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EDI Newsletter
Department of Financial Services Division of Worker’s Compensation Bureau of Data Quality and Collection
Inside this issue
Meet Lisel ....................................2
Meet the Team; EDI ...................3
Meet the Team; Triage ................4
Team News..................................5
Sequencing and Calculations ......5
Crossword ...................................6
Technical Tip ...............................7
Word Search................................8
FAQ .............................................9
Contact Information ....................9
Special points of interest
Triage team is traveling soon, please see page 4 for additional details
Welcome! By: Victoria LaPonzina
Welcome to the first EDI Newsletter of 2017. In this newsletter we will discuss
general issues based off patterns and trends that we see as a team, as well as
the Top 10 Overall Errors for the previous month. We will also post some helpful
(we hope) technical tips in order to provide an overall better service to you. The
team encourages your input (thoughts, questions, topics you wish to be
discussed) for future editions of the Newsletter.
In this issue... … You will find some helpful tips on calculations. We will also discuss some of
the most common errors received during December 2016, in hopes to help get
acceptance percentages up. While you may not be experiencing any of these
errors, you will still hopefully find this information helpful when submitting
future transactions.
I thought I would share a
picture of the EDI team upon
returning from the holidays.
- VL
January 2017 Volume 1, Issue 1
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About Lisel
Lisel is the Bureau Chief for
Data Quality and Collection,
which includes EDI (Claims
and Medical), Triage and
Training, Document
Management and Public
Records, and has been in
this role at the Division of
Workers’ Compensation for
2 years. She previously
worked with the Division of
Risk Management (DRM)
for 12 years, where she was
responsible for various
claims-handling duties ,
contract management, data
management and analysis
and has over 15 years of
healthcare management
experience in the private
sector. In her free time
enjoys traveling with her
family, cooking and is a big
movie buff!
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Lisel Laslie, Bureau Chief
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For this first issue, I thought it would be nice to include a picture of each individual member of the team in order to
put a face to a name from an email that some of you have no doubt received. Above are pictured the EDI team
members, those who assist on Medical and Claim EDI daily issues. Those individuals who are members of the
Triage EDI Team are featured on the next page.
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Meet the Teams EDI Team
Michelle Carter, Sr. Management Analysis
Supervisor
Michelle has been with the Division for 12
½ years . Being a former auditor, she likes
working in EDI because of the audit
perspective. No one claim is alike and she’s
able to look at things from a different
angle. She enjoys shopping and
relaxing. Her favorite food is lasagna –
especially from Olive Garden.
Sylvia McKenzie, Government Operations
Consultant II
Sylvia has been with the Division for two
years and five months. She feels as though
she is a natural-born public servant and
likes working in EDI to ensure the accurate
payment of claims. In her spare time she
enjoys billiards, crime drama movies and
reading. Soul food is her favorite food.
Victoria LaPonzina, Government Analyst I
I have been working with the Division for
three years. I feel like EDI is a puzzle and I
enjoy the challenges presented by EDI
claims issues every day. I enjoy reading,
cooking, cleaning, and going to the movies.
Katina Ferrell, Government Analyst I
Katina has worked with the EDI team for
one year, 13 overall with the Division. She
enjoys the every day challenges presented
by the section. She loves playing video
games with her godson (console only), as
well as traveling, shopping, and reading.
Her favorite food is pizza.
Robin Yergin, Government Analyst I
Robin has also been with the EDI team for
one year, and five years overall with the
Division. Robin enjoys ensuring proper
claim reporting and payments issued to the
IW. In her spare time, Robin loves training
and showing dogs—her favorites are
German Shepard and Corgis. Her favorite
food is also pizza, we all enjoy pizza!
Justin Hale, Government Analyst I
Justin has been with the Division for
four years, two with the EDI team. He
enjoys working with quality people.
During his spare time he likes to relax,
listen to old school music, watch
college sports, and read the news. His
favorite dish is chicken and rice.
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EDI TRIAGE TEAM
Triage and training works with
individual companies and teams
one on one in order to assist them
with identifying problem areas and
resolve their issues. This is done to
help improve the company’s
acceptance rate.
If you feel as though your
company can benefit from
additional training from the Triage
Team, please contact Tonya
Granger
([email protected]
, 850-413-1709). The Triage Team
can provide additional training via
webinar, schedule an office visit
for you to come to us, or, if you
are in Florida, for us to come to
you.
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EDI Triage Team
Tonya Granger, Sr. Management Analysis
Supervisor
Tonya has been working for the Division for
35 years. She says that she enjoys working
in EDI and Triage because it gives the ability
to solve problems. She enjoys going
camping with her family in her camper,
watch her daughter play volleyball, and
playing with Snapchat filters (see Holiday
Greetings email that was sent). Her
favorite food is seafood.
Linda Yon, Government Analyst II
Linda has been working for the Division for
37 years and has been involved with EDI for
26 of those years. She enjoys working one-
on-one with trading partners to help solve
errors and explain the challenging world of
EDI, as well as working with the national
IAIABC EDI Committees to continue to
improve the national standard. She loves
spending time with her grandsons and
relaxing in the mountains of NC. Her
favorite type of food is Chinese.
Peggy Barnidge, Operations Review
Specialist
Peggy is the newest member to the team,
she has been here 2 months, but has
worked for different government agencies
for 8 years. She has enjoyed learning the
other side of claims and helping the
trading partners. She is very active and
loves riding her motorcycle, camping,
boating, fishing & traveling. Her favorite
food is Japanese.
Margaret Forsman, Government
Operations Consultant II
Margaret has been with the Triage team
for a little over a year and with the state
for 28. She enjoys working individually
with trading partners and really digging in
with issues by reviewing all transactions.
Her favorite activities include
scrapbooking, making home-made cards,
reading, and to go on cruises—where she
enjoys her favorite food, seafood.
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EDI Triage Team News!
The EDI Triage Team is traveling
soon and may be coming to a city
near you!
Margaret and Peggy will be
traveling to Tampa, St. Petersburg,
and Sarasota between April 3rd
and 7th (specific dates and times
between cities will be released
soon). If you are currently in
Triage or would like to sign up for
additional training while Margaret
and Peggy are in town, please
contact Tonya Granger
([email protected]
, 850/413-1709).
“But we filed a MTC PD!”
EDI can be challenging and we have
all been left feeling frustrated by
errors we have come across on
rejected transactions—and
sequencing issues can be one of the
toughest concepts to understand.
According to the Top 10 Error
Report, NO SROI S1-7/04/CD/VE/PY
OR PD ON FILE for a MTC FN is one
of the most common errors
received.
You know that you have filed a MTC
PD, you can see it in the Warehouse!
So, why did your MTC FN reject? The
error simply states MTC PD, but in
the Edit Matrix Sequencing Tab, you
can see additional stipulations
required for the MTC PD. A MTC PD
MUST HAVE either Partial Denial
Code A or E if a MTC FN is to accept
without a Suspension on file. Or a
MTC PY MUST HAVE Lump Sum
Settlement Code “SP” or “SF” if a
MTC FN is to accept without a
Suspension on file. If your MTC PD or
PY do not report the previously
mentioned codes, then you will need
to file an intervening Suspension
prior to your MTC FN.
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Calculation Tips
When paying indemnity benefits , there are some pretty simple formulas to
ensure that the payment is accurate for the benefit type. The formulas for
each type of benefit are broken down and available in the Edit Matrix’s
Calculation’s Tab. Furthermore, we expect that all calculations to be rounded
up to the nearest penny. For example, for BTC 050 (Temporary Total Benefits,
TT, or TTD) the Gross Weekly Amount is calculated as the Average Weekly
Wage multiplied by 0.6667—meaning if the AWW is $150.00 you would
multiply $150.00 x 0.6667 = $100.005, but since you round up we expect the
GWA for BTC 050 to be $100.01. By using the proper formula and rounding
correctly, you can avoid both rejections and under/overpayment TA-FL errors.
This is also the same formula for determining the Compensation Rate.
Medical EDI Team News!
The cutoff date for Revision E
submissions is set for March 15,
2017. Effective March 16, 2017,
original bills submitted with Revi-
sion Code E will no longer be ac-
cepted by the Division. If changes
need to be made to previously
submitted bills, they can be made
under either Revision E or F.
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Across
2. This MTC is a periodic report
filed every six months from the
date of injury once indemnity
benefits are paid
8. A code which represents the
classification of a claim
Down
1. The percentage of the amount
of loss an IW has received by a
doctor
2. This MTC is filed to suspend
benefits due to administrative
non-compliance
3. This amount is the base rate at
which a benefit is paid, it is based
off of the AWW/CR and the type
of benefit
4. The first day qualifying as a day
of disability in the first period of
disability
5. The number assigned to a
claim by the Division
6. A code which identifies the
type of recovery being made
7. This MTC is filed to report
settlement information
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EDI Puzzler
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Technical Tip
As you may be aware, you can review your own
Top 10 Error Report and overall Report Card in
the Warehouse.
The benefit to being able to review the Top 10
Error Report is that you can see where your
trouble areas are, determine if it is an
understanding the rule issue or a computer
system issue. If an issue can be rectified by either
fixing a computer system problem or asking for
additional clarification on an edit, this can aide
you in getting a higher acceptance rating. By being
able to generate your own Report Card, you can
view a detailed breakdown of all the transactions
you submitted for the chosen time period and
determine which transactions are your problem
transactions, and you will then be able to work
towards fixing them.
Simply log into the Warehouse (if you need access
to the Warehouse, please refer to FAQ section,
page 9) and when you reach the Main Menu you
will see a series of grey buttons.
Click on the button that says “Report Cards &
Statistical Reports,” and you will be brought
to a new menu.
Click on the top button “Generate Claims EDI
Report Cards.”
From there, you will be able to view a Report
Card or Top 10 Error Report from this
screen. You will be able to choose a date
period from which to view either the Report
Card or the Top 10 Errors Report and/or you
can choose to only view certain transactions.
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Word Bank
AMOUNTPAID CONTROLNUMBER EOBR
FEIN ICD MEDICALEDI
MEIG RESPONSEFILE RESUBMISSION
TRANSACTION
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Medical EDI Puzzler
T H R F F R P J M A J P R T A
G T Z E B O F G M L R E O R F
S I Q O S L Q O P R B H C A E
F L E W O P U H V M D Z U N F
P B M M O N O J U G N U A S R
E J Y C T S U N V D Q U O A Z
G Z I P X C L V S X K F Q C E
O C A E C O I I D E S N D T A
K I Q L R K P H A F F N P I N
D A M T G C O B E P T I Y O I
J L N W P Q H W O K M Z L N E
H O I D E L A C I D E M E E F
C K T M B O H I O C N D U S D
I Q M I L J G E Q Q C A I I C
R E S U B M I S S I O N I C D
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Q: Could you please reset my password? Could you please give me access to the Warehouse?
A: There are administrators for every company that has access to the Warehouse. These administrators
have the ability to complete both of these actions. Please find out who your company administrator is for
the Warehouse and ask them for assistance when you need a password or your
password has expired.
Q: We received a fine that we do not believe we should have received.
A: Please contact your designated CPS Liaison (if you do not know who is your CPS
Liaison, please email [email protected] ).
Frequently Asked Questions
EDI is tricky, but we are here to help in any way that we can. How can we better assist you ?
What topics would you like to see in future issues?
We Would Appreciate Your Feedback!
Please contact us!
You can reach the EDI team by emailing us at [email protected]
You can reach the Medical EDI team by emailing us at
[email protected]
If you feel as though you could use additional Training Assistance with the Triage
Team, please contact the Triage Claims EDI Contact Tonya Granger at
[email protected] or 850-413-1709.
