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eClaims Frequently Asked Questions

eClaims

Key Facts

  1. Is eClaims a mandate?

    Yes. The Workers' Compensation Board (Board) implemented the IAIABC Claims R3.0 standard on April 23, 2014. The Board adopted the latest IAIABC Claims EDI R3.1 standard on January 24, 2022.

  2. Does the eClaims mandate affect medical reporting?

    No. The eClaims filing process will have no impact on health care providers or their reporting requirements. Health care providers will continue to file their reports as they currently do, using the current medical forms. Medical reporting will be evaluated during the Board business process reengineering effort that is currently under way. To learn more about the CMS-1500 XML initiative visit CMS-1500 Overview (ny.gov).

  3. When a payer submits a First Report of Injury (FROI) to the Board in satisfaction of the employer's obligation to report the injury (WCL §110[2]), does the payer need to file the Employer's First Report of Injury/Illness (Form C-2F) with the Board?

    No. A timely FROI satisfies the employer's duty to report the injury to the Board.

    IMPORTANT: A timely FROI does not replace the requirement of WCL §110(1). The employer and/or payer should retain the C-2F form as required and produce the C-2F form to the claimant upon request.

  4. What should an uninsured employer or their counsel file to controvert a claim?

    No Insurance cases are controverted by nature. Should the employer still wish to file a Notice of Controversy, they may raise the issues at the first hearing or file a written letter with the Board that will be scanned into the case folder.

  5. The local Social Security Administration (SSA) office, NYS Department of Labor, or social services agency has asked for a Notice that Payment of Compensation Has Been Stopped or Modified (Form C-8/8.6) which is now obsolete. How do I inform them that the Subsequent Report of Injury (SROI) has replaced the C-8/8.6 form?

    The Board has done outreach with Social Security Administration offices, Dept. of Labor, and local social services organizations throughout the implementation of eClaims. Part of this outreach included a formal letter informing them of the recent changes. If needed, a copy of this letter can be found here Updated SROI Replaced C-8 document.

Trading Partners

  1. Who or what is a Trading Partner?

    A trading partner is an entity that enters into an agreement with the Board to exchange data electronically. A trading partner can be an insurance company, third-party administrator, or self-insured employer.

  2. What is a Trading Partner Profile?

    Trading partners will be required to complete an Electronic Partnering Agreement and profile. The profile requires the trading partner to specify the type of trading partner they are, as well as key organization attributes such as FEIN, address, contact names, etc.

  3. Is there a charge or fee for completing the Trading Partner Profile documents?

    No.

  4. How can I register and complete all the forms to become an eClaims trading partner?

    The eClaims Trading Partner Registration process is now available.

  5. Does a third-party administrator (TPA) have any reporting requirements?

    Yes. TPAs should review section 2 of the eClaims R3.1 Implementation Guide and register to become an eClaims trading partner. All registrants should carefully review the overview, requirements, and instructions.

  6. Can an insurer or self-insured employer submit data for claims using more than one TPA?

    Yes. Our Trading Partner Profile will support the submission of data for a single claim administrator and from multiple approved TPAs. Claim administrators will need to communicate these relationship requirements to the Board when completing an Electronic Partnering Agreement. Trading partners will need to monitor data quality for timely and accurate submission regardless of the number of TPAs they use to administer their claims processes.

eClaims Data Submission

  1. How can I submit my eClaims filings?

    Using a secure file transfer protocol (SFTP), you may submit a flat file. Flat files must adhere to the IAIABC EDI Claims Release 3.1 format and can be submitted directly to the Board's SFTP server or through a third-party vendor. The Board also offers a secure web data entry application intended primarily for small volume filers, but not limited solely to that group.

  2. Will the Board authorize third-party vendors to submit Claims EDI Release 3.1 filings on behalf of claims administrators?

    The list below includes known vendors offering a Claims EDI Release 3.1 related product and/or service for submitting claims data electronically. This listing is in alphabetical order and does not represent an endorsement by the Board of any vendor listed, or a recommendation of one vendor over another. The Board does not warrant or represent that this information is current, complete, or accurate. The Board assumes no responsibility for any errors in the information provided, nor assumes any liability for any damages incurred as a consequence, directly or indirectly, of the use and application of this information, and shall be held harmless against all claims, suits, judgments and/or damages resulting from the disclosure of any of this information, including all costs and fees.

    NOTE: If you are a vendor with Claims EDI Release 3.1 experience and would like to have your company added or removed, please contact eClaims@wcb.ny.gov

    Additional information regarding EDI vendors may be obtained from the IAIABC.

  3. How will a trading partner know if the Board has accepted or rejected an electronic FROI/SROI filing?

    The EDI IAIABC claims standard adopted by the Board (See Subject Number 046-477) includes an acknowledgment process. Each file, as well as each transaction within a file, is acknowledged. Acknowledgments will indicate whether the file or individual transaction has been accepted or rejected. A reason will be provided for rejected transactions.

  4. Will the Board develop reports or a process to assist trading partners in monitoring performance?

    Effective 9/20/2019, eClaims Inquiry (link: eClaims Inquiry Overview (ny.gov)) has been expanded to include the ability for flat file (FTP) trading partners (Senders) to view their FTP acceptance rate performance to determine if they are meeting the 90% acceptance rate target as stated in the eClaims R3.1 Implementation Guide section 3.9. The expansion includes the following reports: FTP Acceptance Chart, Transaction Errors by Rejection Reasons, and Transaction Errors by Claim Administrator Claim Number.

  5. Will an Extensible Markup Language (XML) option be available for the submission of EDI Claims Release 3.1?

    XML will be a future consideration.

  6. What is the deadline to submit transactions on a daily basis?

    • Monday, Tuesday, Wednesday, and Friday - Data files uploaded before 8 p.m. ET will be processed that night.
    • Thursday - Data files uploaded on Thursdays before 6 p.m. ET will be processed that night.

    Acknowledgment files will be available for download the next day before 9 a.m. ET. The acknowledgment file for any flat file sent on Friday will be available Monday morning (even if Monday is a holiday).

  7. Has the Board eliminated the use of W numbers?

    No. The Board converts DN0006 (Insurer FEIN) to the W Number. For most insurers, the nine-digit FEIN is sent since they only registered one Board-assigned W Number for that FEIN. When multiple Board-assigned W Numbers are registered for the same FEIN, the Board informs the submitter to send the Board-assigned W Number as the Insurer FEIN value. The Board returns the nine-digit FEIN in the acknowledgment record.

  8. What data should be submitted if the field is "AA" (If Applicable/Available Transaction Accepted) or "AR" (If Applicable/Available Transaction Rejected)?

    If a claim administrator has the information necessary to submit data in the field, the field should be populated with the data. If, however, the claim administrator does not have the information to populate this field, it should be left blank and not populated with data that is not accurate. Data Elements listed as "AR" have edits applied and will be rejected if an edit is not met. Data Elements listed as "AA" do not have applied edits and will be accepted as entered. For example, DN0051 (Employer Phone Number) is listed on the Element Requirement Table as "AR." This field should only be populated if you can report the claimant's actual phone number but could be rejected if it does not meet the 0051-111 edit listed on the Population Restriction table, which requires the phone number to be between 10 and 15 digits long or the edit listed on the DN Error Message Table with Error Code 028 requiring all digits to be 0-9.

  9. Where can I find the Board FEIN and Postal Code?

    The header record of the data file needs to have its Receiver ID (DN0099) be 146013200 122410019 which is the Board's FEIN and Postal Code separated by seven spaces. Additional information can be found in section 3.3 of the eClaims R3.1 Implementation Guide.

IAIABC

  1. Our organization is not familiar with the IAIABC. Where can we get more information?

    Visit the IAIABC website.

  2. Where can we obtain a copy of the IAIABC's EDI Implementation Guide for Claims?

    Guides must be obtained from the IAIABC. There is a charge for non-EDI members.

Training

  1. Is training available?

    Yes. The Board holds regular trading partner webinars to cover important Claims EDI topics. Trading partners may also visit the IAIABC website for training opportunities.

Appropriate Maintenance Type Code (MTC) Filing

  1. Death Benefits: New York legal statute currently requires separate cases for death and accident. How will the eClaims EDI process work with this requirement?

    For EDI, each case will require a FROI to precede any SROI filing(s). The FROI for the death case must have some unique values from the FROI on the accident case so that it is not rejected as a duplicate.

    The DNs listed below illustrate how NY will distinguish the injury FROI from the death FROI when the date of does NOT occur on the same date as the injury:
    DN Data Element Name Injury Claim value Death Claim value
    0031 Date of Injury Date injury occurred Date death occurred
    0057 Employee Date of Death Date death occurred Date death occurred
    0146 Death Result of Injury Code N for No Y for Yes or U for Unknown
    The DNs listed below illustrate how NY will distinguish the injury FROI from the death FROI when the date of death does occur on the same date as the injury:
    DN Data Element Name Injury and Death Claim are the same case value
    0031 Date of Injury Date injury/death occurred
    0057 Employee Date of Death Date injury/death occurred
    0146 Death Result of Injury Code Y for Yes or U for Unknown

    Note: DN0146 (Death Result of Injury Code) is required if DN0057 (Date of Death) is not null. DN0057 (Date of Death) is required if DN0146 (Death Result of Injury Code) = Y. DN0057 (Date of Death) is required if DN0146 (Death Result of Injury Code) is not null effective 2/15/2017, based on eClaims R3.0 change log ID #256 posted on 8/15/2016.

    For claim administrators that generate flat files, we recognize that reprogramming your computer systems to generate the correct FROI-SROI transactions for the death case may be costly and difficult. Therefore, due to the extremely low volume of death cases, claim administrators should consider a manual process using the eClaims FROI-SROI Web Data Entry application to submit FROI and SROI filings for death cases (when the death is the result of an accident/illness not occurring on the same day). Paper filings are not allowed.

  2. If both a Subsequent Report of Injury – Change in Benefit Amount (SROI-CA) and a Subsequent Report of Injury – Change in Benefit Type (SROI-CB) apply, should only a SROI-CB be sent or both?

    If both the rate and benefit type code are changing, the SROI-CB is the appropriate MTC to file. Please refer to NYS Business Scenarios (MS Excel) 2-5 for details.

  3. Payments are being suspended to the injured worker because he has failed to respond to the requests for job searches - failed to show labor market attachment. We are not under direction on this particular case, so it is not a suspension directed by the Board. What SROI would be filed?

    The appropriate MTC would be a Subsequent Report of Injury - Full Suspension (SROI-SX) with DN0418 (Full Suspension Reason Code) of "SJ" (Suspension, Pending Appeal or Judicial Review) populated. A detailed reason(s) for the suspension should be entered in the suspension narrative field.

  4. The employer (insured) is paying the claimant wages, however, we (claim administrator) are accepting the claim without liability per Section 21-a. Should we file a Subsequent Report of Injury – Employer Paid (SROI-EP) with DN0075 (Agreement to Compensate Code) equal to “W” Without Liability?

    Yes. Effective 3/28/2016, New York implemented the IAIABC Claims EDI standard change to allow claim administrators to report DN0075 (Agreement to Compensate Code) on the SROI-EP and Subsequent Report of Injury – Employer Reinstatement (SROI-ER).

  5. What MTC should I send if we are paying the claimant under 21-a and we want to suspend payments?

    If paying pursuant to 21-a, the claim administrator should send a SROI-SX with DN0418 (Full Suspension Reason Code) of SJ populated (Suspension, Pending Appeal, or Judicial Review). For further information regarding 21-a see "Process for Section 21-a and Claims Paid Without Liability" and Subject No. 046-1136.

  6. What should I file if I have filed a suspension and a decision reclassifying a Benefit Type (Modified Prior Awards) as a SROI-CB is not allowed per the sequencing rules when there is a break in continuity of benefits?

    If you have filed a suspension and the SROI-CB is not a filing option per the sequencing rules, you can file a SROI-PY (Payment Report). The SROI-PY will allow the reclassification of your Benefit Type and should have DN0202 (Reduced Benefit Amount Code) populated with "R" (Reclassification of Benefit). In the alternative, you may also file a SROI-RB (Reinstatement of Benefits) immediately followed by a SROI-SX with DN0418 (Full Suspension Reason Code) of SD populated (Suspension, Directed by Jurisdiction) .

  7. How do I accept a case after a FROI-04/SROI-04 has been filed?

    Both a FROI-04 and a SROI-04 can be used to deny a claim, for example:

    1. A FROI-04 can be used to deny a claim as your first filing.
    2. To accept a claim after your accepted FROI-04, for cases with a date of accident prior to 1/1/2019, you need to submit a FROI-00 with Claim Type Code other than N (Notification Only). If you try to file a FROI-00 with N after your FROI-04, it will be rejected.
      For cases with a date of accident on or after 1/1/2019, you need to submit a FROI-00 with Agreement to Compensate Code of L (With Liability). If you try to file a FROI-00 with W (Without Liability) after your FROI-04, it will be rejected.
    3. A SROI-04 can only be used to deny a claim after a FROI-00/AQ/AU/UR has been accepted.
    4. To accept a claim after your SROI-04, you need to submit a SROI that indicates what event has occurred that shows acceptance or a SROI-02. If sending a SROI-02, for cases with a date of accident prior to 1/1/2019, you will need to send DN0196 (Date of Rescission). For cases with a date of accident on or after 1/1/2019, the Agreement to Compensate Code shows acceptance of a claim.
  8. How do I report an overpayment?

    When the claim administrator seeks to recover an alleged overpayment for benefits to the claimant, the claim administrator must file the applicable SROI or SROI-02, if no other SROI is due, with an Add/Update to DN0433 (Overpayment Amount - Current) as defined by NYCRR §300.23(g).

Transaction Reports

  1. If we are using a vendor, will we be able to access the .zip file containing the transaction reports from New York State's sFTP server or will we have to have our vendor download that file and receive it from them?

    The forms zip file will be placed on our sFTP server for your vendor to pick up. You would obtain the .zip file through your vendor.

  2. Will the transaction report PDFs in the .zip file be populated with the transaction claim information?

    Yes. The Board will populate the transaction reports using the transaction data sent by the claim administrator.

  3. Where can I get all of the technical details for how the Board creates the forms .zip file and the transaction report PDFs contained within it?

    Please review section 3.6 of the eClaims R3.1 Implementation Guide.

  4. Can a FROI or SROI PDF document be served via email on the parties?

    If either of the parties of interest (POI) have designated email for service, the carrier can serve the PDF via email for that POI. But, for example, if the claimant's attorney allows service by email, and the claimant does not, the PDF must be served by U.S. mail on the claimant.

Periodic Reports

Please see the Periodic Report Event Table (MS Excel) and SROI-SA scenarios for further details.

  1. When is the periodic report due?

    1. The Subsequent Report of Injury - Sub-Annual (SROI-SA) is due 180 days from the date of accident. If there is not a full date of accident, then 180 days from the filing date of the initial FROI.
      OR
    2. If DN0299 (Award/Order Date) falls within that first 180 days, the SROI-SA will instead be due 180 days from the Award/Order Date (duly filed date of Notice of Decision) where there is a Board direction to continue payments. The SROI-SA is required every 180 days until the continuing payments stops.
      OR
    3. If the case is closed with no continuing payments within the first 180 days, the SA will instead be due 180 days from initial closure. If the case is reopened within six months of the initial closure, the SROI-SA would then be due within 180 days from subsequent closure if there are no continuing payments.

    After the initial 180 days has passed:

    1. If the case is reopened and an award of additional indemnity (no continuing payments) is made and the case is closed per Notice of Decision, the SROI-SA is due within 180 days from the Award/Order date (Notice of Decision duly filed date).
      OR
    2. If a case is reopened and an award of additional indemnity is made (no continuing payments) and the case remains continued, the SROI-SA would not be due until 180 days from subsequent closure.
      OR
    3. If a case is reopened and an award of additional indemnity with continuing payments is made, the SROI-SA is due 180 days from the Award/Order Date (duly filed date of Notice of Decision) where there is a Board direction to continue payments. The SROI-SA is required every 180 days until the continuing payments stop.

    Note: SROI-SA on a reopened case is optional at this time unless the Board has directed continuing indemnity payments.

  2. What is the definition of "open"?

    If no notice has been issued stating no further action or the claim has been reopened after such a notice has been issued, then the case is considered open. If a notice has been issued stating that no further action is planned at the time, but indemnity benefits are continuing, then the case is considered open.

  3. After the first SROI-SA filing, are subsequent SROI-SAs a cumulative total to date or only what was paid since the last SROI-SA was filed?

    Each SROI-SA is a "cumulative" total of each Benefit Type Code (BTC) and Other Benefit Type (OBT) paid to date on the claim.

Data Element Reporting

Please see DN Reporting Specifics to NYS Document for additional details.

  1. What date should be entered for DN0193 (Suspension Effective Date)?

    The suspension effective date should be the last THROUGH date which the indemnity benefit is due.

  2. What date should be entered for the DN0299 (Award Order Date)?

    This should be the date that the Notice of Decision was duly filed if decision is from a hearing, Reserved Decision, or Board Panel Decision. This should not be the date of hearing. If the decision is from an Administrative Decision or Proposed Decision, the date should be the date the decision became final.

    Note: An exception would be in the situation of an Aggregate Trust Fund (ATF) deposit. Since Notices of Decision are issued in advance of the due date of the deposit, the date the deposit is due should be listed as the Award/Order Date. (i.e., Notice of Decision filed on 10/30/13 directing an ATF deposit due on 12/9/13. In this situation the Award/Order Date should be listed as 12/9/13.)

  3. How do I indicate that indemnity payments are being made without acceptance of liability pursuant to §21a?

    If indemnity benefits are being made without acceptance of liability, Agreement to Compensate Code (DN0075) should be listed as "W" – Without liability on the first SROI filed with a benefit segment. Please note that Section 21-a no longer applies once Accident, Notice, and Causal Relation (or Occupational Disease, Notice, and Causal Relation) has been established or 365 days have passed since the first Benefit Payment Issue Date reported on the SROI.

    Note: §21a does not apply to medical-only cases, it only applies once there is lost time and a SROI is sent showing payment of the lost time has begun.

  4. How is an acceptance of a claim listed on a FROI/SROI?

    1. For cases with a date of accident prior to 1/1/2019, DN0074 (Claim Type Code) identifies the acceptance of a claim. If this code is listed as anything other than N=Notification Only, the claim administrator has accepted the claim.
    2. For cases with a date of accident on or after 1/1/2019, DN0075 (Agreement to Compensate Code) shows acceptance of a claim.

      Note: If a Notice of Indexing is issued by the Board, the claim administrator must indicate if the claim is accepted by entering the appropriate Claim Type Code/Agreement to Compensate Code or file a FROI-04 or SROI-04 indicating that the claim has been denied. Please see the Event Table for due dates of the acceptance and denial.
  5. How do I accept a case after a FROI-04/SROI-04 has been submitted?

    Both a FROI-04 and a SROI-04 can be used to deny a claim. For example:

    • A FROI-04 can be used to deny a claim as your first filing. The process to accept a claim after your FROI-04 is accepted depends on the date of injury or illness:
      1. Prior to January 1, 2019 - you need to submit a FROI-00 with Claim Type Code other than N (Notification Only). If you try to file a FROI-00 with N after your FROI-04, it will be rejected.
      2. On or after January 1, 2019 - you need to submit a FROI-00 with Agreement to Compensate Code of L (With Liability). If you try to file a FROI-00 with W (Without Liability) after your FROI-04, it will be rejected.
    • A SROI-04 can be used to deny a claim but can only be sent after a FROI-00/AQ/AU/UR/04 or another SROI has been accepted. To accept a claim after your SROI-04 has been accepted, you must submit a SROI that indicates the event (IP/AP/EP/CD/ER/RB/PY with benefit segment) that shows acceptance or a SROI-02.
      1. Prior to January 1, 2019 – you need to send DN0196 (Denial Rescission Date).
      2. On or after January 1, 2019 - On or after January 1, 2019 – the Agreement to Compensate Code shows acceptance of a claim. Agreement to Compensate Code = L (With Liability) indicates acceptance of a claim or Agreement to Compensate Code = W (Without Liability) during the first 365 days of first Benefit Payment Issue Date and/or the Board has made an ANCR (Accident, Notice and Causal Relationship) finding indicating acceptance pursuant to Section 21a. For details regarding acceptance pursuant to Section 21a, please visit Process for Section 21-a and Claims Paid Without Liability.
  6. How do I update the DN0198 (Denial Reason Code) and/or DN0197 (Denial Reason Narrative) after a FROI-04/SROI-04 has been submitted?

    Since New York does not accept FROI/SROI-02 to update these data elements, a SROI-04 must be filed to update Denial Reason Codes and/or Denial Reason Narratives.

  7. What is the difference between the "through" date (used by IAIABC in Claims EDI) and the "to" date (used by the Board in decisions)?

    Since New York does not accept FROI/SROI-02 to update these data elements, a SROI-04 must be filed to update Denial Reason Codes and/or Denial Reason Narratives.

  8. What is the difference between Initial Date Disability Began and First Day of Disability After the Waiting Period?

    The "to" date is the next business day beyond the date in which that last benefit day was payable. The "through" date is through the close of business in which that last benefit day was payable. For example, a Notice of Decision directs payments "to" November 15th when the claimant returned to work; however, the "through" date would be November 14th as you are paying through close of business.

  9. When would a reimbursement from the claim administrator to the employer be expected when the employer paid wages in lieu of compensation?

    The Board will issue a decision directing reimbursement to an employer based upon a reimbursement request being submitted by said employer.

  10. How is the reimbursement paid to the employer from the claim administrator to be reported to the Board?

    This should be reported on the appropriate SROI per the NYS R3.1 Event Table. The Board would also accept the Benefit Type Code (BTC) 250 and 270 in lieu of 050 and 070 for the period in which the employer paid.

  11. If a claim administrator's system requires DN0293 (Lump Sum Payment/Settlement Code) to be populated with a code on the Subsequent Report of Injury - Payment Report (SROI-PY), what should be used if we are not reporting a Section 32 settlement?

    For cases other than a Section 32 settlement the claim administrator may use "AW" Award or "NS" Non-Specified Lump Sum Payment. This code is an optional reporting for all PYs that do not report a Benefit Type Code of 5xx.

  12. How does a claim administrator note they are taking credit against a prior schedule loss of use (SLU)?

    If a claim administrator is taking credit against a prior SLU, they could note the lost time under the appropriate degree of disability and then report DN0126 (Benefit Credit Code) as "P" Advance. Effective 4/29/2022, per the NYS R3.1 Event Table, claim administrators will also report "Z2" for Net to Zero DN0442 to note the credit against the prior SLU.

  13. How should Special Funds §14-6 and §15-8 recoveries be reported on a SROI?

    DN0226 (Recovery Code) of 800 (Special Fund Recovery) should be used to report a §14-6 recovery and 850 (Second Injury Fund) should be used to report a §15-8 recovery.

    Note: The reporting of recoveries for §14-6 and §15-8 are optional.

  14. How should a claim administrator who has Section 32 medical payments (i.e., Medicare set aside) payable to the claimant report on the SROI-PY?

    The full payment of the Section 32 Waiver Agreement settlement to the claimant may be reported as BTC 500 – Unspecified Lump Sum. If, however, due to internal reporting a claim administrator must report these as separate payments, they may report the Medicare set aside portion as 501 – Medical Lump Sum.

    Note: You can also still use Other Benefit Type (OBT) 370 – Total Other Medical, however, BTC 501 – Medical Lump Sum would be more appropriate. If the OBT 370 or BTC 501 is used, the Board would expect a payment segment for both the indemnity and medical payments to the claimant as they are both monies due directly to the claimant. The underreporting of the Section 32 payment to the claimant could result in a possible penalty that should not have been assessed.

  15. Which SROI should be reported if the claim administrator mistakenly submitted the wrong BTC?

    This would depend on the event and claim circumstances. For example, if a Subsequent Report of Injury - Initial Payment (SROI-IP) was submitted with temporary total disability (TTD) benefits and you later discovered they should have been temporary partial disability (TPD) benefits per the medical report, the SROI-CB would be the most appropriate. DN0202 (Reduced Benefit Amount Code) should be equal to "R" Reclassification of Benefit. This will allow you to report the new TPD benefits while dropping the TTD benefits from the SROI-CB transaction.

  16. When are the Work Week Type Code and Work Days Scheduled Code required?

    Work Week Type Code is required on the First Report of Injury – Original (FROI-00) and First Report of Injury – Upon Request (Grandfathered) (FROI-UR) if all of the following occurs:

    • DN0064 (Number of Days Worked Per Week) is a value other than 5.
    • DN0031 (Date of Injury) is on or after 3/1/14.
    • DN0290 (Type of Loss Code) is either 01 (Traumatic Injury) or is not present.
    • DN0074 (Claim Type Code) is either I or L (Indemnity or Became Lost Time).

    DN0205 (Work Days Scheduled Code) is required on the FROI-00 and FROI-UR if the Work Week Type Code is F (Fixed) and the Date of Injury is on or after 3/1/14.

  17. What are the values for DN0204 (Work Week Type Code) and DN0205 (Work Days Scheduled Code)?

    DN0204 (Work Week Type Code) values are:

    • S = Standard Work Week (set work days each week are Monday through Friday inclusive)
    • F = Fixed Work Week (set work days each week, but not Monday through Friday inclusive)
    • V = Varied Work Week (scheduled work days change from week to week)

    DN0205 (Work Days Scheduled Code) values are: S = Scheduled and N = Not Scheduled.

    FORMAT = DDDDDDD where each D is a calendar day of the week (First position is Sunday, second position is Monday, third position is Tuesday, etc.).

  18. How do I file a SROI when I am paying intermittent lost time?

    If there is intermittent lost time or a non-consecutive period on a claim, you should file the appropriate SROI. The Claims Weeks and Days would be inclusive of the days paid and/or awarded for intermittent lost time. You should send DN0212 (Non-Consecutive Period Code) if the employee returns to work at least once during the waiting period (W = Waiting Period), or the benefit period (B = Benefit Period) being reported does not represent a continuous period of time.

    Note: An Employer's Report of Injured Employee's Change in Status or Return to Work (Form C-11) should continue to be filed to note the various intermittent lost time periods.

  19. Payer files FROI-00 with N (Notification Only) and then Accident, Notice and Causal Relationship) (ANCR)/Occupational Disease, Notice and Causal Relationship (ODNCR) is established. Does payer need to file FROI/SROI for acceptance?

    Yes, per regulation 300.22 the payer should file the proper FROI/SROI to correct DN0074 (Claim Type Code) (to anything other than N=Notification only) for "acceptance" if the date of accident is prior to 1/1/2019. For dates of accident on or after 1/1/2019, the payer should file the proper FROI/SROI to correct DN0075 (Agreement to Compensate Code) to show acceptance.

  20. How do I file a SROI when I am reporting payment of child support?

    You should file the appropriate SROI and use the Adjustments, Credits and Redistributions (ACR) with DN0130 (Benefit Redistribution Code) "H" = Court Ordered Lien.

    Note: This must be reported with every SROI when the injured worker is not receiving the full weekly compensation amount due.

  21. How do I reference a document on a SROI-CB or SROI-CA in compliance with 12 NYCRR 300.23(a) since these transactions do not allow a narrative field in IAIABC Claims EDI R3.1?

    In IAIABC Claims R3.1, a new data element has been added to replace the paper correspondence that claim administrators are currently sending in Claims R3.0. DN0439 (Benefit Change Reason Code) is mandatory on all SROI-CB (Change in Benefit Type) and SROI-CA (Change in Benefit Amount) transactions and will identify the reason the Benefit Type Code or Net Weekly Amount has changed. DN0439 (Benefit Change Reason Code) only replaces the correspondence notifying the Board of the reason for the change upon filing the SROI-CB or CA and does not replace the need for the claim administrator to make sure the corresponding evidence is in the case folder.

    Note: The Board has determined that supporting documentation must be filed within three days of the SROI-CB or SROI-CA that purportedly supports the reduction in the payment rate. If CA/CB is rejected, then supporting documentation should be submitted within five days. The supporting documentation can be either mailed or e-mailed to wcbclaimsfiling@wcb.ny.gov.

FROI/SROI-02 (Change)

  1. How do I determine when I have to submit a Change-02 or the change on the subsequent Maintenance Type Code (MTC)? For example, if I submit a SROI-IP with payments continuing, and the claimant subsequently returns to work, would I file an SX with Suspension reason S1 or would I need to submit a Change-02 and an SX?

    New York State has worked through the tables to ensure that when a reportable event occurs, the event comes through rather than a Change-02. In this specific example, New York State expects that an SX with Suspension Reason Code S1 would be reported. Change-02s are primarily concerned with changing something that was reported on a previously accepted MTC. Change-02s should not be used for the reporting of new events.

  2. Can I submit a SROI-02 if I recently sent a SROI that was missing historical (prior) benefits but included the more recent benefits?

    The Board implemented a relaxed edition of the SROI-02 requirements to allow the introduction of certain "new" historical benefits on the SROI-02. This is permitted if the newly introduced Benefit Type Codes Benefit Period Through Date does not equal or exceed that of the Benefit Period Through Date on the last accepted SROI.

    Example 1: I submitted a SROI-UR and included the most recent Benefit Type Code (BTC) of 040 (Permanent Partial Disability - PPD/Unscheduled) for benefits paid 1/1/2010 through 12/12/2014. I accidentally left off the historical BTC 050 (Temporary Total - TTD) paid 1/1/2007 through 12/31/2007, and BTC 070 (Temporary Partial - TPD) paid 1/1/2008 through 12/31/2009. Will my SROI-02 including the TTD and TPD be accepted? Yes. The through date on the TTD and TPD benefits does not exceed the through date of the last accepted Benefit Period Through Date of 12/12/2014 for the PPD benefits.

    Example 2: I submitted a SROI-UR and included the TTD and TPD benefits from Example 1 but forgot to include my PPD benefits. Will my SROI-02 including the PPD benefits be accepted? No. The through date on the PPD benefits exceeds that on the last accepted Benefit Period Through Date of 12/31/2009 for the TPD benefits.

  3. If we are reporting an overpayment on a SROI-02, do we also have to file a Request for Further Action by Carrier/Employer (Form RFA-2) requesting reimbursement?

    Yes, a new subdivision (g) of section 300.23 of Title 12 NYCRR is hereby added to read as follows:

    In the event that the insurance company, self-insured employer or third-party administrator seeks to recover an alleged overpayment of benefits to the claimant, such insurance company, self-insured employer or third-party administrator must file notice to the Board in the format prescribed by the Chair that identifies the amount of such overpayment. Such prescribed notice shall be due as follows:

    • When a request for further action is submitted to the Board by the carrier, self-insured employer or third-party administrator, such prescribed notice requesting recovery of an overpayment shall be submitted on the same day as the request for further action.
    • When a hearing is scheduled and the carrier, self-insured employer or third-party administrator has requested recovery of an overpayment at the scheduled hearing, the carrier, self-insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment no less than 10 days before the date of the hearing. The Workers' Compensation Law Judge will not consider any requests for direct recovery of an overpayment that are not timely made.
    • When the Board directs recovery of an overpayment, the carrier, self-insured employer or third-party administrator must file the prescribed notice identifying the amount of the overpayment within 10 days of such decision.
  4. If we previously submitted a SROI-02 reporting an overpayment and are required to file Form RFA-2 if we want reimbursement, do we have to file another SROI-02 at the same time that Form RFA-2 is filed?

    No, not if the SROI-02 lists the current overpayment amount. If the SROI-02 does not list the current overpayment amount, you must file a new SROI-02.

  5. Can we submit Form RFA-2 requesting that the overpayment be addressed without filing a SROI-02 reporting the overpayment?

    No, you need to submit Form RFA-2 to ask for the hearing and list the overpayment amount on the SROI-02.

  6. Can more than one update on a Change-02 still be submitted?

    Yes, you may continue to submit more than one change on a Change-02 transaction, except for Match Data Elements. As with Claims EDI R3.0, if multiple Match Data Elements are being changed at the same time, in Claims EDI R3.1 you will continue to file one Change-02 transaction per Match Data Element.

Web Data Entry

  1. I have noticed while using eCase and Web Data Entry at the same time that my Web Data Entry freezes at times. What causes this and how can I avoid it?

    Since both applications utilize the same username and password, if you log out of eCase and/or are timed out of eCase, you will also be logged out of any other Board applications that you are currently logged into within the same browser.

    If you open a separate browser for each application (for example, Microsoft Edge for eCase and Google Chrome for Web Data Entry) you will be able to avoid your Web Data Entry application logging you out/freezing if you log out of the eCase application.

OnBoard

  1. What is the OnBoard Project?

    The OnBoard Project is a part of the Business Process Reengineering Program. The new system will offer exciting elements, including improved and expanded access to real-time claim data, new electronic self-service features for interacting with the Board, and a reduction in the overall number of paper forms to improve system responsiveness to stakeholder needs. The eClaims EDI R3.1 upgrade provides the foundational data pillars for the OnBoard Project. More information is available on the OnBoard Project website.

  2. How and when will the Claims EDI R3.1 upgrade be rolled out?

    The Claims EDI R3.1 upgrade will be implemented into Board systems in a two-phased approach:

    • Phase one was implemented on January 24, 2022.
    • Phase two consists of incorporating Claims EDI R3.1 into the OnBoard implementation. This will take place concurrently with the launch of OnBoard. At this stage, trading partners will have been using Claims EDI R3.1 for some time on the Board's current systems but will now change over to use OnBoard. Phase two will include smaller refinements and adjustments of the Claims EDI R3.1 implementation, which will be based on feedback we receive during phase one.
  3. How can I stay up to date on eClaims news?

    You can subscribe to have eClaims news sent straight to your inbox.



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