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Medical Reporter will help you manage
the detailed medical claims reporting you need to meet data collection
organization (DCO) requirements, as well as the collection and
submission of medical transactions for the International Association of
Industrial Accident Boards and Commissions (IAIABC) in appropriate
jurisdictions.
The service combines ISO’s extensive
workers comp experience with the medical-data and healthcare analytics
expertise of ISO subsidiary Verisk
Health
to deliver a powerful reporting solution through the Verisk Health
Intelligence PlatformTM (VHIP), a sophisticated set of
tools for strategic analysis of healthcare data. Medical Reporter will
accept either a native feed (proprietary, ANSI) directly from your
system or a feed from your medical bill provider’s system to generate
the specific medical-data call required by each jurisdiction.
Medical
Reporter will subject each report to applicable jurisdictional/DCO
edits before submission to identify potential data issues. The service
also provides you and your bill provider with secure online access to
resolve data concerns as they occur. As part of wcPrism, Medical
Reporter will eliminate the need to maintain multiple data feeds to
accommodate increasingly complex requirements that vary by jurisdiction
and DCO.
NEW MEDICARE SECONDARY PAYER
REQUIREMENTS:
ISO helps carriers comply with
mandate
On
July 1, 2009, new mandatory reporting of payments to Medicare-eligible
workers, written into the Medicare, Medicaid, and SCHIP Extension Act of
2007 (MMSEA), went into effect for workers compensation, liability
insurance (including self-insurance), and no-fault insurance.
For
our workers comp clients, ISO has enhanced its Workers Compensation
Transactional Reporting Program (WCTRP) to include additional fields
that satisfy the new reporting requirements. We also updated our V-Comp
Solutions Medical Reporter feed to ISO ClaimSearch® Universal Format
claims reporting process. Through the ISO
ClaimSearch Medicare Secondary Payer Reporting Service, ISO will
report claims data to the Centers for Medicare &
Medicaid Services (CMS) on behalf of our customers.
ISO
has developed the necessary record layouts, registration procedures and
processing workflows – including CMS acknowledgment and error
rejection/correction routines — that allow carriers reporting through us
to fully comply with the mandate.
Timeline
for CMS mandates (updated
7/09)
- 9/30/09 — carriers must register their
data-reporting method
- 7/1/09 — test and production Query
Input Files accepted
- 1/1/10 — Claim Input File testing
begins
- 1/1/10
— production Claim Input Files accepted
- 4/1/10 to 6/30/10 — initial production
Claim Input File submissions due
NEW MEDICAL DATA CALL:
ISO
updates its WCTRP in response to call for additional medical data
To help carriers comply with a new data
collection call for more detailed medical data, ISO has updated its
WCTRP and made the enhanced transactional reporting plan available to
customers on April 1, 2009. The enhanced WCTRP accommodates the call’s
28 new data elements, which include 5 policy/claim linking elements and
23 medical procedure and diagnostic elements.
The call comprises medical
transactions for all workers compensation claims, including medical
only, beginning with transactions occurring in third-quarter 2010.
Carriers must report third-quarter 2010 transactions by December 31,
2010, and continue reporting on a quarterly basis thereafter. All
submissions of transactions occurring within a quarter are due at the
end of the following quarter. Optionally, carriers can report monthly.
On behalf of clients using our enhanced WCTRP to collect the additional
data elements, ISO will handle the data feed to the data collection
organization to satisfy their reporting requirements.
Timeline for new medical data call
- 2Q
2010 — certification testing begins
- 3Q 2010 — first quarter of
transactions affected by new call
- 12/31/09 — carriers must report 3Q
2010 transactions
IAIABC’S EDI MEDICAL
ISO
continues to support carriers’ compliance
The
work of the IAIABC’s Medical Committee continues, as it develops the
common definitions and coding structures for reporting medical
billing/payment transactions that meet the technical and business
requirements of claims administrators and state jurisdictions and
ensures that the IAIABC medical transactions are current with
HIPAA-mandated standards. ISO continues to support carriers in complying
with reporting requirements for medical billing/payment transactions by
keeping current with the latest IAIABC EDI standards and
jurisdiction-specific requirements and will transmit carriers’
transactions to the appropriate jurisdictions on their behalf.
For more information . . .
. . . on the wcPrism suite of data management and
compliance solutions for workers compensation, send e-mail to
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. Or call
ISO Customer Service at 1-800-888-4476.
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Information about property/casualty insurance risk
