Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69L - Division of Workers' Compensation › Chapter 69L-56 - ELECTRONIC DATA INTERCHANGE (EDI) REQUIREMENTS FOR PROOF OF COVERAGE AND CLAIMS (NON-MEDICAL) › Section 69L-56.3013 - Electronic Periodic Claim Cost Reports

Current through Reg. 50, No. 138; July 16, 2024
(SROI MTC SA, FN as found in the IAIABC Implementation Guide
				  for Claims: First, Subsequent, Header, Trailer & Acknowledgement Detail
				  Records, Release 3, January 1, 2009 Edition).
On or before the compliance date established in the insurer's
				  Primary Implementation Schedule set forth in paragraph
				   69L-56.300(3)(a),
				  F.A.C., the insurer shall file the electronic form equivalent for claim cost
				  information otherwise reported on Form DFS-F2-DWC-13 adopted in Rules
				   69L-56.4013 and
				   69L-3.025, F.A.C. If payment has
				  been made for any of the Benefit Type (BT) Codes or Other Benefit Type (OBT)
				  Codes listed in subsections (1) and (2) of this section, the claim
				  administrator shall report on the Electronic Claim Cost Report, the cumulative
				  amount paid (i.e., Benefit Type Amount Paid, Other Benefit Type Amount) in
				  dollars and cents for each applicable BT Code, with the exception of BT Codes
				  reporting employer payment, and OBT Code. The claim administrator shall also
				  report the amount of weeks (i.e., Benefit Type Claim Weeks) and/or days (i.e.,
				  Benefit Type Claim Days), the effective date of each indemnity benefit (i.e.,
				  Benefit Period Start Date), and the date through which indemnity benefits were
				  paid at the time of reporting (i.e., Benefit Period Through Date), unless
				  otherwise indicated below. For purposes of the Electronic Claim Cost Report,
				  the Benefit Period Start Date shall be reported as the earliest date benefits
				  were paid for a Benefit Type Code, regardless of whether multiple disability
				  periods were paid for the Benefit Type Code.
(1) Benefit Type (BT) Codes:
(a) BT Code 010: Fatal/Death.
(b) BT Code 020: Permanent Total
				(PT).
(c) BT Code 021: Permanent
				Total Supplemental (PT Supp).
(d)
				BT Code 030: Permanent Partial Scheduled/Impairment Income Benefits (IB) (Dates
				of Injury on or after 1/1/94).
The claim administrator shall not report BT Code 030 (IB) or
				  BT Code 530 (Lump Sum Payment/Settlement of IB) if one or more of the following
				  BT Codes have been paid: BT Code 020 (PT), 021 (PT Supp), 520 (Lump Sum
				  Payment/Settlement of PT), or 521 (Lump Sum Payment/Settlement of PT
				  Supp).
(e) BT Code 030:
				Permanent Partial Scheduled/Wage Loss Benefits (Dates of Injury prior to
				1/1/94).
1. Benefit Type Claim Weeks, Benefit
				Type Claim Days, Benefit Period Start Date and Benefit Period through Date are
				not required to be reported.
(f) BT Code 040: Permanent Partial
				Unscheduled/Supplemental Income Benefits (SB) (Dates of Injury 1/194 through
				9/30/2003).
1. BT Code 040 (SB) or 540 (Lump
				Sum Payment/Settlement of SB) shall not be sent as the earliest/only indemnity
				benefit paid.
(g) BT Code
				050: Temporary Total (TT).
(h) BT
				Code 051: Temporary Total Catastrophic (TT @ 80%).
(i) BT Code 070: Temporary Partial (TP).
For Dates of Injury prior to 1/1/94, Benefit Type Claim
				  Weeks, Benefit Type Claim Days, Benefit Period Start Date and Benefit Period
				  through Date are not required to be reported.
(j) BT Code 090: Permanent Partial
				Disfigurement/Permanent Impairment Benefits (PI) (Dates of Injury 8/1/79
				through 12/31/1993).
1. The claim
				administrator shall not report BT Code 090 (PI) or BT Code 590 (Lump Sum
				Payment/Settlement of PI) if one or more of the following BT Codes have been
				paid: BT Code 020 (PT), 021 (PT Supp), 520 (Lump Sum Payment/Settlement of PT),
				or 521 (Lump Sum Payment/Settlement of PT Supp).
2. Benefit Type Claim Weeks, Benefit Type
				Claim Days, Benefit Period Start Date and Benefit Period through Date are not
				required to be reported.
(k) BT Code 240: Employer Paid
				Unspecified/Salary in Lieu of Compensation.
1.
				The claim administrator may alternatively report BT Code 242: Employer Paid
				Vocational Rehab Maintenance/specifically for Salary in Lieu of Comp for TT -
				Training and Education; BT Code 250: Employer Paid Temporary Total/specifically
				for Salary in Lieu of Comp for TT; BT Code 251: Employer Paid Temporary Total
				Catastrophic/specifically for Salary in Lieu of Comp for TT @ 80%; and/or BT
				Code 270: Employer Paid Temporary Partial/specifically for Salary in lieu of
				Comp for TP Payable; however, if the claim administrator's knowledge of the
				injury is on or after its production implementation date for reporting the
				Electronic Claim Cost Report, BT Codes 242, 250, 251, and 270 shall not be
				reported with BT Code 240.
2.
				Benefit Type Amount Paid is not required to be reported for BT Codes 240, 242,
				250, 251, and 270.
(l) BT
				Code 410: Vocational Rehab Maintenance/TT Training and Education.
(m) BT Code 500: Unspecified Lump Sum
				Payment/Settlement of indemnity benefits.
Benefit Type Claim Weeks, Benefit Type Claim Days, Benefit
				  Period Start Date and Benefit Period through Date are not required to be
				  reported.
(n) BT Code 501:
				Medical Lump Sum Payment/Settlement. The claim administrator is not required to
				report BT Code 501: Medical Lump Sum Payment/Settlement, unless it is
				accompanied or preceded by BT Code 500 Unspecified Lump Sum Payment/Settlement.
1. If BT Code 501 is the only payment
				reported, the Electronic Claim Cost Report will be rejected.
2. Benefit Type Claim Weeks, Benefit Type
				Claim Days, Benefit Period Start Date and Benefit Period through Date are not
				required to be reported.
(o) BT Codes 5xx: Lump Sum Payment/Settlement
				of a specific BT Code in paragraphs (1)(a) through (l) of this subsection.
Benefit Type Claim Weeks, Benefit Type Claim Days, Benefit
				  Period Start Date and Benefit Period through Date are not required to be
				  reported.