Kansas Administrative Regulations › Agency 51 - DEPARTMENT OF LABOR-DIVISION OF WORKERS COMPENSATION › Article 9 - MEDICAL AND HOSPITAL › Section 51-9-17 - Release 3.1 standards for trading partner profiles; submission of data; first reports of injury

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each
			 insurer, group-funded workers compensation pool, and self-insured employer
			 shall participate in the electronic data interchange (EDI) program and shall
			 submit to the director a completed EDI trading partner profile at least 30 days
			 before submitting claim information pursuant to the international association
			 of industrial accident boards and commissions' (lAIABC's) release 3.1
			 standards, as provided in K.S.A. 44-557a  and amendments thereto. The EDI
			 trading partner profile shall be completed according to the "Kansas EDI release
			 3.1 guide for reporting first (FROI) and subsequent (SROI) reports of injury"
			 as revised on July 16, 2018 by the Kansas department of labor and hereby
			 adopted by reference. This document shall be referred to as the "Kansas EDI
			 release 3.1 guide" in this regulation.
(b) Each insurer, group-funded workers
			 compensation pool, and self-insured employer shall report to the director
			 within five days any changes to information submitted in the EDI trading
			 partner profile.
(c) All claim
			 information submitted pursuant to K.S.A. 44-557a, and amendments thereto, by
			 electronic data interchange shall be submitted according to the Kansas EDI
			 release 3.1 guide.
(d) All claim
			 information submitted pursuant to K.S.A. 44-557a, and amendments thereto, and
			 the Kansas EDI release 3.1 guide's first report of injury, commonly called
			 "FROI 00," shall be considered the filing of an accident report pursuant to
			 K.S.A. 44-557, and amendments thereto. This information shall not be open to
			 public inspection, except as provided in K.S.A. 44-550b  and amendments
			 thereto.
(e) All claim information
			 submitted pursuant to K.S.A. 44-557a, and amendments thereto, shall be
			 considered a medical record to the extent that the information refers to an
			 individual worker's identity. No references in the claim information to an
			 individual worker's identity shall be open to public inspection, except as
			 provided in K.S.A. 44-550b  and amendments thereto. For purposes of this
			 regulation, the claim number used by an insurance carrier, self-insured
			 employer, or group-funded workers compensation pool to identify an individual
			 worker's claim shall be considered a reference to the individual worker's
			 identity.
(f) On or before the
			 compliance date specified in subsection (g), each insurer shall file claim
			 information for all "lost time/indemnity" and "denied" cases through EDI rather
			 than by submitting paper forms. The insurer shall file the electronic form in
			 accordance with the Kansas EDI release 3.1 guide.
(g) Each insurer shall comply on or before
			 the implementation date of November 29, 2018 for reporting electronic FROI or
			 SROI. Each claim administrator submitting claims as EDI filings in production
			 status using the IAIABC's release 3 national standard shall convert to release
			 3.1 and shall be in production status by the implementation date. Jose Castillo
			 Acting Director