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Changes on the horizon for workers’ compensation claims with IAIABC EDI Release 3.1

The International Association of Industrial Accident Boards and Commissions (IAIABC) develops standards for the Electronic Data Interchange (EDI) of workers’ compensation claims. Today, a growing number of states have chosen to implement a more efficient, paperless claims-reporting process by using the IAIABC workers’ comp EDI Standard for first reports of injury (FROI) and subsequent reports of injury (SROI). The newest version of these standards is the IAIABC EDI Release 3.1, scheduled to be implemented September 2018.

New release seeks to provide clarity to changes in claims

Release 3.1 was developed to modify the rules for changes within claims to provide greater insight into which data elements are changing and the nature of each change—whether an addition, update, and so on. Now, state jurisdictions will be able to identify the specific data elements that claim administrators are changing in a transaction.

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New data elements required in 3.1

Release 3.1 includes 35 new data elements (17 included on the FROI and 28 included on the SROI). If you work with jurisdictions that are moving to 3.1, you’ll need to ensure that you have these new data elements in your claims system.

State-mandated EDI claims reporting adds additional compliance rules and data integrity edits to the already varied workers’ compensation state laws. Once a state mandates Release 3.1, submitting FROIs and SROIs in the new format is required.

Several states to adopt 3.1

The first states to indicate that they’ll adopt the new release include Oklahoma, Georgia, Kansas, and Iowa. Insurers providing coverage in these states will need to prepare for the update.

Staying on top of EDI compliance

When a state decides to transition to Release 3.1, they will submit their plan and implementation date to the IAIABC. The IAIABC coordinates with each state to ensure staggered implementation dates. This alleviates the burden on claim administrators dealing with multiple state implementations simultaneously. The states will also publish their state-specific Release 3.1 requirements for claim administrators.

ISO WCS team provides information and support for Release 3.1

The industry is ever-changing, and this new release is just another step in the refinement of the EDI process. Transitioning to a new release of an IAIABC EDI standard can be daunting. Our team is working with states to identify their new data integrity edits, testing and implementation plans, and requirements for claim administrators. We’re also working with industry claim administrators to guide them through the new process.

Verisk’s ISO Workers’ Comp Solutions has a team of EDI experts and a suite of comprehensive products to support all essential analytical, compliance, and EDI reporting needs. If you’re currently a client, our team will work with you to iron out the details of how to implement the changes, including the new change process, new report types, and new data element requirements. For more information on transitioning to Release 3.1, please contact Robbie Tanner at robbie.tanner@verisk.com or Linda Yon at linda.yon@verisk.com.


Robbie Tanner

Robbie Tanner is product manager for wcCapture at Verisk. You can contact Robbie at robbie.tanner@verisk.com.

Linda Yon

Linda Yon is assistant product manager for wcCapture at Verisk. You can contact Linda at linda.yon@verisk.com.


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