Workers Compensation Information Services

ISO continues to enhance the products within wcPrism®, its suite of workers compensation data management and compliance reporting solutions.  In 2011, ISO released Version 11.0 of the Workers Compensation Transactional Reporting Plan (WCTRP) in June and Version 11.1 in December. The WCTRP includes the data elements and updates needed to satisfy the reporting requirements for Unit Statistical Reports (USR), WCPOLS and Proof of Coverage (POC), Individual Case Reports (ICR), Detailed Claim Information (DCI), the Medical Data Call, Aggregate Financial Calls, First Reports of Injury (FROI), Subsequent Reports of Injury (SROI), and the Centers for Medicare and Medicaid Services (CMS) claims reporting.  Recent and upcoming developments in workers compensation data reporting are highlighted below.

California Medical Data Call – The Workers Compensation Insurance Rating Bureau of California (WCIRB) has announced it is initiating a Medical Data Call to its carriers in an effort to obtain the information needed to analyze and price medical cost containment solutions proposed for state legislation.  In December 2012, ISO will begin reporting medical transactions occurring in the third quarter of 2012 to the WCIRB for its wcPrism carriers writing in California. 

Redesigned Detail Claim Information (DCI) Program – The NCCI announced the data collection program for Detailed Claim Information (DCI) requiring data providers to supply detailed information for workers compensation claims that involve lost time benefits for the purpose of supplementing state law pricing analysis and state insurance department reporting.  In 2011, ISO completed the required certification and has implemented monthly DCI reporting for its wcPrism carriers.

Centers for Medicare & Medicaid Services (CMS) – Starting in 2011, ISO began quarterly reporting of claim information to CMS for its wcPrism carriers to comply with the mandatory claims reporting requirements of Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.  This wcPrism offering operates in conjunction with the CMS Service developed by ISO ClaimSearch®.

State Regulatory Data Capture System (wcCapture) –  In addition to ISO’s core workers compensation compliance products, which have traditionally focused on the insurance carrier side of compliance, ISO has made recent strides in the development of products that focus on the regulatory side. Since 2009, ISO has been the production vendor for the state of New Jersey for Release 1 FROI and SROI. As of July of 2010, ISO has been the production vendor for the state of West Virginia for Release 3 FROI and SROI, and will be working with West Virginia to develop its IAIABC Medical Program.  Also in 2010, ISO contracted with the state of Alaska for Release 3 FROI and SROI and is currently working with Alaska to roll out the program.  In 2011, ISO executed an agreement with New Jersey (NJCRIB) to upgrade to the IAIABC Release 3 standard for Claims.  In addition, ISO contracted with the state of North Carolina (NCIC) to deliver IAIABC Release 3 services through XML and IAIABC Medical Data Reporting. 

Workers Compensation Analytics (wcAnalyzer) – In 2010, ISO developed an analytics platform designed specifically for workers compensation.  ISO’s platform — aimed at two primary business functions, compliance and operations — is now available to both states and trading partners of the state. For states, our analytics platform complements our state data collection product (wcCapture) in that it provides the capability to examine and measure compliance, monitor workers compensation programs, and identify positive or negative data trends.  For carriers, the platform provides the ability to take a performance-based, proactive approach to compliance, as well as to obtain a data-driven understanding of where claims dollars are being spent.  In 2011, ISO added Argo Group as its first carrier customer for claims data analytics and New Jersey (NJCRIB) as its first DCO customer for medical data analytics.  ISO expects additional market expansion in 2012.

For more information regarding ISO’s workers compensation products and services, please visit the Workers Compensation Reporting page of our web site.