1 SROI SA, FN Electronic Periodic Claim Cost Reports Electronic DWC-13 Equivalent Required to be filed with DWC per Rule 69L-56.3013, F.A.C

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SROI SA, FNSROI SA, FN

Electronic Periodic Electronic Periodic Claim Cost ReportsClaim Cost Reports Electronic DWC-13 Equivalent Electronic DWC-13 Equivalent Required to be filed with DWC Required to be filed with DWC

perper Rule Rule 69L-56.3013, 69L-56.3013, F.A.C.F.A.C.

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Periodic ReportsPeriodic Reports are are Subsequent Reports Subsequent Reports (SROI) that equate to FL’s (SROI) that equate to FL’s Claim Cost Report (DWC-Claim Cost Report (DWC-13).13).

Represented by SROI Represented by SROI SA, FNSA, FN..

SROI SA, FN – Electronic SROI SA, FN – Electronic Periodic Claim Cost ReportsPeriodic Claim Cost Reports

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Periodic filings, SROI Periodic filings, SROI SA, FNSA, FN report the total cumulative report the total cumulative amounts paid in indemnity amounts paid in indemnity ((BenefitsBenefits segment) and segment) and certain medical costs certain medical costs ( (Other BenefitsOther Benefits segment.) segment.)

SROI SA, FN – Electronic SROI SA, FN – Electronic

Periodic Claim Cost ReportsPeriodic Claim Cost Reports

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Pop Quiz: Pop Quiz:

Are the “Are the “BenefitsBenefits

Segments” on an SA Segments” on an SA

or FN:or FN:

““Event”Event” Benefit Benefit Segments, Segments, or or

““Sweep”Sweep” Benefit Benefit Segments?Segments?

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Answer: Answer:

““Sweep” Sweep” Benefit Benefit

SegmentsSegments

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Recap:Recap: A “Sweep” A “Sweep” Benefits Benefits Segment does Segment does NOT NOT require the require the following ‘event-driven’ data following ‘event-driven’ data elements:elements:

•• MTC MTC •• Gross Weekly Amount Gross Weekly Amount

•• Gross Weekly Amount Gross Weekly Amount Effective Date Effective Date

•• Net Weekly Amount Net Weekly Amount

•• Net Weekly Amount Effective Net Weekly Amount Effective Date Date

•• Benefit Payment Issue Date Benefit Payment Issue Date


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Recap:Recap: A “Sweep” A “Sweep” Benefits Benefits Segment only requires reporting Segment only requires reporting of the following “historical’ data of the following “historical’ data elements:elements:

•• Benefit Type Code, Benefit Type Code, •• Benefit Period Start Date Benefit Period Start Date (except (except legacy claims), legacy claims),

•• Benefit Period Through Date Benefit Period Through Date (except (except

legacy claims), legacy claims),

•• Benefit Type Claim Weeks, Benefit Type Claim Weeks,

•• Benefit Type Claim Days, andBenefit Type Claim Days, and

•• Benefit Type Amount Paid Benefit Type Amount Paid


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Recap:Recap: For Periodic For Periodic MTC’s SA, FN, MTC’s SA, FN, “Benefit “Benefit Period Start Date”Period Start Date” is: is:

• Earliest dateEarliest date for a BTC; for a BTC; • Even if multiple benefit Even if multiple benefit periods have been paid periods have been paid for the BTC.for the BTC.

““Benefit Period Start Benefit Period Start Date”Date”

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““Benefit Period Through Benefit Period Through Date”Date”Recap:Recap: For Periodic MTC’s For Periodic MTC’s

SA, FN, SA, FN, ‘Benefit Period ‘Benefit Period Through Date’Through Date’ is: is:

• Latest dateLatest date for a BTC;for a BTC;• Even if multiple benefit Even if multiple benefit periods have been paid for periods have been paid for the BTC.the BTC.

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In general:In general:

SROI SASROI SA (Sub-Annual)(Sub-Annual) is is required to be filed for required to be filed for Open Open casescases every 6 monthsevery 6 months from the from the DOI until the claim is closed.DOI until the claim is closed.

SROI FNSROI FN (Final Report)(Final Report) is is required for required for Closed casesClosed cases where no further indemnity or where no further indemnity or medical benefits are medical benefits are anticipated to be paid.anticipated to be paid.

SROI SA, FN – Electronic SROI SA, FN – Electronic Periodic Claim Cost ReportsPeriodic Claim Cost Reports

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SROI MTC SROI MTC

SASA

Sub-AnnualSub-Annual

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Specifically, in accordance Specifically, in accordance with Rule with Rule 69L-56.3013(4)(a), 69L-56.3013(4)(a), F.A.C.:F.A.C.:

SROI SROI SA (Sub-Annual)SA (Sub-Annual) is is due:due:

• DOI + DOI + 6 Months6 Months (+30 (+30 Days), orDays), or• DOI + DOI + 12 months12 months (+30 (+30 Days) if Days) if LT occurs > 6 LT occurs > 6 Months from DOIMonths from DOI

SROI SASROI SA

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SA, Sub-AnnualSA, Sub-Annual is also is also required to be filed with required to be filed with DWC if the claim is re-DWC if the claim is re-opened to pay opened to pay ongoingongoing indemnity or reportable indemnity or reportable medical benefits medical benefits (per Rule (per Rule 69L-56.3013(4)(b)3., F.A.C.69L-56.3013(4)(b)3., F.A.C.))

• Due aDue at t 6 month intervals6 month intervals from DOI (+ 30 Days) until from DOI (+ 30 Days) until Final is filed.Final is filed.

SROI SASROI SA

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The first MTC The first MTC SASA (Sub- (Sub-Annual) must not be sent Annual) must not be sent prior to the end of six (6) prior to the end of six (6) months from the months from the Date of Injury, or the Date of Injury, or the transaction will reject. transaction will reject.

Sequencing RuleSequencing Rule(in Edit Matrix) for(in Edit Matrix) for

SROI SA (Sub-Annual)SROI SA (Sub-Annual)

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If a subsequent SROI MTC If a subsequent SROI MTC SA is sent more than 7 days SA is sent more than 7 days before the date it is due, it before the date it is due, it will be considered an will be considered an amendment amendment to the to the previously accepted MTC SA previously accepted MTC SA (vs. a duplicate or the next (vs. a duplicate or the next required MTC SA filing.)required MTC SA filing.)

Duplicate Processing Duplicate Processing NoteNote

(in Edit Matrix) for (in Edit Matrix) for ““SA after SA”SA after SA”

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Example: Example: DOI = 9-1-06DOI = 9-1-06

11stst SA: SA:File no earlier than File no earlier than 3-3-1-071-07 and no later and no later than than 3-31-073-31-07 (Not always exactly 180 days-use (Not always exactly 180 days-use calendar mo’s) calendar mo’s)

22ndnd SA: SA: File no earlier than 7 File no earlier than 7 days prior days prior to 9-1-07 and to 9-1-07 and no later than 30 no later than 30 days days after 9-1-07 (10-1-07) to after 9-1-07 (10-1-07) to

fulfill the 2fulfill the 2ndnd SA filing SA filing reqm’t.reqm’t.

““Duplicate Processing” Duplicate Processing” Note Note

(SA after SA)(SA after SA)

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Another Example: Another Example: DOI = 8-31-DOI = 8-31-0606

11stst SA: SA: File no earlier than File no earlier than 3-3-1-071-07 and no later and no later than than 3-31-073-31-07.. (If 6 mo. interval yields invalid date, use 1st (If 6 mo. interval yields invalid date, use 1st day of next mo.)day of next mo.)

22ndnd SA: SA: File no earlier than 7 File no earlier than 7 days prior days prior to 8-31-07 to 8-31-07 and no later than 30 and no later than 30 days days after 8-31-07 (9-30-07) to after 8-31-07 (9-30-07) to

fulfill the 2fulfill the 2ndnd SA filing SA filing reqm’t.reqm’t.

““Duplicate Processing” Duplicate Processing” Note Note

(SA after SA)(SA after SA)

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Monthly Monthly Missing SA Missing SA

ReportReport

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Due to a decline in the Due to a decline in the proper filing of Claim Cost proper filing of Claim Cost reports, DWC instituted a reports, DWC instituted a “Monthly Missing SA “Monthly Missing SA Report” Report” last year (11/1/09)last year (11/1/09)

• Posted in Data Posted in Data Warehouse under Warehouse under ‘Proprietary Claims EDI ‘Proprietary Claims EDI Reports’.Reports’.

Monthly Missing SA Monthly Missing SA ReportReport

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However, due to an However, due to an internal data clean up internal data clean up project , the ‘Missing SA’ project , the ‘Missing SA’ report had been report had been temporarily suspended. temporarily suspended.

• It was resumed in April It was resumed in April 2010. 2010.

• The due date for The due date for reconciling the initial reconciling the initial April report will be April report will be August 2, 2010.August 2, 2010.


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• Please reconcile each Please reconcile each month’s month’s Missing SA Missing SA reportreport. . • An email advisory will be An email advisory will be sent when each Missing sent when each Missing SA Report is posted in the SA Report is posted in the warehouse. warehouse. • This revised version of This revised version of the report includes the the report includes the EE’s Name and Date of EE’s Name and Date of Birth (SSN was removed.)Birth (SSN was removed.)


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DWC sends email DWC sends email notification regarding the notification regarding the posting of the posting of the Missing SA Missing SA ReportReport to each person to each person having a data warehouse having a data warehouse account. account.

• However, if you do not However, if you do not want to receive emails want to receive emails for this purpose …for this purpose …


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… … your account your account administrator can administrator can ‘uncheck’ the “Receives ‘uncheck’ the “Receives Monthly Missing MTC SA Monthly Missing MTC SA Report Notices” in your Report Notices” in your warehouse warehouse account/profile.account/profile.


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The The Monthly Missing SA Monthly Missing SA ReportReport identifies: identifies:

• Claims that are due an Claims that are due an SA transaction, and SA transaction, and • Claims for which no SA Claims for which no SA or FN has been filed with or FN has been filed with DWC. DWC.


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TheThe Missing SA ReportMissing SA Report includes:includes:

• OPEN, LOST TIME Claims OPEN, LOST TIME Claims (not cancelled or total denials (not cancelled or total denials where no indemnity has been where no indemnity has been paid)paid) for which for which • A DWC-1 or DWC-13 A DWC-1 or DWC-13 (paper (paper or EDI)or EDI) is ‘on file’ and ..., is ‘on file’ and ...,


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Claims where:Claims where:

• DOI DOI > > 1/1/2005; or1/1/2005; or

• EDI R1/R3 acceptedEDI R1/R3 accepted (any (any

DOI);DOI); oror

• PT/PT Supp $ paidPT/PT Supp $ paid (any DOI);(any DOI); oror

• Recent DWC FormRecent DWC Form (1, 4, 12, or (1, 4, 12, or

13)13) rec’d on/after 1/1/2008rec’d on/after 1/1/2008 (regardless of DOI). (regardless of DOI).

Monthly Missing SA ReportMonthly Missing SA Report

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DWC advises Claim DWC advises Claim Admin.’s to ensure they Admin.’s to ensure they file an SA file an SA (and receive a (and receive a TA)TA) every 6 months from every 6 months from DOI until the claim is DOI until the claim is closed and an FN is sent closed and an FN is sent and accepted. and accepted.

• Missing SA’s or FN’s Missing SA’s or FN’s should be triggered and should be triggered and filed with DWC. filed with DWC.


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The The Missing SA ReportMissing SA Report also also incorporates the below incorporates the below timeframes:timeframes:

• If IB is initial payment:If IB is initial payment: SASA due due nextnext 6 month increment 6 month increment after Payment Issue Date.after Payment Issue Date.• If Settlement is Initial If Settlement is Initial Payment:Payment: SASA due due nextnext 6 6 month increment after month increment after Award/order Date.Award/order Date.


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The Bureau of Monitoring The Bureau of Monitoring and Audit will also have and Audit will also have access to query the access to query the Monthly Missing SA Monthly Missing SA Reports. Reports.

• PT Section of M&A is PT Section of M&A is also soliciting overdue also soliciting overdue SA’s (respond to these SA’s (respond to these upon receipt of request.)upon receipt of request.)


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SROI MTC SROI MTC

FNFN

FinalFinal

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As mentioned earlier, aAs mentioned earlier, a SROI SROI FN (FINAL)FN (FINAL) EDI DWC-13 EDI DWC-13 equivalent, is required to be equivalent, is required to be filed with DWC if the claim is filed with DWC if the claim is Closed.Closed.

SROI FNSROI FN

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In accordance with Rule In accordance with Rule 69L-56.3013(4)(b), 69L-56.3013(4)(b), F.A.C.,F.A.C., SROI SROI FN (Final)FN (Final) is is due: due:

• On or before On or before 30 days after 30 days after the due date of the next SAthe due date of the next SA, , or or

• After final paymentAfter final payment of of indemnity and medical indemnity and medical benefits, orbenefits, or

• Upon closureUpon closure of claim by of claim by Claim Administrator. Claim Administrator.

SROI FNSROI FN

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SROI SROI FN (Final)FN (Final) may be may be sent prior to the due date sent prior to the due date of the next “SA” if :of the next “SA” if :

• The case is closed and The case is closed and no further indemnity or no further indemnity or medical benefits will be medical benefits will be paid. paid.

SROI FNSROI FN

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SROI SA, FN Electronic Claim SROI SA, FN Electronic Claim Cost Cost

In addition to indemnity benefits, In addition to indemnity benefits, the following the following Other Benefit TypeOther Benefit Type Codes/AmountsCodes/Amounts are required on are required on Electronic Claim Cost Reports MTC SA Electronic Claim Cost Reports MTC SA and FN: and FN:

• OBT 300 OBT 300 (Funeral),(Funeral),• OBT 310/311 OBT 310/311 (Penalties),(Penalties),• OBT 320/321 OBT 320/321 (Interest),(Interest), • OBT 370 OBT 370 (Other/Misc. medical)...(Other/Misc. medical)...

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SROI SA, FN Electronic Claim SROI SA, FN Electronic Claim CostCost… …

• OBT 380 OBT 380 (Voc Rehab Eval)(Voc Rehab Eval)

• OBT 390 OBT 390 (Voc Rehab Education – (Voc Rehab Education – includes post-secondary education includes post-secondary education to dependent) to dependent)

• OBT 400 OBT 400 (Other Voc Rehab),(Other Voc Rehab),

• OBT 430 OBT 430 (Unallocated Indemnity) (Unallocated Indemnity) andand

• OBT 475 OBT 475 (Mileage/Travel Expenses.(Mileage/Travel Expenses.

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SROI SA, FN Electronic Claim CostSROI SA, FN Electronic Claim Cost Miscellaneous Medical includes Miscellaneous Medical includes costs costs not otherwise classified or required to be not otherwise classified or required to be reported to DWC pursuant to reported to DWC pursuant to Rule 69L-Rule 69L-7.602, F.A.C., 7.602, F.A.C., including,including,

• Custom handicapped equipped Custom handicapped equipped housing, incl. ramps, wide doorways, housing, incl. ramps, wide doorways, etc.,etc.,

• Custom vans,Custom vans,• Therapeutic hot tubs,Therapeutic hot tubs,• Home attendant care,Home attendant care,• On-site field case management On-site field case management

services…services……

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• … …Telephonic nurse case Telephonic nurse case management services management services (except where Claim Admin. (except where Claim Admin. uses the services of a case uses the services of a case manager for a face-to-manager for a face-to-face meeting with the face meeting with the physician to conduct a physician to conduct a telephone call with the treating telephone call with the treating physician or participate in a physician or participate in a team conference, in which case team conference, in which case the claim administrator should the claim administrator should report under medical EDI codes report under medical EDI codes 99361 through 99373),99361 through 99373),• HHospice, etc.ospice, etc.

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SROI SA, FN Electronic Claim CostSROI SA, FN Electronic Claim Cost

Expense items should Expense items should notnot be be reported underreported under Other Medical/OBT Other Medical/OBT 370, 370, e.g.:, e.g.:,

• Cost for bill review services, orCost for bill review services, or

• Determining correct medical Determining correct medical reimbursement relating to PPO reimbursement relating to PPO discounts,discounts,

• Drug screen expenses, etc.Drug screen expenses, etc.

Note:Note: Payments to the EE for EE-paid Rx are Payments to the EE for EE-paid Rx are reported as an ‘employee reimbursement’ via reported as an ‘employee reimbursement’ via the medical EDI format (vs. Other medical). the medical EDI format (vs. Other medical).

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SROI SA, FN Electronic Claim CostSROI SA, FN Electronic Claim Cost FL FL no longer requiresno longer requires the inclusion the inclusion of the following costs on the SROI SA of the following costs on the SROI SA or FN, since the following are or FN, since the following are reported via the medical EDI format: reported via the medical EDI format:

• OBT Code 350 OBT Code 350 (Physician),(Physician),

• OBT Code 360 OBT Code 360 (Hospital),(Hospital),

• OBT Code 450 OBT Code 450 (Pharmacy)(Pharmacy)

• OBT Code 455 OBT Code 455 (Durable medical),(Durable medical),

• OBT Code 460 OBT Code 460 (Physical therapy)(Physical therapy) and and

• OBT Code 465 OBT Code 465 (Chiropractic).(Chiropractic).

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SROI SA, FN Electronic Claim SROI SA, FN Electronic Claim CostCost

SROI SA/FN is SROI SA/FN is not not required for the required for the following types of claims (and therefore following types of claims (and therefore not on Missing SA Report): , unless one not on Missing SA Report): , unless one or more BTC’s or required OBT’s have or more BTC’s or required OBT’s have been paid:been paid:

• FROI 04 FROI 04 (Total Denial)(Total Denial)• 00/PD 00/PD (Indemnity Only Denied)(Indemnity Only Denied)• 00/CD 00/CD (Compensable Death, No Depndts)(Compensable Death, No Depndts)• 00/VE 00/VE (Compensable Volunteer)(Compensable Volunteer)• S8 S8 (Claim transferred to another juris)(Claim transferred to another juris)• PY with RBAC S or N PY with RBAC S or N (Settlement with (Settlement with

$0)$0)• FROI 01 FROI 01 (Claim cancelled)(Claim cancelled)

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Caveats andCaveats andTips for Tips for

Successfully Successfully Filing SROI SA, FNFiling SROI SA, FN

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Caveats and Tips for Filing SA, Caveats and Tips for Filing SA, FNFN

The majority of SA filings are The majority of SA filings are rejecting for the error:rejecting for the error:

NBR OF BENEFITS SHOULD NOT NBR OF BENEFITS SHOULD NOT BE > WHAT IS ON FILEBE > WHAT IS ON FILE

• As mentioned earlier, this appears As mentioned earlier, this appears to be caused by incorrectly leaving off to be caused by incorrectly leaving off BTC(s) on either the initial transaction BTC(s) on either the initial transaction that ‘set the benefit picture’, or due that ‘set the benefit picture’, or due to including the “R” code that to including the “R” code that excuses missing benefits.excuses missing benefits.

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If a suspension is not yet ‘on If a suspension is not yet ‘on file’file’ and you need to report a and you need to report a BTC paid in the past that was BTC paid in the past that was improperly left off the previous improperly left off the previous accepted filing, our program accepted filing, our program will allow you to ‘introduce’ the will allow you to ‘introduce’ the new Benefit type via MTC CB. new Benefit type via MTC CB. (Even though you are not actually (Even though you are not actually changing the current BTC to the new changing the current BTC to the new BTC.)BTC.)

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However, if you need to However, if you need to report a BTC that was paid report a BTC that was paid in the past but left off the in the past but left off the previously accepted previously accepted transaction but transaction but a a suspension has already suspension has already beenbeen filed, it is difficult to filed, it is difficult to fix the ‘benefit picture’ with fix the ‘benefit picture’ with another transaction / MTC. another transaction / MTC.

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In this case, you would In this case, you would notnot send send a SROI RB if indemnity benefits a SROI RB if indemnity benefits have truly not been reinstated. have truly not been reinstated. If you filed an RB, you would be If you filed an RB, you would be precluded from sending another precluded from sending another Sx with the same (true) Susp. Sx with the same (true) Susp. Effective Date. Effective Date.

Therefore, you would need to Therefore, you would need to send a request to the Claims EDI send a request to the Claims EDI Team for special handling. Team for special handling.

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As a result of seeing this As a result of seeing this situation occur for legacy as situation occur for legacy as well as new claims, FL has well as new claims, FL has proposed a new Lump Sum proposed a new Lump Sum Payment/Settlement Code Payment/Settlement Code ((ND – Non DisputedND – Non Disputed)) to to enable the reporting of a enable the reporting of a one time payment of back one time payment of back benefits without having to benefits without having to “change” or “reinstate” “change” or “reinstate” benefits (benefits (pending IRR pending IRR discussion/votediscussion/vote.).)

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The majority of FN filings The majority of FN filings are rejecting for are rejecting for the error:the error:

NO SROI S1-8, 04, CD, VE, NO SROI S1-8, 04, CD, VE, PY OR PD ON FILE PY OR PD ON FILE

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For For non-legacynon-legacy claims, one of claims, one of the following must be ‘on file’ the following must be ‘on file’ before the before the FNFN will be accepted: will be accepted:

• Suspension (S1-S8); orSuspension (S1-S8); or

• Total Denial (FROI or SROI 04), Total Denial (FROI or SROI 04), or, or,

• Partial/Indemnity Only Denial (PD Partial/Indemnity Only Denial (PD Code A or E), or Code A or E), or

• Final Settlement Final Settlement (PY w/LSPS Code (PY w/LSPS Code SF, SP)SF, SP)

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(cont’d) …(cont’d) …

If none of these transactions If none of these transactions were previously filed, an were previously filed, an FNFN will also be accepted if:will also be accepted if:

• Paper DWC-1 was filed or, Paper DWC-1 was filed or,

• Claim was acquired via AQ Claim was acquired via AQ and the acquiring Claim and the acquiring Claim Admin. never paid indemnity Admin. never paid indemnity (i.e., no subsequent AP, PY.) (i.e., no subsequent AP, PY.)

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Caveats and Tips for Filing SA, Caveats and Tips for Filing SA, FN FN

Other common errors for Other common errors for SA, FNSA, FN filings are: filings are:

PI % CANT BE 1ST RPTED ON THIS PI % CANT BE 1ST RPTED ON THIS MTC MTC

PI % CANT BE CHANGED VIA THIS PI % CANT BE CHANGED VIA THIS MTC MTC

MMI CANT BE 1ST RPTED ON THIS MMI CANT BE 1ST RPTED ON THIS MTCMTC

AVG WAGE MUST BE CHANGED VIA AVG WAGE MUST BE CHANGED VIA MTC 02 CB CA AP OR RBMTC 02 CB CA AP OR RB

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Caveats and Tips for Filing Caveats and Tips for Filing SA, FNSA, FN

• PI, MMI, and AWW PI, MMI, and AWW information is required information is required to be reported via EDI to be reported via EDI DWC-4 equivalents, e.g., DWC-4 equivalents, e.g., 02, CA, CB, RB, PY02, CA, CB, RB, PY (where it was not (where it was not applicable at time the applicable at time the EDI First Report was EDI First Report was filed.)filed.)

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SA and FN filings are also SA and FN filings are also often rejected for:often rejected for:

BEN TYPE CODE PREVIOUSLY BEN TYPE CODE PREVIOUSLY REPORTED NOT SENT ON SROIREPORTED NOT SENT ON SROI

• Here, you may need to Here, you may need to legitimately report the “R” legitimately report the “R” code if a BTC was totally code if a BTC was totally converted to another BTC…converted to another BTC…

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• ... and is no longer ... and is no longer applicable to the claim, or applicable to the claim, or

• OBT 430 (Acquired OBT 430 (Acquired Unallocated Indemnity) Unallocated Indemnity) needs to be included to needs to be included to show prior BTC’s ‘rolled up’, show prior BTC’s ‘rolled up’, or or

• A Benefit Type Code(s) A Benefit Type Code(s) really was inadvertently left really was inadvertently left off the transaction.off the transaction.

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Another error frequently Another error frequently occurring for occurring for FNFN filings is:filings is:

IF DOI >= 1/1/94, BTC 030 IF DOI >= 1/1/94, BTC 030 (IB) DAYS CANT BE > 0 (IB) DAYS CANT BE > 0

• DWC expects IB (030) to have DWC expects IB (030) to have been paid in whole weeks (unless been paid in whole weeks (unless claim was settled or EE died claim was settled or EE died before IB days could be before IB days could be reclassified into another BTC.)reclassified into another BTC.)

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SCENARIO:SCENARIO:

SROI MTC SROI MTC

“SA”“SA”With Recovery Code With Recovery Code

“880” “880” (Voided Indemnity (Voided Indemnity

Benefit Check)Benefit Check)

Rule 69L-56.3013, F.A.CRule 69L-56.3013, F.A.C..

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SROI MTC “SA” SROI MTC “SA” ScenarioScenario

With Recovery Code “880”With Recovery Code “880” The Claim The Claim Administrator Administrator previously sent MTC previously sent MTC “00/IP” to report its “00/IP” to report its initial payment of TT initial payment of TT benefits eff. 6/16/07. benefits eff. 6/16/07.

MTC “S1” was MTC “S1” was subsequently sent to subsequently sent to report the suspension report the suspension of TT benefits eff. of TT benefits eff. 8/24/07.8/24/07.

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With Recovery Code “880”With Recovery Code “880” On 8/29/07, two days On 8/29/07, two days after the Claim after the Claim Administrator had sent the Administrator had sent the SROI S1, the employer SROI S1, the employer informed the Claim informed the Claim Administrator the Administrator the employee actually returned employee actually returned to work on 8/11/07, two to work on 8/11/07, two weeks earlier. weeks earlier.

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With Recovery Code “880”With Recovery Code “880” As a result, the previous As a result, the previous SROI S1 reflected the SROI S1 reflected the payment of TT benefits for payment of TT benefits for 2 weeks more than were 2 weeks more than were due. due.

Because the Claim Because the Claim Administrator confirmed Administrator confirmed the check had not yet been the check had not yet been tendered, a stop payment tendered, a stop payment was placed on the check. was placed on the check.

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With Recovery Code “880”With Recovery Code “880” On 12/21/07, the Claim Admin. On 12/21/07, the Claim Admin. sends its initial Sub-Annual sends its initial Sub-Annual (SROI SA) to DWC to report the (SROI SA) to DWC to report the total cumulative amount paid total cumulative amount paid for TT and some medical costs.for TT and some medical costs.

The “SA” reflects the The “SA” reflects the reduction in TT previously reduction in TT previously reported on the S1, as a result reported on the S1, as a result of the recovery/cancellation of of the recovery/cancellation of the lastthe last TT TT check. check.

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With Recovery Code “880”With Recovery Code “880” Note:Note: Prior to filing the Prior to filing the initial SROI SA, the Claim initial SROI SA, the Claim Administrator must file a Administrator must file a SROI 02SROI 02 to report the to report the change in the change in the “Initial “Initial Return to Work Date”Return to Work Date” and and “Suspension Effective “Suspension Effective Date”,Date”, as FL does not look as FL does not look at this information on at this information on Electronic Claim Cost Electronic Claim Cost Reports. Reports.

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With Recovery Code “880”With Recovery Code “880” The Claim Administrator The Claim Administrator must ensure that a must ensure that a Recovery Segment is sent Recovery Segment is sent on the “SA” to explain the on the “SA” to explain the difference in the lower difference in the lower amount of TT benefits amount of TT benefits reported on the “ SA” reported on the “ SA” compared to the higher compared to the higher amount previously amount previously reported on the “S1”.reported on the “S1”.

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With Recovery Code “880”With Recovery Code “880”

The claim administrator The claim administrator sends its Initial MTC SA on sends its Initial MTC SA on 12/21/07.12/21/07.

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With Recovery Code “880”With Recovery Code “880” 1 BT, 2 OBT’s, and 1 Recovery are 1 BT, 2 OBT’s, and 1 Recovery are

reported. reported.

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With Recovery Code “880”With Recovery Code “880” The Benefit Segment for 050 The Benefit Segment for 050 reflects the total amount paid for reflects the total amount paid for TT (does not include the amount TT (does not include the amount recovered.)recovered.)

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With Recovery Code “880”With Recovery Code “880” Let’s compare the previous S1 to Let’s compare the previous S1 to the SAthe SA SASAS1S1

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With Recovery Code “880”With Recovery Code “880” In addition to the 2 OBT’s, Recovery In addition to the 2 OBT’s, Recovery Code 880 and corresponding Code 880 and corresponding Amount are sent to reflect Amount are sent to reflect indemnity benefits (TT) were indemnity benefits (TT) were voided/cancelled.voided/cancelled.

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In addition to BTC’s and In addition to BTC’s and certain OBT’s, SROI certain OBT’s, SROI SASA and and FNFN should also report the should also report the following information if following information if applicable to the claim:applicable to the claim:

• OngoingOngoing adjustmentsadjustments;;

• OngoingOngoing creditscredits;;

• OngoingOngoing redistributionsredistributions; ; andand

• RecoveriesRecoveries..

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Questions?Questions?

Documents

1 SROI SA, FN Electronic Periodic Claim Cost Reports Electronic DWC-13 Equivalent Required to be filed with DWC per Rule 69L-56.3013, F.A.C