Colorado Division of Workers’ Compensation

Electronic Data Interchange Participation Policy for FROI

August 1, 2002

It is the goal of the Division of Workers’ Compensation (DOWC) to promote the participation in and success of Electronic Data Interchange (EDI).  Therefore, DOWC will provide guidance and assistance throughout the course of this project.  Mutual success for the Sender (i.e., Carrier, Third Party Administrator, Permitted Self-Insurer, and Servicing Agent/Sender) and DOWC is dependent upon clear guidelines and understanding of the EDI system’s capabilities and limitations. Key requirements, listed below, are essential in achieving the program’s goals.  Participation in the EDI project requires Sender acceptance of these requirements.  If DOWC modifies these EDI requirements, the Sender will receive 30 days written notice.  To the extent required by law, DOWC shall retain the content of all data transmissions in confidence.

COLORADO SENDER REQUIREMENTS

1.    Sender will transmit data via the method and time specified in the transmission profile approved by DOWC.

2.      Sender’s transmission of the data must conform to DOWC requirements specified in:  Trading Partner Profile, Transmission Profile, Data Element Matrix, Event Table, Edit Matrix.

3.      Sender’s format of data elements and definitions will conform to the International Association of Industrial Accident Boards and Commissions (IAIABC) data dictionary, including future amendments, unless this requirement is modified by DOWC.

4.       Sender’s transmissions are subject to periodic DOWC data quality audits.

5.      Sender will complete and send to DOWC: EDI Sender Acceptance Form (WC175), Trading Partner Profile (WC170), Transmission Profile (WC169), Claims Administrator Insurer List (WC172) and Third Party Administrator Location List (WC171) before testing commences.

6.      Sender must meet testing requirements as detailed in DOWC Sender Testing Requirements to be approved for production.  Once the Sender is approved for production, the sender will no longer file the equivalent paper forms.

7.       Sender’s rejection rate must continue to meet acceptable levels for the Sender to remain in production.

8.       Sender will be able to accept the AK1 acknowledgement file transmitted by DOWC.

9.      Sender will electronically transmit correction of all errors identified and reported by DOWC via the AK1 acknowledgement.  All statutory time requirements for reporting must be met. 

10.   Sender will pay all transmission costs.

11.   Sender may withdraw from participation in EDI transmissions upon 30 days written notice to DOWC.

            12  Sender shall retain the content of the data transmissions in confidence to the extent required by law.