Frequently Asked Questions
- Is eClaims a mandate?
Yes. The WCB has established an eClaims implementation schedule. All Claim Administrators must complete their transition to the new eClaims filing process per the implementation schedule.
- How will the eClaims mandate be rolled out?
The WCB will stagger the implementation beginning in June of 2013 continuing through March of 2014. Initial phases will include national carriers and TPAs followed by groups of New York specific Claim Administrators. The WCB has developed an extensive stakeholder communication plan that has supported transparent and continuous two-way communications with all stakeholders impacted by eClaims. The eClaims implementation schedule was developed based on the extensive feedback received by the Claim Administrator community.
- Does the eClaims mandate affect medical reporting?
No. The new eClaims filing process will have no impact on Medical Providers or their reporting requirements. Medical Providers will continue to file their reports as they presently do today using the current medical forms. Medical reporting will be evaluated during the WCB business process reengineering effort that is currently under way.
- Does the eClaims mandate impact the hearing process?
No. The hearing process will remain the same but the format of some supporting documentation may change.
- Will the WCB continue to assemble and index cases?
Yes. The assembly and indexing process will continue.
- Which WCB forms currently submitted by Claim Administrators will be replaced by the eClaims filing process?
- C-2: Employer's Report of Work Related Injury/ Illness
- VF-2: Political Subdivision's Report of Injury to Volunteer Firefighter
- VAW-2: Political Subdivision's Report of Injury to Volunteer Ambulance Worker
- C-7: Notice that Right to Compensation is controverted
- C-669: Notice to Chair of Carrier's Action on Claim for Benefits
- C-8/8.6: Notice That Payment of Compensation Has Been Stopped or Modified
- Will a C-2 submitted by the employer satisfy the FROI filing requirements?
No. Employers will still be able to file C-2 reports; however, claim administrators will be required to submit a FROI for every reportable claim. A FROI will satisfy the C-2 filing requirement, but a C-2 will not satisfy the FROI filing requirement.
- Will the WCB still require filing of paper forms such as the C-240 and C-11?
Yes. Some paper forms will still be required since the information cannot be filed via a FROI/ SROI transaction.
- Who can I contact regarding eClaims?
The WCB has established an email address specifically for eClaims. Please send your questions and/or comments to eClaims@wcb.ny.gov.
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- Who or what is a Trading Partner?
A trading partner is an entity that enters into an agreement with the Workers' Compensation Board (WCB) to exchange data electronically. A trading partner can be an Insurance Company, Third Party Administrator or Self-Insured Employer.
- What is a Trading Partner Profile?
Trading partners will be required to complete a trading partner agreement and profile. The profile requires the trading partner to specify the type of trading partner they are as well as the specification of key organization attributes such as FEIN, address, contact names, etc.
- Will there be a charge or fee for completing the Trading Partner Profile documents?
- When can I register and complete all the forms to become an eClaims Trading Partner?
The eClaims Trading Partner Registration process is now available.
- Will Third Party Administrators have any reporting requirements?
Yes. TPAs should review section 2 of the eClaims Implementation Guide and register to become an eClaims Trading Partner. Trading Partner Registration must be submitted at least 60 calendar days prior to the Trading Partner testing date, which can be found in the eClaims Test and Implementation Schedule (MS Excel). All registrants should carefully review the overview, requirements, and instructions.
- Will a carrier or self-insured be able to submit data for claims using more than one TPA?
Yes. Our Trading Partner Profile will support the submission of data for a single claims administrator and from multiple approved TPAs. Claims administrators will need to communicate these relationship requirements to the WCB when completing a Trading Partner 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.
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eClaims Data Submission
- Who should be involved in eClaims on the claim administrator side?
We recommend that you immediately begin to identify the lead business and technical resources within your claims organization that are responsible for regulatory reporting. If you plan to submit flat files, begin project planning immediately with your Information Technology and Project Management units. For all Claim Administrators, begin to evaluate your data quality and the paper based processes that will be impacted by the WCB's transition to the eClaims filing process.
- Our organization is not familiar with Electronic Data Interchange (EDI); where can we get more information?
The WCB is developing training that will explain what EDI is; the training will be available on the WCB's website.
- How can we ensure that we collect the required information or data for eClaims?
Claim Administrators are strongly encouraged to review the tables in preparation for a full EDI implementation as announced in Subject No. 046-477. These tables should be shared with both business and technical representatives within your organization. We urge claim administrators to pay particular attention to those data elements defined as mandatory or mandatory conditional. We recommend that insurers, along with their Third Party Administrators, evaluate both their business and technical processes to ensure their ability to collect accurate information for timely transmission to the WCB prior to the mandated implementation. NYS Requirement Tables
- How can I submit my eClaims filings? Will there be a web data-entry option?
Using a secure file transfer protocol (SFTP), you may submit a flat file. Flat files must adhere to the IAIABC EDI Claims Release 3 format and can be submitted directly to the WCB's SFTP server or through a third-party vendor. The WCB will also offer a secure data-entry web application intended primarily for small volume filers, but not limited solely to that group.
- Will the WCB authorize third party vendors to submit Claims EDI Release 3 filings on behalf of Claim Administrators?
Yes. The WCB does not currently authorize vendors to submit claims data electronically. Below is a partial list of known vendors. The WCB anticipates that, as part of its eClaims implementation, it will authorize experienced Claims EDI Release 3 vendors to submit claims data to the WCB following satisfactory completion of testing with the WCB.
The list below includes known vendors offering a Claims EDI Release 3 related product and/or service for submitting claims data electronically. This listing is in alphabetical order and does not represent an endorsement by the WCB of any vendor listed, or a recommendation of one vendor over another. The WCB does not warrant or represent that this information is current, complete, or accurate. The WCB 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 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 at: http://www.iaiabc.org
- How will a trading partner know if the WCB has accepted or rejected an electronic FROI/ SROI filing?
The EDI IAIABC claims standard being adopted by the WCB (See Subject Number 046-477) includes an acknowledgment process. Every file and every 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.
- Will the WCB develop reports or a process to assist trading partners in monitoring performance?
The IAIABC Claims Standard provides an acknowledgment process for every transaction submitted in a data file. The acknowledgment process provides enough information for a trading partner to self-monitor the timeliness of its filings and its acceptance and rejection rates. Trading partners will be able to use the Event, Element Requirement, and Edit Matrix tables the WCB publishes to interpret the acknowledgment reports. The acknowledgment reports will provide the information needed to determine the success or failure of submissions for both events and data elements. Everyone is encouraged to understand the importance of these tables and the relationship they have to their business process and the collection and reporting of quality information.
- Will an XML (Extensible Markup Language) option be available for the submission of EDI Claims Release 3?
XML will be a future consideration; however, in the first phase of implementation it will not be considered.
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- Our organization is not familiar with the IAIABC. Where can we get more information?
Visit the IAIABC website
- Where can we obtain a copy of the IAIABC, Claims Release 3.0 Implementation guide?
Guides must be obtained from the IAIABC . There is a charge for non-EDI members.
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- Will training be provided?
Yes. The WCB provided a series of training programs for Claim Administrators who will be implementing eClaims. The series consists of:
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Appropriate MTC Filing
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 DNís listed below illustrate how NY will distinguish the injury FROI from the death FROI:
||Data Element Name
||Injury Claim value
||Death Claim value
||Date of Injury
||Date injury occurred
||Date death occurred
||Employee Date of Death
||Date death occurred
||Date death occurred
||Death Result of Injury Code
||N for No
||Y for Yes or U for Unknown
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 App to submit FROI and SROI filings for a death cases (when the death is the result of an accident/illness not occurring on the same day). Paper filings will not be allowed.
Please refer to NYS Business Scenarios 4-5 and 4-6 for details.
- If both a SROI-CA and a 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 2-5 for details.
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- 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 pickup. You would obtain the .zip file through your vendor.
- 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.
- 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 Implementation Guide.
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