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Medical Transaction Data Reporting

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Medical Transaction Data Reporting

April 14, 2014

Medical transaction data reporting is now required in California for NAIC groups that write at least 1% of the California workers’ compensation market and the WCIRB has launched the new California Medical Transaction Data Quality Assurance Program.

Effective the third quarter of 2012, NAIC Groups that write at least 1% of the California workers’ compensation market (based on written pure premium) are required to submit medical transaction data (Medical Data Call). The analysis of this data provides the WCIRB with insight into emerging cost trends, improves the WCIRB’s ratemaking process, and gives the WCIRB better tools to evaluate legislative or regulatory system changes such as those contained in Senate Bill No. 863 (2012).  Additional information regarding eligibility and reporting requirements is located in the California Medical Data Call Reporting Guide which is available in the Data Reporting section of the WCIRB website.

In December of 2013, the WCIRB’s Governing Committee approved the California Medical Transaction Data Quality Assurance Program (Program) to promote the timely, complete and accurate submission of medical transaction data. The Program was approved on a pilot basis beginning with data submitted for the first quarter of 2014. During the pilot, insurers will receive timeliness results and communication regarding their performance compared to the standards adopted by the Program; however, no fines or credits will be issued. Beginning with data submitted for the first quarter of 2015, insurers will be subject to monetary fines and eligible for incentive credits, as outlined in the Program.

All Expected Files, as defined in the Program, must be received on or before the Timeliness Incentive Credit Submission Deadline to quality for a credit and must be received by the Timeliness Due Date in order to be considered timely and avoid being subject to fines. This table summarizes the key dates related to the Program’s pilot period and first year of data reporting after the pilot ends.

Medical Data Call
Reporting Period 
Timeliness Incentive Credit Submission Deadline Timeliness Due Date
1st Quarter 2014 (Pilot) May 15, 2014 June 30, 2014
2nd Quarter 2014 (Pilot) August 15, 2014 September 30, 2014
3rd Quarter 2014 (Pilot) November 15, 2014 December 31, 2014
4th Quarter 2014 (Pilot) February 15, 2015 March 31, 2015
1st Quarter 2015 May 15, 2015 June 30, 2015
2nd Quarter 2015 August 15, 2015 September 30, 2015
3rd Quarter 2015 November 15, 2015 December 31, 2015
4th Quarter 2015 February 15, 2016 March 31, 2016

 

A complete copy of the Program  is available in the Data Quality Programs section of the WCIRB website. To register for one of the upcoming webinars and learn more about the Program,  visit the Medical Transaction Data Quality Assurance Webinars page. 

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