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California Medical Transaction Data Quality Assurance Program

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California Medical Transaction Data Quality Assurance Program

The California Medical Transaction Data Quality Assurance Program was created to meet the WCIRB’s ratemaking needs and respond to the California Department of Insurance directive to collect medical transaction data in California. Insurers who are a part of the program are required to submit medical data submissions on either a monthly or quarterly basis to the WCIRB.

The due date for quarterly Medical Data Call submission is the last calendar day of the following quarter. The timeliness of an insurer’s submissions is evaluated based on the WCIRB’s expectation of the minimum number of files to be submitted by the due date of each calendar quarter.

For each calendar quarter, if the WCIRB receives all expected files and they are successfully processed on or before the Timeliness Incentive Credit Submission Deadline, the insurer receives a Timeliness Incentive Credit of $1,000. These credits are subject to a non-refundable aggregate maximum credit balance of $7,500 that can used to offset fines levied pursuant to this program.

Insurers are subject to monetary fines and other administrative action for failure to submit data or for failure to address documented data quality reporting issues in a timely manner.