CHAPTER 11
ELECTRONIC DATA INTERCHANGE (EDI)
876—11.1(85,86) Purpose. The purpose of this chapter is to establish the procedure for fulfilling reporting requirements of the division of workers’ compensation.
876—11.2(85,86) Definitions. The following definitions apply to 876—Chapter 3 and this chapter.
“EDI” means electronic transmission or reception, or both, of data through a telecommunications process utilizing a value-added network or the Internet as set forth in the EDI partnering agreement.
“EDI partnering agreement” means the written agreement between an entity and the division of workers’ compensation specifying the terms and manner of reporting by EDI.
“Filed” means receipt and acceptance of a report by the division of workers’ compensation. A report is considered to be “filed” on the date it is accepted (TA) by the division of workers’ compensation. A report that is submitted but rejected (TR) is not considered “filed.” A report that is accepted with errors (TE) must be corrected within five days after the acknowledgement is sent.
“Implementation plan” means the written document prepared by a reporter specifying a timetable for reporting by EDI.
“Report” means a first report of injury (FROI) or a subsequent report of injury (SROI), or both.
“Reporter” means the person who is responsible for reporting to the division of workers’ compensation pursuant to the Iowa workers’ compensation laws and includes an employer, an employer who has been relieved from insurance pursuant to Iowa Code section 87.11, and an insurance carrier which provides an employer workers’ compensation insurance.
“Reporting” means submission of claims data and data fields of information of a report.
876—11.3(85,86) Form of reporting. The format of EDI reporting must be the current version of the International Association of Industrial Accident Boards and Commissions Release 2 FROI/SROI.
876—11.4(85,86) Manner of reporting. The manner of EDI reporting is electronic.
876—11.5(85,86) Voluntary reporting deadline. All reporters must either sign an EDI partnering agreement or submit an implementation plan by December 1, 1999. The division of workers’ compensation must approve implementation plans.
The implementation plans must be approved before January 1, 2000.
876—11.6(85,86) Mandatory reporting deadline. All reporters must sign a partnering agreement and begin reporting by EDI no later than July 1, 2001. Reporting by any means other than EDI after July 1, 2001, will not be acceptable. Reporters are responsible for reporting by EDI. A reporter may contract with another entity for reporting but the reporter is ultimately responsible for reporting. Any entity reporting on behalf of a reporter must also sign an EDI partnering agreement.
876—11.7(85,86) Required reports. A reporter shall file reports as required by Iowa Code sections 86.11, 86.12, and 86.13, 876—subrules 3.1(1) and 3.1(2), this chapter and the partnering agreement. Reports required to be filed include, but are not limited to, the following:
First report of injury (FROI). See 876—subrule 3.1(1);
Subsequent report of injury (SROI). See 876—subrule 3.1(2);
Annual report on every claim that is open on June 30 each year. The annual report shall show all benefits paid since the claim was initiated through June 30 of the current year. A final report shall be filed in lieu of the annual report if the claim is closed and the final report is filed before the date when the annual report is scheduled to be filed; and
Final report filed at the time the claim is closed. The final report indicates that no further benefit payments are contemplated.
These rules are intended to implement Iowa Code sections 85.26, 86.8, 86.11, 86.12 and 86.13.
[Filed 9/4/98, Notice 7/29/98—published 9/23/98, effective 10/28/98]
[Filed 2/15/02, Notice 1/9/02—published 3/6/02, effective 4/10/02]
[Filed 5/20/04, Notice 4/14/04—published 6/9/04, effective 7/14/04]
[Filed 11/4/05, Notice 9/14/05—published 11/23/05, effective 1/1/06]