NCIC FROI/SROI R3 EDI Requirements Version 1.7 - Available for Download
The NCIC FROI/SROI R3 requirements are immediately available for download on the NCIC FROI/SROI Implementation Guide and Requirements page.
NCIC's FROI/SROI Implementation Guide and Requirements page provides an overview of and a link to download each requirement document. Information regarding changes to NCIC's Requirements can be accessed by utilizing the 'Track Changes Document.'
NCIC FROI Requirement Change to Accept All Claims Filed on or after April 1, 1997, Electronically (EDI)
Effective immediately, NCIC will allow all FROI claims filed on or after April 1, 1997, to be submitted via EDI. With the initial implementation of NCIC FROI EDI, the event per Event Table was based on the Date the Employer had Knowledge of the Injury vs. Trading Partner (TP) Production Date. These events required the continued reporting of claims on paper if the claim was established prior to EDI start date. NCIC has received feedback from its TP's whose preference is to file all new claims via EDI, and based on this feedback NCIC has implemented the following changes.
In order to allow NCIC to receive all FROI reports via EDI, the Event Table has been changed per 'A. FROI Event Table' below, and the edit that restricted the TP's ability to report all FROI claims has been removed per 'B. Edit Matrix Population Restriction' below.
- FROI Event Table change:
FROI MTC 00 Original: Adding two new events to replace previous events:
- A claim must be reported to the Commission using a FROI 00 if medical expenses exceed > $2000 and Date Employer Had Knowledge of Injury (DN0040) is >= 04/01/1997. NCIC will accept all claims in addition to this event.
- The injured worker misses more than one day of work and Date Employer Had Knowledge of Injury (DN0040) is >= 04/01/1997. NCIC will accept all claims in addition to this event. Also, added the through date of 6-30-14 to the previous FROI 00 Event and removed Note: A FROI 00 is not required to be filed for injuries that would not require a filing of a Form 19.
- Edit Matrix Population Restriction:
Removed the following edit on: DN0040 Date Employer Had Knowledge of Injury edit 045 Value is < required by jurisdiction: If DN0104 Test Production Indicator = P, Date Employer Had Knowledge of Injury (DN0040) must be >= Trading Partner approved production implementation date. Notes:
- Claims established prior to Trading Partner approved production implementation date must be filed on paper.
- Claims established on or after Trading Partner approved production implementation date must be filed via EDI.
If these requirement events per Event Table change will cause hardship to your organization, please send an email with the subject line of 'NCIC Form 19 Event Table Change' to the address below by July 1, 2014. In the email, explain your circumstances and the nature of the hardship. Please also indicate how long it will take you to comply with the changes.
For more information, please contact the NCIC EDI Support Team at firstname.lastname@example.org
IMPORTANT ANNOUNCEMENT REGARDING FROI/SROI REPORTING
Effective immediately, the North Carolina Industrial Commission is suspending the acceptance of Claims EDI transactions for SROI (Subsequent Report of Injury) reports. The Commission will continue to accept and process Claims EDI transactions for FROI (First Report of Injury) reports with the exception of the FROI 04 Denial. In order to maintain the integrity and efficiency of the administration and adjudication of workers’ compensation claims, the Commission will be pursuing an IRR (Issue Resolution Request) with the IAIABC (International Association of Industrial Accident Boards and Commissions). The goal of the IRR would be to allow carriers and employers to report specific body parts for which liability and compensability are accepted and/or denied. The Commission will provide updates on the progress of the IRR and future plans for SROI reports as they become available.
The following Claims EDI transactions will continue to be accepted by the Commission:
- FROI 00 (Original)
- FROI 01 (Cancel)
- FROI 02 (Change)
- FROI AQ (Acquired Claim)
- FROI AU (Acquired / Unallocated)
- FROI CO (Correction)
Trading Partners submitting FROI EDI transactions should not submit a Form 19 to the Commission.
Until further notice, and based on the NCIC Event Table, the following Claims EDI transactions (FROI/SROI reports) will not be accepted and Trading Partners will receive a rejection acknowledgement (TR) from the Commission:
- SROI 02 (Change)
- SROI 04 (Denial)
- SROI AP (Acquired / Payment)
- SROI CA (Change in Benefit Amount)
- SROI CB (Change in Benefit Type)
- SROI CO (Correction)
- SROI EP (Employer Paid)
- SROI ER (Employer Reinstatement)
- SROI FN (Final)
- SROI IP (Initial Payment)
- SROI PY (Payment Report)
- SROI RB (Reinstatement of Benefits)
- SROI RE (Reduced Earnings)
- SROI S1 (Suspension, Return to Work, or Medically Determined/Qualified Return to Work)
- SROI S4 (Suspension, Claimant Death)
- SROI S7 (Suspension, Benefits Exhausted)
- SROI S8 (Suspension, Jurisdiction Change)
- SROI SD (Suspension, Directed by Jurisdiction)
All carriers and employers shall submit the appropriate IC Forms (Forms 60, 61, 62, 63, 28, 28B, 28C, 28T) on paper or electronically. The Commission will be contacting Trading Partners who have submitted SROI EDI transactions to resolve any issues with those reports.
ANNOUNCEMENT REGARDING MEDICAL BILL REPORTING ELECTRONIC DATA INTERCHANGE (EDI)
In response to requests from employers, carriers, and third-party administrators, the Industrial Commission will delay the mandatory implementation date for Medical Bill Reporting via EDI from March 1, 2014, to July 1, 2014. This purpose of this postponement is to allow these stakeholders additional time for preparation and necessary programming. No additional extensions will be granted.
- Electronic reporting for Medical Billing will become available on March 1, 2013, and mandatory implementation is required for workers’ compensation carriers and self-insured employers by July 1, 2014.
- Electronic reporting will occur via EDI transactions, using the Medical Billing 2.0 reporting standards adopted by the IAIABC.
- Medical Billing EDI testing will be available beginning January 2, 2013.
Additional information on EDI transactions can be found online at the IAIABC website, http://www.iaiabc.org
The North Carolina Industrial Commission has contracted with Insurance Services Office, Inc. (ISO) to manage its electronic reporting. ISO will be administering registration of carriers, self-insurers, medical bill review companies and third party administrators as trading partners, EDI testing, and data collection and submission of EDI data to the NCIC.
If you have any questions or concerns regarding implementation of EDI FROI/SROI or EDI MED reporting in North Carolina, please contact ISO at email@example.com
If you would like to join the NCIC EDI Mailing List to receive important announcements on North Carolina's reporting requirements, please send an email to firstname.lastname@example.org. Contacts indicated on the Trading Partner Registration will be automatically added to this list.