|WCIRB Indemnity Transaction Data Reporting Overview
This webinar covers WCIRB Indemnity Data Reporting Guide and data reporting requirements, and includes a Q&A session.
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Highlights of transactional indemnity data reporting, also referred to as the Indemnity Data Call, are as follows:
Transactional indemnity data on California workers’ compensation claims will be collected in accordance with the reporting requirements and record structure specified in the current version of Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for First and Subsequent Reports of Injury (FROI/SROI). To view more information about WCIS, visit the California Division of Workers Compensation website.
NAIC Groups that write at least 1% of the California workers’ compensation market, as determined by written pure premium, are required to submit transactional indemnity data to the WCIRB. Market share is determined based on calendar year written premium at the pure premium rate level at the NAIC level. Once required to submit medical transaction data, a NAIC Group is required to report that data even if its California market share declines to less than 1%. Insurers whose share of the California workers’ compensation market is less than 1% are also encouraged to submit transactional indemnity data.
Data submissions will be required and subject to audit beginning with indemnity transactions occurring in the 2nd Quarter 2020 and are due by September 30, 2020.
Insurer groups may report transactional indemnity data to the WCIRB on either a daily, weekly or monthly basis. All transactions occurring during a quarter are due to the WCIRB no later than the end of the subsequent quarter. Indemnity data transactions on a claim are required to be reported until transactions no longer occur for the claim in which a Final Transaction (FN) is generated with the Claim Status (DN73) set to ‘closed’ as specified in the WCIS EDI reporting requirements.
Each insurer group must complete a certification process in order to be ready to submit production indemnity data. The certification process begins by the insurer submitting a test plan to the WCIRB. If the insurer is using multiple submitters, the certification process must encompass each submitter. The WCIRB’s Indemnity Data Call team will work closely with insurer groups and their submitter(s) throughout the data certification process.
Indemnity Data Call transactions are to be submitted electronically to the WCIRB via secure transfer to the WCIRB’s File Transfer Protocol (FTP) server as a flat file.
An insurer group may exclude data for claims that represent up to 15% of its gross premium for the state of California from the WCIRB indemnity data reporting requirement, but only in rare circumstances and subject to WCIRB approval. The exclusion may be utilized for small subsidiaries or business segments for the Insurer asserts that it would be an extreme hardship to develop the necessary infrastructure to create the necessary record(s). The exclusion option must be by business segment and not on claim type or characteristics. For additional information on the process by which an insurer may request to exclude the reporting of a portion of its California business, refer to WCIRB Form 104 California Indemnity Data Call – Business Exclusion Request Form or contact the Indemnity Data Call team at [email protected].
Submissions of transactional indemnity data by Third Party Entities that have been approved for data submission by the WCIRB are allowed. However, the insurer group for which the data is being submitted is responsible for the quality of the data. For additional information on the process by which an insurer may request approval for a Third Party Entity to be used to submit its California medical transaction data, refer to WCIRB Form 902 Third Party Entity Registration or contact the Indemnity Data Call team at [email protected].
Rather than auditing each data record individually, the WCIRB will review an insurer’s entire submission for accuracy and completeness in a manner similar to how such data is audited in other jurisdictions.
WCIRB Indemnity Data Reporting Guide - detailed information regarding reporting rules, structure, record layouts, data dictionary and editing rules
WCIRB Indemnity Data Call Edit Matrix - for file acceptance and file processing data validation edit numbers and descriptions
WCIRB Bulletin 2019-01 - Reporting Indemnity Transaction Data
To view questions concerning indemnity transaction data reporting, view the FAQ page.
For any other questions concerning transactional indemnity data reporting, please send an email the Indemnity Data Call Team at [email protected].