    10 = PMXWCI FORMATTED EXTRACT SCREEN, 04 = INQ MENU, 09 = AIWC MAIN MENU.
    REPLACE * WITH Y TO SELECT: 01=INCIDENT REPT, 02=POST ACTVTY, 03=CLAIM LOG


                                           Figure 6.4




TOTALS SCREENS

Figures 6.5 and 6.6 on the following page are examples of the totals screens which will
appear at the end of the extracts. The claim totals (Figure 6.5) will not show if the report
was in the Incident format, but both totals screens will show if the report was in the Claim
format. To view these screens, page forward through the extract using the PA1 key, or its
equivalent.




                                               6-8
Figure 6.5 displays claim totals by current status categorized by claim type.

PMXWCI                ACCIDENT/INJURY & WC CLAIMS EXTRACT               PAGE   005
     DEPT/DIV = ADMIN-GOV CNCL/YOUTH          DATE RANGE =      04/01/97 - 06/30/97

                        ************ CLAIM TOTALS ************

                                       MEDICAL ONLY      IC REPORTABLE           TOTAL

           OPEN/ACTIVE                     16                  2                    18
           CLOSED/ACTIVE                    7                  0                     7
           CLOSED/INACTIVE                  0                  0                     0
           PAYMENT W/OUT PRED               0                  0                     0
           DENIED                           0                  0                     0
           SETTLED                          0                  0                     0
                                        -----              -----                 -----
           TOTAL CLAIMS FILED              23                  2                    25




     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     10 = PMXWCI FORMATTED EXTRACT SCREEN, 04 = INQ MENU, 09 = AIWC MAIN MENU.
     01=INCIDENT REPT, 02=POST CLAIM ACTIVITY, 03=VIEW CLAIM ACTIVITY LOG.
                                        Figure 6.5


Figure 6.6 displays total cases categorized by type and broken out by those with lost work
days, without lost work days and with restricted work days only. . This report also shows
total First Aid and Report Only incidents and total Death cases.

PMXWCI                ACCIDENT/INJURY & WC CLAIMS EXTRACT          PAGE            030
     DEPT/DIV = EAST CAROLINA UNIV         DATE RANGE = ALL INCIDENTS

                        ********** INCIDENT TOTALS **********

                     WITH LOST        W/OUT LOST        RESTR WORK
                     WORK DAYS        WORK DAYS         DAYS ONLY          TOTAL

       INJURY            8                88                0               96
       ILLNESS           0                 7                0                7
                     -----             -----            -----            -----
       TOTAL             8                95                0              103

       TOTAL REPORT ONLY CASES            25
       TOTAL FIRST AID CASES              71
       TOTAL DEATH CASES                   1




     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     10 = PMXWCI FORMATTED EXTRACT SCREEN, 04 = INQ MENU, 09 = AIWC MAIN MENU.
     01=INCIDENT REPT, 02=POST CLAIM ACTIVITY, 03=VIEW CLAIM ACTIVITY LOG.

                                           Figure 6.6




                                               6-9
Branching To Other Options Or Screens From The Claim Or Incident List

To return to a new Accident/Injury & WC Claims extract screen, enter 10 on the
CHOOSE OPTION line or press F10; to return to the Incident And Claim Inquiry Menu,
enter 04 on the CHOOSE OPTION line or press F4; to return to the AIWC Main Menu,
enter 09 or press F9. To branch to a specific claim or incident from the Claim or Incident
list, simply replace the asterisk “*” with a “Y” and depress the desired PF Key or type the
desired option in CHOOSE OPTION. For example, to branch to the Claim Log, press F3
or enter 03 on the CHOOSE OPTION line. The system will then branch you to the Claim
Log for the claim or incident selected with “Y”.




                                           6-10
WC Claim Activity/Expenditures Extract
Selection of Option 7 will display the AIWC Claims Activity/Expenditures extract screen
(Figure 6.7) which allows you to extract specific information related to expenditures or
claim activity by effective date or date posted, based on the criteria you select. You may
also go directly to this screen by typing PMXEXP (space) from a blank screen. After you
have selected the report parameters, the system will display listings, total expenditures and
total number of actions for the activity extract, or just totals if you desire.

Selecting Criteria
                                                     s
To select specific information, simply overlay the X’ on the formatted extract screen with
the desired value(s). For example, if you want to report on only IC Reportable claims in
your agency you would enter “I” in CLAIM TYPE. You may mix and match any
combination of the parameters to pull out the kind of information you need at a given
time. Wherever no parameter is overlayed, the system will default to all information
entered in that field
PMXEXP F              WC CLAIM ACTIVITY/EXPENDITURES EXTRACT

              ***** FILL IN PARAMETERS TO EXTRACT SPECIFIC INFORMATION *****

     DATE RANGE FOR EXPENDITURES (DATE PAID)         XX XX XX      -   XX XX XX
     DATE RANGE FOR ACTIVITY (EFFECT DATE)           XX XX XX      -   XX XX XX
     DATE RANGE FOR ACTIVITY (DATE POSTED)           XX XX XX      -   XX XX XX

     DEPARTMENT/DIVISION                             XX - XX
     SECTION CODE (NON-UNIV USE 00 & 4 DIGITS)       XXXXXX
     BUDGET CODE EXTRACT                             XXXXX     XXXXX    XXXXX
     COMPANY EXTRACT                                 XXXX      XXXX     XXXX
     FUND EXTRACT (1ST 4 DIGITS OF CENTER)           XXXX      XXXX     XXXX
     CLAIM TYPE (I=IC-REPORTABLE, M=MED ONLY)        X    (DEFAULTS TO BOTH)
     IF TOTALS ONLY ARE DESIRED, ENTER Y             X

              *****    MARK TYPE OF ACTIVITY DESIRED (DEFAULTS TO ALL)            *****

     _ ALL EXPENDITURES    _ INDEMNITY   _ MEDICAL       _ PRESCRIPTIONS    _ OTHER EXPENSES


     CHOOSE OPTION: __     SSN: ___ __ ____ # __         NAME:   __________________
    04=INQUIRIES MENU,     09=AIWC MAIN MENU

                                            Figure 6.7

Take a few minutes to experiment with the formatted extract screen. Once you familiarize
yourself with it, it will become a valuable tool in monitoring activity in your agency. The
following is a list of parameters and a brief description of each.

DATE RANGE FOR EXPENDITURES                      Enter the date range (MM DD YY) for
                                                 which you want the expenditure breakdown,
                                                 based on the date the payment was made.
                                                 For example, if you wish to see certain
                                                 expenditures paid during the month of June,
                                                 enter 06 01 97 - 06 30 97.
DATE RANGE FOR ACTIVITY
           (EFFECT DATE)                         Enter the date range (MM DD YY) for
                                                 which you want to see expenditures and


                                             6-11
                            claim activity based on the effective date of
                            the activity. For example, if you wish to see
                            expenditures for doctor visits in January,
                            although not necessarily paid for in that
                            month, enter the beginning and ending dates
                            for January.

DATE RANGE FOR ACTIVITY
           (DATE POSTED)    Enter the date range (MM DD YY) for
                            which you want to see claim activity based
                            on the date you posted them to the system.
                            For example, if you wish to see activity
                                                                      t
                            which occurred in one quarter, but didn’ get
                            posted to the system until the following
                            quarter, enter the date range of the time
                            period in which you posted the activity.

DEPARTMENT/DIVISION         This defaults to your department/division
                            number, as this is usually the only area for
                            which you have security clearance. If you
                            have security clearance for other areas, you
                            can enter the department code here to view
                            the applicable information.

SECTION CODE                Enter the six-digit code for the section or
                            university department for which you are
                            requesting information. (non-universities
                            enter 00 and 4 digits.)

BUDGET CODE EXTRACT         If you wish to see expenditures for a
                            particular Budget code or codes, enter the
                            appropriate code here.

COMPANY EXTRACT             If you wish to see expenditures for a
                            particular Company code, enter the
                            appropriate code here.

FUND EXTRACT                If you wish to see expenditures for a
                            particular Fund code, enter the appropriate
                            code here. (The fund code is the first four
                            digits of the Center code.)

CLAIM TYPE                  If you wish to see expenditures only for one
                            type of claim, enter the appropriate code: I
                            for IC Reportable or M for Medical Only. If


                           6-12
                                              you want expenditures for both claim types,
                                              do not enter anything, as the system defaults
                                              to both.

IF TOTALS ONLY ARE DESIRED...                 If you do not want a detailed list of activity
                                              by employee, enter a Y for totals only. For
                                              example, if you only want the total amount
                                              of Indemnity and do not want to see each
                                              indemnity action posted, enter the Y.

MARK THE TYPE OF ACTIVITY
                   DESIRED                    The system will display all actions on all
                                              claims (e.g., payments, comments, etc.)
                                              unless you specify the parameter options.
                                              Activities may be based on the effective date
                                              of the action or the date the action was
                                              posted to the system. If you wish to see all
                                              expenditures, based on the date paid, enter
                                              an X on the appropriate line. If you only
                                              wish to see expenditures in a certain
                                              category, (INDEMNITY, MEDICAL,
                                              PRESCRIPTIONS, OTHER EXPENSES),
                                              type an X on the appropriate line. You may
                                              only choose one category at a time in this
                                              manner.

Figure 6.8, on the following page, is an example of a listing produced with the only
selection criteria being the DATE RANGE FOR EXPENDITURES (DATE PAID) from
6-1-97 to 6-30-97. As you can see, this gives you detailed information about claims or
incidents where expenditures were paid in that date range. The listing will be displayed by
type of expenditure (the last page of the listing is displayed to show the order in which the
expenditures are listed). Note that lost work days are related to the activity requested in
the report, thus the expenditures extract will not include lost days in the waiting period or
restricted days with full pay.




                                            6-13
    PMXEXP              WC CLAIM ACTIVITY/EXPENDITURES LISTING         PAGE                  008
                                 EXPENDITURES
     DEPT/DIV = ADMIN-GOV CNCL/YOUTH       DATE RANGE = 06/01/97 - 06/30/97

     EFF DATE/       ACTION DESCR/           PYMT REQ/ DATE PD/        AMOUNT    EMPLOYEE NAME/
     POST DATE     EMPLOYEE LOCATION         FROM DATE TO DATE         LOST/RESTR CLAIM NUMBER
    * 05-12-97   DOCTOR VISIT-OT             06-04-97 06-05-97         $226.21   MORRIS, CAROL
      06-12-97   LAMONT WOOTEN                                                    111-22-3333-01
    * 05-12-97   PRESCR BILL                 06-03-97     06-03-97      $20.05   MORRIS, CAROL
      06-12-97                                                                    111-22-3333-01
    * 05-09-97   PRESCR BILL                 06-03-97     06-03-97       $6.93   MORRIS, CAROL
      06-12-97                                                                    111-22-3333-01
    * 06-02-97   INDEMNITY PYMT                           06-02-97     $273.09   KELLOG, LYDIA C
      06-12-97   TTD            DATES:       05-28-97     06-03-97        7/0    111-22-3333-01
    * 06-09-97   INDEMNITY PYMT                           06-09-97     $212.20   CROWN, SHERRYL
      06-12-97   TTD            DATES:       06-06-97     06-12-97        7/0    111-22-3333-01
    * 06-10-97   INDEMNITY PYMT                           06-10-97     $273.09   KELLOG, LYDIA C
      06-12-97   TTD            DATES:       06-04-97     06-10-97        7/0    111-22-3333-01

    CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     PF10 = PMXEXP FORMATTED EXTRACT SCREEN, PF9 = AIWC MAIN MENU.
     REPLACE * WITH Y TO SELECT: 01=INCIDENT REPT, 02=POST ACTVTY, 03=CLAIM LOG

                                                 Figure 6.8


TOTALS SCREENS

Figures 6.9 and 6.10 are examples of the last two pages of the extract. To view these
screens, page forward through the extract using the PA1 key, or its equivalent.

Figure 6.9 displays the number of occurrances of each activity type for the claims which
met the criteria specified in the extract request.

    PMXEXP                     ACCIDENT/INJURY & WC CLAIMS EXTRACT                    PAGE   009

     DEPT/DIV = ADMIN-GOV CNCL/YOUTH                    DATE RANGE =   06/01/97 - 06/30/97

                    ****** ACTIVITY TOTALS FOR THIS INQUIRY ******

         INCIDENT OCCURRED               0         IC FORM SENT OR REC            0
         CLAIM FILED                     0         SUBROGATION RECOVERY           0
         CLAIM CLOSED                    0         SETTLEMENT                     0
         CLAIM RE-OPENED                 0
                                                   EMPLOYEE CONTACTED             0
         PROVIDER VISIT/BILL            50         EMPL WENT ON WC LEAV           0
         PRESCR/EQUIP BILL               2         EMPL RET W/OUT RESTR           0
         INDEMNITY PAYMENT               3         EMPL RET WITH RESTR            0
         OTHER EXPENSE                   0         LOST DAYS WTG PERIOD           0

                                                   COMMENTS ONLY                  0



     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     PF10 = PMXEXP FORMATTED EXTRACT SCREEN, PF9 = AIWC MAIN MENU.
     01=INCIDENT REPT, 02=POST CLAIM ACTIVITY, 04=VIEW CLAIM ACTIVITY LOG.

                                                 Figure 6.9




                                                  6-14
Figure 6.10 displays a breakdown of expenditures by type in each category as well as the
number of lost and restricted workdays associated with the expenditures covered in the
criteria specified in the extract request.

    PMXEXP                ACCIDENT/INJURY & WC CLAIMS EXTRACT                   PAGE    010

     DEPT/DIV = ADMIN-GOV CNCL/YOUTH           DATE RANGE =      06/01/97 - 06/30/97

                 ****** EXPENDITURES TOTALS FOR THIS INQUIRY ******
             INDEMNITY              MEDICAL                   OTHER EXPENSES

       TTD      $758.38   PHYSICIAN    $4,676.56          MANAGED CARE           $.00
       TPD         $.00    FACILITY          $.00        REHAB COMPANY           $.00
       PPD         $.00      TRAVEL          $.00       MD BILL REVIEW           $.00
       PTD         $.00      PRESCR       $26.98           FUNERAL EXP           $.00
     DEATH         $.00   EQUIPMENT          $.00       RE-EMPL ASSIST           $.00
           ------------       OTHER          $.00       EQUIP/PROPERTY           $.00
     TOTAL      $758.38             ------------           SALARY CONT           $.00
                              TOTAL    $4,703.54             AMBULANCE           $.00
      21 LOST WORK DAYS (REQ ACTIVITY ONLY)                   ATTORNEY           $.00
       0 RESTR WORK DAYS (REQ ACTIVITY ONLY)                     OTHER           $.00
                                                                         ------------
             *** TOTAL EXPENDITURES     $5,461.92                                $.00


     CHOOSE OPTION: __ SSN: ___ __ ____ # __ NAME: __________________
     PF10 = PMXEXP FORMATTED EXTRACT SCREEN, PF9 = AIWC MAIN MENU.
     01=INCIDENT REPT, 02=POST CLAIM ACTIVITY, 04=VIEW CLAIM ACTIVITY LOG.

                                          Figure 6.10




                                            6-15
AIWC Quarterly Report Request Screen

Selection of Option 8 will display the AIWC Quarterly Report Request Screen (Figure
6.11) which will require entry of the employee and manhour information needed for the
production of the quarterly report. After the required information is entered press
ENTER and the report will be produced. The report will appear on seven screens, which
you can scroll through using the PA1 key or its equivalent.
PMXQTR F           AIWC QUARTERLY REPORT REQUEST SCREEN

      **** FILL IN PARAMETERS AND HIT ENTER TO DISPLAY QUARTERLY REPORT ****

 DEPARTMENT/DIVISION OR UNIVERSITY             XX - XX
 QUARTER NUMBER OR DATE RANGE                  X             XX XX XX   -   XX XX XX

 NUMBER OF EMPLOYEES IN REPORTING PERIOD       XXXXXXXX
  (ON PAYROLL)


 NUMBER OF MANHOURS IN REPORTING PERIOD        XXXXXXXXXXXX
  (AN AVERAGE EMPLOYEE WORKS APPROXIMATELY
   500 MANHOURS PER QUARTER)



 CHOOSE OPTION: __ SSN: ___ __ ____ # __        NAME:     __________________
04=INQUIRIES MENU, 09=AIWC MAIN MENU


                                           Figure 6.11

Following is the list of data fields which must be completed to display the quarterly
Accident/Injury and Workers’Compensation Statistical Report:

DEPARTMENT/DIVISION                                      This will automatically default to your
                                                         department/division number

QUARTER NUMBER OR DATE RANGE                             Enter either the number associated with
                                                         the calendar quarter the report will
                                                         cover (e.g., 2) or the date range
                                                         covered in the quarter (e.g., April 1,
                                                         1997 - June 30, 1997).

NUMBER OF EMPLOYEES IN
           REPORTING PERIOD                              Enter the number of employees (on
                                                         payroll) for the reporting period.
NUMBER OF MANHOURS IN
           REPORTING PERIOD                              Enter the number of manhours worked
                                                         in the reporting period. (An average,
                                                         full time, employee works
                                                         approximately 500 manhours per
                                                         quarter.)




                                             6-16

				
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