1 fl edi r3 test requirements rule 69l-56.320, f.a.c

1

FL EDI R3 FL EDI R3 TestTest

RequirementsRequirements

Rule 69L-56.320, F.A.C.

2

FL R3 Test FL R3 Test RequirementsRequirements Rule Rule 69L-56.320,69L-56.320,

F.A.C., addresses the F.A.C., addresses the requirements the Claim requirements the Claim Administrator must meet Administrator must meet to move from to move from Test to Test to Production status.Production status.

3

However, the Primary and However, the Primary and Secondary Implementation Secondary Implementation Schedules addressed in the Schedules addressed in the current rule are no longer current rule are no longer applicable; applicable;

• Therefore, Therefore, newnew Trading Trading partnerspartners must must test all test all MTC’s.MTC’s.

FL R3 Test FL R3 Test RequirementsRequirements

4

During the testing During the testing period, all DWC Forms period, all DWC Forms required by Rule 69L-3, required by Rule 69L-3, F.A.C. must continue to F.A.C. must continue to be mailed to the Division.be mailed to the Division.


5

Claim Admin. must Claim Admin. must achieve acceptance (TA) achieve acceptance (TA) for the minimum number for the minimum number of filings of filings for for each each categorycategory of EDI filings of EDI filings specified in thespecified in the FL Claims FL Claims EDI R3 ‘Test Process’ EDI R3 ‘Test Process’ document (on website) document (on website) prior to being considered prior to being considered for production status.for production status.


6

Claim Admin. will not be Claim Admin. will not be authorized to move to authorized to move to production status at different production status at different times for separate categories times for separate categories of required test EDI filings of required test EDI filings (e.g., EDI DWC-1’s, EDI DWC-(e.g., EDI DWC-1’s, EDI DWC-13’s, etc.).13’s, etc.).

• All specified MTC’s/Filing All specified MTC’s/Filing Types must be approved Types must be approved before Claim Admin can ‘go before Claim Admin can ‘go live’ with R3.live’ with R3.


7

In addition to testing the In addition to testing the specified MTC’s/Filing specified MTC’s/Filing Types, the Trading Partner Types, the Trading Partner must also must also respond to and respond to and resolve several different resolve several different types of TA-FL types of TA-FL Reconciliation ErrorsReconciliation Errors in the in the Data Warehouse before Data Warehouse before requesting authorization for requesting authorization for production status. production status.


8

R3 test files should R3 test files should report the electronic report the electronic equivalent of the DWC-1 equivalent of the DWC-1 (paper or R1), DWC-12, (paper or R1), DWC-12, DWC-13 and DWC-4 DWC-13 and DWC-4 being sent to the being sent to the Division for Division for actual actual claims.claims.


9

Note:Note: When testing R3 When testing R3 filings for the Electronic filings for the Electronic First Report of Injury or First Report of Injury or IllnessIllness using actual claims, using actual claims, the trading partner should the trading partner should use cases that were use cases that were received and processed by received and processed by DWC after DWC after 3/31/2010.3/31/2010. All claims/DWC- All claims/DWC-1’s (paper or R1) entered 1’s (paper or R1) entered prior to 3/31/10 have been prior to 3/31/10 have been copied to our test copied to our test database.database.


10

Use real JCN’s from JCN Use real JCN’s from JCN list when sending list when sending standalone test SROI filings standalone test SROI filings for actual claims where the for actual claims where the DWC-1 (paper or R1) was DWC-1 (paper or R1) was established in DWC claims established in DWC claims system on or before system on or before 3/31/10. Do 3/31/10. Do notnot use use Production JCN’s if the Production JCN’s if the claim was established claim was established AFTER 3/31/10.AFTER 3/31/10.


11

Use the Use the test JCNtest JCN returned returned for the test 00/IP (or other for the test 00/IP (or other EDI DWC-1 equivalent) when EDI DWC-1 equivalent) when sending “standalone” test sending “standalone” test SROI filings (e.g., SA) SROI filings (e.g., SA)

• See test filing categories c See test filing categories c – f in Test Process – f in Test Process document on web).document on web).


12

If you are a new Claim If you are a new Claim Admin. and are unable to Admin. and are unable to test with actual claims, test with actual claims, “mock” electronic filings“mock” electronic filings may instead be created and may instead be created and sent for testing purposes.sent for testing purposes.


13

Mock filings must Mock filings must still contain valid still contain valid data and must data and must notnot be be identical to identical to IAIABC or Florida IAIABC or Florida Business Scenarios. Business Scenarios.


14

If you send mock test If you send mock test data, you need to be data, you need to be confident of the quality of confident of the quality of your live production data.your live production data.

• There is only a 30 day There is only a 30 day grace period for FROI late grace period for FROI late filing penalties after going filing penalties after going ‘live’, and‘live’, and

• Going back to “testing” Going back to “testing” status is not an option. status is not an option.

15

If you change Match Data If you change Match Data (e.g., SSN, DOI) for an (e.g., SSN, DOI) for an actual claim, you must actual claim, you must notnot send the JCN provided for send the JCN provided for that claim on your JCN that claim on your JCN Listing. Listing.

• New FROI’s (e.g., 00/IP) New FROI’s (e.g., 00/IP) will will notnot have a JCN. have a JCN.

16

Note:Note: Only one JCN Only one JCN Listing will be produced Listing will be produced after you file your Trading after you file your Trading Partner paperwork. Partner paperwork.

• JCN Lists can be JCN Lists can be generated upon request. generated upon request.

•Send email to Send email to [email protected] for revised JCN List.

17

Seeking Production Seeking Production Approval Approval When you think you have When you think you have satisfied satisfied allall testing testing requirements, send an email to requirements, send an email to [email protected] and request ‘production approval’.

• Production approval Production approval process is described in the process is described in the ‘Test Process’ document on ‘Test Process’ document on the Claims EDI Webpage (and the Claims EDI Webpage (and following slides.)following slides.)

18

Seeking Production Seeking Production ApprovalApproval

To determine the status of your To determine the status of your testing, from the Test Warehouse Main testing, from the Test Warehouse Main Menu, click on ‘Report Cards & Menu, click on ‘Report Cards & Statistical Reports’; then select Statistical Reports’; then select ‘Generate Claims EDI Report Card’ to ‘Generate Claims EDI Report Card’ to yield counts and %’s for each category yield counts and %’s for each category of EDI filings.of EDI filings.

19

Seeking Production Seeking Production Approval Approval

If it appears testing If it appears testing requirements for all requirements for all categories have been categories have been met, email met, email [email protected] to request production approval.

20

Seeking Production Seeking Production Approval Approval

Note:Note: Filings that are Filings that are assigned ‘TA-FL’ will count assigned ‘TA-FL’ will count as accepted transactions, as accepted transactions, but will appear in a separate but will appear in a separate column in the Report Card.column in the Report Card.

• They should be added to They should be added to the ‘TA’ counts when the ‘TA’ counts when determining if testing determining if testing requirements have been requirements have been achieved.achieved.

21

Seeking Production Seeking Production ApprovalApproval

Although the “FL Claims Although the “FL Claims EDI R3 Test Process” EDI R3 Test Process” document indicates each document indicates each category must be evaluated category must be evaluated on the basis of one on the basis of one transmission / Division transmission / Division Rec’d Date, you may also Rec’d Date, you may also request credit for filings request credit for filings submitted over time via submitted over time via multiple transmissions/ Div multiple transmissions/ Div Received Dates. …Received Dates. …

22

Questions?Questions?

23

After you get back to the After you get back to the office, ALL Questionsoffice, ALL Questions, ,

either Business or Technical, either Business or Technical, should be sent via email to should be sent via email to [email protected]

This email address is copied This email address is copied to all members of the EDI to all members of the EDI

team. It is the quickest and team. It is the quickest and most efficient way for us to most efficient way for us to respond to your concerns. respond to your concerns.

24

Please complete your Please complete your Training Feedback forms.Training Feedback forms.

1 fl edi r3 test requirements rule 69l-56.320, f.a.c

Documents

test jcn

fl r3 test requirements

r3 test files

test database

r3 filings

mock test data

testing requirements

standalone test sroi