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Workers' Comp

Prepare for IAIABC Claims Release 3.1 by Starting with Your EDI Reporting Process

October 8, 2017
4 MIN READ

The IAIABC (International Association of Industrial Accident Boards and Commissions) maintains and develops electronic reporting standards in the Workers Compensation arena. Since 2003, the IAIABC Claims Release 3.0 has been in publication. In September of 2015, the Claims Committee embarked on a journey to create a new version of the standard that would include new functionality, yet build on the current standard. IAIABC Claims Release 3.1 Guide has been released and can be found on the IAIABC website. Some features of the standard include identification of changed data within a transaction, new transaction types and 38 new data elements. Per the standard, a jurisdiction may mandate Release 3.1 no earlier than one year after publication and 180 days after their tables are published. The thought of reviewing the new guide and preparing for a major project to implement the updated standard may seem daunting. Mitchell, having experts intimately involved in the development and approval process of Release 3.1, would like to share a few things to help your organization prepare for the implementation.

1. How do you handle Claims EDI Reporting today?

The first step in deciding how to move forward with Release 3.1 is understanding how you handle Release 1, 2, and 3 Claims EDI Reporting. Does your company manage their EDI reporting in house or do you use a vendor? How is the process working for you? Now may be a good time to explore your options. Vendors have multiple solutions for reporting to meet your specific needs which may reduce the overall build and ownership costs in the long run.

2. Do you have the resources required to launch an implementation?

Whether you choose to partner with a vendor or build 3.1 in house, resources will be needed. The type and amount of resources may vary based on how you proceed. Typically, a cross functional team consisting of EDI subject matter experts, business owners and technical resources are required for a successful implementation.

3. Do you or someone in your organization understand the updated 3.1 requirements?

In order to implement 3.1 in any form, someone from your organization must have a good understanding of the 3.1 requirements. Getting up to speed on the requirements is easy and the 3.1 implementation guide can be downloaded directly from the IAIABC. The IAIABC has resources such as in-person and web-based modules that will be available for purchase. The IAIABC also has bi-annual conferences where leaders in the industry meet to define and update the standards. It’s helpful to know who the experts in the industry are and reach out to the IAIABC with questions. Membership is required to obtain the 3.1 guide and resources, but these documents provide invaluable information. Contact the IAIABC at www.iaiabc.org.

4. Do you have all the data elements required?

Release 3.1 added multiple data elements including detailed dependent information. If you find you do not currently have the data in your claim system, you may need to add the data fields and begin collecting data prior to implementation of the 3.1 release. Not all jurisdictions will require every data element within the standard, so it may be prudent to review the jurisdictions you do business in to understand their requirements before modifying your system.

5. Do you know who is implementing 3.1 and when?

As of time of publication, there is only speculation regarding which jurisdictions will jump on the 3.1 bandwagon. Maine announced that they plan to release their tables soon after 3.1 is published. Several other jurisdictions have indicated their interest as well. The IAIABC will catalog this type of information, however, it is a good idea to review jurisdictional websites and keep a record of jurisdictions’ intentions. Once a jurisdiction decides to implement 3.1, identify your claim volume and determine whether or not the jurisdiction is already utilizing a prior EDI standard. This will help determine if you can use a jurisdiction web portal or, if perhaps, a lower cost vendor solution is right for you. If the jurisdiction is high volume, you will want to choose the most efficient method of reporting for your organization.

6. How will you train your organization?

Many different areas of your business will need information regarding 3.1. Organizations differ in what role is responsible for EDI reporting, however, data collection begins with the claims examiner. Organizations with a planned training program and the same level of support post implementation of a new jurisdiction will be more equipped to handle issues as they arise. As with any new implementation, there will be challenges. Make sure that you have prepared your front line with the resources required to do their jobs effectively. In summary, there are a lot of changes incorporated in IAIABC Claims Release 3.1, and early preparation is the key to success. Beginning to think through your organization’s needs early will help guide you to a path of success on your 3.1 journey. Tina Queen is a product manager at Mitchell International and the IAIABC claims committee chair responsible for the creation and publication of the 3.1 standard.