All insurance carriers are required to report workers’ compensation claims through the Electronic Data Interchange.
Download the Current VT EDI Trading Partner Agreement [PDF] Document. (This document also contains profile and implementation information)
What EDI formats does Vermont use?
We use the standard International Association of Industrial Boards and Commissions (IAIABC) flat-file format for First Reports of Injury (transmission type 148). See the 148 layout table for the list of required and optional fields and their respective sizes (download here [PDF]). Use of the standard IAIABC header and footer is expected. All file formats and terms are defined by IAIABC Release 1. For further information please contact Becky Morris at email@example.com or 802-828-5985.
What transaction codes does Vermont accept?
For IAIABC 148 (first reports) submissions we accept MTC values of ‘00’ ‘01’ ‘02’ ‘CO’.
Please note that ’04′ is not in this list. A denial requires the filing of VT Workers’ Comp Form 2 which captures data out of the IAIABC 148 spec.
What type of injury reports does Vermont require to be filed?
By statute, Vermont requires all FROIs to be reported to our jurisdiction. This includes all medical only, lost time, and indemnity claims.
Does Vermont require the use of the Agency Claim Number (state file no.)?
Although the use of our state file number (which you will receive in our acknowledgment file) is preferable, we will also try to map injury reports to existing files in our database using the SSN + INJURY DATE. The Injury Date is the actual date of injury — not the date it was reported. This applies mainly to claims that are submitted with an MTC other than “00″.
What is the lag time for transmitting electronically?
The first report transmissions must be sent within 7 days after the Date of Injury. The date we use for the DATE RECEIVED is different than the IAIABC standard. We use the time stamp for the date that you write the data to the mailbox rather than the date that we download data. If you send data on a Friday night, we will load it to the database on the following Tuesday or Wednesday, but Friday’s date will be recorded as the date we received.
If data is in error, what is the procedure?
We evaluate the transmission on a claim-by-claim basis and load all of the ‘successful’ or ‘accepted with errors’ claims. ‘Accepted with errors’ means that the claim is accepted with errors on non-critical fields. Any claim that has a ‘fatal’ error (meaning that there was one or more errors that require us to reject the claim) is not loaded. Once rejected, you must fix the problem or problems and resubmit the claim. Corrections to rejected claims should be re-sent as an ’00′ and not a ‘CO’ because rejected claims are never entered into our system. Corrections to reports that ARE accepted should be sent as ‘CO’.
What does ‘Duplicate’ mean?
In our system, a duplicate refers to a paper report that mirrors a one already received (or will be received) via an EDI transmission. A duplicate is not a fatal error and does not affect your accuracy rating. With EDI, the employer no longer needs to report on paper, but may send one in error. Because of this we may already have a report of the injury on paper from your insured before the EDI transmission arrives. We always check SSN + INJURY DATE in our database. If we already have an injury reported, you will receive the agency claim number that we assigned to the first report we received. If a pattern is detected, we may inform you that duplicates have been coming in. If so, you should contact your insured and to verify that they aren’t sending paper copies of the First Reports of Injury to us.
Injuries submitted more than once during a single transmission or resubmitted later are simply ignored unless they have an ’01′ ’02′ ‘CO’ code.
How do I transmit flat file data?
We are currently accepting electronic reports through the following services:
- Ebix – www.ebix.com
10639 Welch Road, Orient, OH 43146
- HealthTech – http:// www.htedi.com
11730 W 135th Street, Suite 31, Overland Park, KS 66221
- ISO – www.wcprism.com
545 Washington Boulevard, Jersey City, NH 07310
- Mitchell International – www.mitchell.com/smartadvisor
6220 Greenwich Drive, San Diego, CA 92122
If you use an EDI vendor not listed here, contact us. We will review the feasibility of adopting their services.
Does Vermont accept the ANSI versions of the transmissions?
No. There are no current plans for implementing ANSI support in the near future. However, some EDI providers offer a translation service to automatically convert your X12 data into compliant IAIABC flat-files.
Does Vermont send EDI acknowledgments?
Yes. We send acknowledgments on all type 148 transmissions using the IAIABC acknowledgment format (AK1). Acknowledgments will be sent in electronic form only.
How often do I need to transmit data?
Reporting should be done at least once a week, assuming you have any claims to report. We download data on Tuesday or Wednesday of each week. All processing and acknowledgments are scheduled to be completed before midnight Wednesday. Reporting may, of course, be more frequent than weekly if you wish.
How does security work?
With our main VAN (AT&T Global Network) each trading partner has a mailbox with an account and user ID, protected by 2 passwords that are known only to the trading partner. We are the only ones who can read the data in our mailbox. No other trading partners can read any of your data in our mailbox and you cannot read their data. When we write acknowledgments to your mailbox, the same restrictions apply; we cannot read anything in your mailbox that we did not send.
When we are ready to receive data, we authorize transmissions from you by entering your account and user ID in our trading partner list. You enter our account and user ID in your account’s partner list. Unless both of these entries match, you will not be able to write data to our mailbox. This means that either partner can revoke permission by removing the specific account information from their mailing list. The mailing list is accessed through 3270 terminal emulator (or a 3270 terminal if you actually have one). It is set up once prior to production (or testing) and does not require any maintenance.
Who pays for the transmission?
The reporter will pay for transmissions according to whatever rates are in effect on the transmitters system. The reporting party will pay for submissions of FROI and for the return acknowledgment if they want it (recommended). Configuring who pays for what is done by setting certain attributes in the trading partner’s profile (this too is done through a terminal session). Both parties must agree on these settings before data can be sent or received.
Other EDI vendors have different fee structures. You must check with each if you need to compare prices (an in depth analysis is beyond the scope of this FAQ).
Who should I contact in your jurisdiction to negotiate an agreement to start testing, or to get more information?
Becky Morris by phone at (802)828-5985, or by e-mail at firstname.lastname@example.org