Illinois Administrative Code › Title 50 - INSURANCE › Part 2907 - INSURANCE OVERSIGHT DATA COLLECTION › Appendix A - Data Element Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
Field #
Data Field
Data Definition
Date Based On:
1
Company NAIC #
Character value 5 digits "00000"
2
Company FEIN
Character value 10 digits "00-0000000"
3
Company Name
Character value any length
4a
Company Contact Name
Character value any length
4b
Company Contact Phone Number
Character value "(000) 000-0000"
5
Company Contact email
Character value any length
6
# of claims opened
A claim received by the insurer during the survey
						  period
Claims opened
7
# of reported medical only claims
The number of claims reported in field #6 in which
						  recovery was limited to medical expenses only
Claims opened
8
# of contested claims
The number of claims reported in field #6 in which
						  resolution was delayed due to a dispute regarding policy language or in which
						  litigation was involved
Claims opened
9
# of claims for which the employee has attorney
						  representation
The number of claims that are opened during the survey
						  period in which the insurer has received notice that the employee has retained
						  legal counsel
All claims
10a
# of claims with lost time and
# of claims for which temporary total disability was
						  paid
a) The number of claims that are opened during the
						  survey period in which the employee incurred time off of less than 3 working
						  days
Claims opened
10b
b) The number of claims that are opened during the
						  survey period in which the employee incurred time off of between 3 and 14
						  calendar days
10c
c) The number of claims that are opened during the
						  survey period in which the employee incurred time off of greater than 14
						  calendar days
11
# of claim adjusters employed to adjust workers'
						  compensation claims
The total number of person hours allocated to adjust
						  workers' compensation claims received by the company during the survey
						  period
All claims
12
# of claims for which temporary total disability was
						  not paid within 14 days from the first full day off, regardless of
						  reason
The number of temporary total disability claims that
						  are opened during the survey period in which temporary total disability
						  benefits were not paid within 14 days from the first full day off, regardless
						  of reason
Claims opened
13a
# of medical bills paid 60 days or later from date of
						  service
a) The total number of medical bills paid during the
						  survey period when the time between the date of service and the date paid was
						  greater than 60 days
All claims
13b
The average days paid on those paid after 60 days for
						  the previous calendar year
b) The average number of days for all claim payments
						  identified in field #13a
All claims
14a
# of claims in which in-house defense counsel
						  participated
a) The total number of claims open at any time during
						  the survey period in which internal counsel was utilized
All claims
14b
Total amount spent on in-house legal services
b) Total expenses (actual or estimated) applied to all
						  internal defense counsel activities associated with the claims reported in
						  field #14a
All claims
15a
# of claims in which outside defense counsel
						  participated
a) The total number of claims open at any time during
						  the survey period in which external (i.e., outside) defense counsel was
						  utilized
All claims
15b
Total amount paid to outside defense counsel
b) Total expenses (actual or estimated) applied to all
						  external defense counsel activities associated with the claims reported in
						  field #15a
All claims
16a
Total amount billed to employers for bill review
a) The total amount of fees billed to employers in
						  connection with all medical bill review services provided by the insurer during
						  the survey period:
1) Review individual bills and identify
						  charges in excess of the Workers' Compensation Commission Fee Schedule.
2) Review individual bills and identify
						  improperly applied Managed Care discount.
3) Review individual bills and identify
						  medically unnecessary procedures.
4) Review individual bills and identify
						  improperly coded medical procedures.
5) Review individual bills and identify
						  medical providers who provide excessive utilization of their services.
6) Review individual bills and identify
						  medical procedures not covered by the Workers' Compensation Commission Fee
						  Schedule.
7) Review bills and identify
						  duplications.
8) Re-price pharmaceutical services based on
						  a reliable method.
9) Track prescription usage and alerts
						  concerning potential abuse.
10) Review bills not covered under the Fee
						  Schedule and determine if the provider has charged according to reasonable and
						  customary rates.
All claims
16b
b) The total allocated expenses paid on behalf of
						  employers for services described in field #16a during the survey period.
17
Total amount billed to employers for fee schedule
						  savings
The total amount of fees billed to employers in
						  connection with all fee schedule discount review services
All claims
18
Total amount charged to employers for any and all
						  managed care fees
The total amount of costs allocated for services
						  provided by a Workers' Compensation Preferred Provider Program as defined in 50
						  Ill. Adm. Code
						  2051.220
All claims
19a
# of claims involving in-house medical nurse case
						  management
a) The total number of claims internal medical nurse
						  management expenses were applied to or associated with during the survey
						  period, regardless of when the claim was opened
All claims
19b
The total amount spent on in-house medical nurse case
						  management
b) The total amount of all internal nurse management
						  expenses associated with the claims reported in field #19a
All claims
20a
# of claims involving outside medical nurse case
						  management
a) The total number of claims external medical nurse
						  management expenses were applied to or associated with during the survey
						  period, regardless of when the claim was opened
All claims
20b
The total amount paid for outside medical nurse case
						  management
b) The total amount of all outside nurse management
						  expenses associated with the claims reported in field #20a
All claims
21
Total amount paid for independent medical exams
The total amount paid for all independent medical exams
						  by the insurer during the survey period
All claims
22
Total amount spent on in-house Utilization Review for
						  the previous calendar year
The total amount of all internal Utilization Review
						  expenses incurred by the insurer during the survey period
All claims
23
Total amount paid for outside Utilization Review for
						  the previous calendar year
The total amount of all external Utilization Review
						  expenses incurred by the insurer during the survey period
All claims