Use this guide as a summary of recent state-by-state requirements announced surrounding electronic billing of no-fault and workers; compensation auto claims.
- Claims payment information is no longer due on March 1 and the new submission deadline will be set when you receive your new instructions
- Effective January 1, 2020, the Alabama Department of Labor, Workers’ Compensation Division, must receive a completed WC-4 Claim Summary Form for all Alabama Workers’ Compensation settlements regardless of whether the settlement goes before a Circuit Court Judge or an ADOL Ombudsman
- Learn More [https://labor.alabama.gov/wc/EDI/edipg1.aspx]
- All form types are accepted electronically based on payer capabilities
- Mandatory EDI for:
- First Report of Injury (FROI)
- Subsequent Report of Injury (SROI)
- Learn More [https://www.dli.pa.gov/Businesses/Compensation/WC/claims/edi/Pages/default.aspx]
- The Michigan Claims EDI implementation process will be included in the replacement of the Workers’ Compensation Agency data system (WORCS). IAIABC Claims Release 3.1 EDI reporting will be included in new system expected to be implemented November 2020.
- Learn More [https://www.michigan.gov/leo/0,5863,7-336-78421_95508_27669—,00.html]
New Jersey Workers’ Compensation & Auto:
- Mandatory for No-Fault Auto effective September 1, 2019 – Senate P.L. 2017, c369 Auto/PIP
- Mandatory for Workers’ Compensation effective November 1, 2019 – Senate P.L. 2016, c64 Workers Compensation
- All healthcare providers or their billing representative processing over 25 claims per month shall submit workers’ compensation and no-fault auto bills with supporting documentation electronically in accordance with the guidelines.
- Provider exemptions: Providers submitting less than 25 bills per month for workers’ compensation or auto Insurance Carriers, medical management companies or their third-party administrators shall accept electronic bills and acknowledge receipt of a complete electronic medical bill to the submitting party
- Payer exemptions: Payers receiving fewer than 25 bills per month for workers’ compensation or auto
- Learn More [https://www.nj.gov/labor/wc/wc_index.html]
New York State:
- The Board has adopted a national standard for Trading Partners to electronically submit employer claims data. The current standard is the International Association of Industrial Accident Boards and Commissions’ (IAIABC) Claims Electronic Data Interchange (EDI) Release 3.1 (R3.1)
- The Board has targeted March 15, 2021 as the date Trading Partners will transition from R3.0 to R3.1 standard submission to New York State.
- In keeping with the IAIABC guidelines, the R3.1 tables and guides will be released on March 16, 2020. In preparation for the R3.1 upgrade, the IAIABC will be conducting Claims EDI Release 3.1 training from March 31, 2020 to April 1, 2020 in Syracuse, NY. Please visit the IAIABC website for registration information.
- Learn More [https://www.wcb.ny.gov/content/ebiz/eclaims/eclaims_overview.jsp]
- South Carolina will be mandating XML reporting with the IAIABC’s EDI Claims Release 3.1 Standard beginning in the Spring of 2020.
- Learn More [https://wcc.sc.gov/claims/electronic-claims-reporting-edi]
Virginia Workers’ Compensation:
- Mandatory for Workers’ Compensation effective July 1, 2019 – 16VAC30-16-80, § 65.2-603 of the Code of Virginia for all medical bills with supporting documentation to be submitted electronically through a clearinghouse.
- Accept electronic medical bills submitted in accordance with the adopted standards;
- Transmit acknowledgments and remittance advice in compliance with the adopted standards in response to electronically submitted medical bills; and
- Support methods to receive electronic documentation required for the adjudication of a bill, as described in 16VAC30-16-80.
- Payer exemptions: processes fewer than 250 workers’ compensation medical bills annually.
- Learn More [https://workcomp.virginia.gov/]
- Mandatory reporting becomes effective January 1, 2020.