Updates/Changes PCCP Item Data Element Field Name Description Condition Comments re update Coverage P033 ANZSIC 1993 Identifies the Australian and New Zealand Standard Industrial Classification code (four-digit level) of the employer holding this particular policy to which the claim is charged pre 1 Jul 2014 Conditional Change date from pre July 2012 t0 pre July 2014 - due to dual coding - an ANZSIC 93 code must be supplied 30 Jun 2014 inclusive. Coverage P034 ANZSIC 2006 Identifies the Australian and New Zealand Standard Industrial Classification code (four-digit level) of the employer holding this particular policy to which the claim is charged post 1 July 2013. Conditional Change date from pre July 2012 t0 post July 2013 - due to dual coding - an ANZSIC 06 code must be supplied from 1 July 2013 inclusive. Claims C008 ANZSIC 1993 Identifies the Australian and New Zealand Standard Industrial Classification code (four-digit level) of the employer holding this particular policy to which the claim is charged pre 1 Jul 2014 Conditional Change date from pre July 2012 t0 pre July 2014 - due to dual coding - an ANZSIC 93 code must be supplied until 30 Jun 2014 inclusive.
Claims C084 MEDICAL CERTIFICATE PROVIDER NUMBER A unique number allocated by Medicare to identify the provider supplying the medical certificate. Optional For a new claim this feld is mandatory, for an update to a claim if any of the fields C131, C083, C084 are populated to indicate a new medical certificate, then all three fields are mandatory and C084 is optional Claims C085 CAPACITY TO WORK AT MEDICAL CERTIFICATE The capacity to work as shown on the Workers’ Compensation medical certificate received for the worker (whether it is a First, Progress or Final certificate) or other indication of the worker’s fitness for work (e.g., report). Conditional 01 Fit for duties, including fit but requiring further treatment. 02 Fit for restricted return to work or for alternative duties. 03 for work. For a new claim this feld is mandatory, for an update to a claim if any of the fields C131, C083, C084 are populated to indicate a new medical certificate, then all three fields are mandatory and C084 is optional injury
Claims C087 WORK STATUS The worker’s last known work status. Conditional 01 Maintained at Work 02 Return to Work – Full Hours 03 Return to Work – Partial Hours 04 Not Working – Injury Related 05 Not Working – Other Reason 06 Unknown – Failure to Provide a Medical Certificate 09 Unknown - Other For a new this field is mandatory, for an update to a claim if any of the data items - C086, C130 and C087 are populated to indicate a change in work status, then all three fields are mandatory
Worker Data C012 WORKER TITLE DESCRIPTION The title of the worker FORMAT Alphanumeric LENGTH 4 characters CARDINALITY 1 CONDITION Mandatory NOTE: The Worker Title field will be a text field not a list of valid titles C013 WORKER SURNAME DESCRIPTION The surname of the Worker FORMAT Alphanumeric LENGTH 30 characters CARDINALITY 1 CONDITION Mandatory C014 WORKER NAMES DESCRIPTION The given names of the worker FORMAT Alphanumeric LENGTH 50 characters CARDINALITY 1 CONDITION Mandatory C015 WORKER RESIDENTIAL ADDRESS LINE 1 DESCRIPTION The first line of the address of the Worker's residential address. FORMAT Alphanumeric LENGTH 30 characters CARDINALITY 1 CONDITION Mandatory
P038 P038.5 ACTUAL NUMBER OF WORKERS Conditional P038 Actual Workers - must be >0 if Actual (P037) is >0 REJECT Actual Workers must be greater than 0 if Actual Wages is greater than 0 P039 P039.3 PREMIUM COLLECTION TYPE Mandatory Must be a valid code REJECT Premium Collection Type entered is invalid P053 P053.1 INITIAL DEPOSIT PREMIUM CHARGED Mandatory Must be greater than or equal to 0 REJECT Initial Deposit Premium Charged must be greater than or equal to $0 P041 P041.1 CURRENT ADJUSTED PREMIUM CHARGED Optional If entered it must be greater than $0 REJECT Current/adjusted Premium Charged was entered but it must be greater than $0 Revalidation Data Element Rule No Field Name Condition Rule Record when fail Error Message P031 P031.11 EFFECTIVE DATE Mandatory if the Effective date is changed then check any claims for this policy\coverage record where the date of occurrence is no longer within the coverage period . If any claims are found they need to be rejected based on the rule for C048.4 REVALIDATION P032 P032.12 EXPIRY DATE Mandatory if the expiry date is changed then check any claims linked to this policy\coverage record where the date of occurrence is no longer within the coverage period . If any claims are found they need to be rejected based on the rule for C048.4 REVALIDATION
Mandatory Rules Data Element Rule No Name Condition Rule Record when fail Error Message P028 P028.M COVERAGE ID Mandatory Mandatory REJECT COVERAGE ID is a mandatory field P029 P029.M COVERAGE TYPE CODE Mandatory Mandatory field REJECT COVERAGE TYPE CODE is a mandatory field P031 P031.M EFFECTIVE DATE Mandatory Mandatory field REJECT EFFECTIVE DATE is a mandatory field P032 P032.M EXPIRY DATE Mandatory Mandatory field REJECT EXPIRY DATE is a mandatory field P035 P035.M ESTIMATED WAGES Mandatory Mandatory field REJECT ESTIMATED is a mandatory field P036 P036.M ESTIMATED NUMBER OF WORKERS Mandatory Mandatory field REJECT ESTIMATED NUMBER OF WORKERS is a mandatory P039 P039.M PREMIUM COLLECTION TYPE Mandatory Mandatory field REJECT PREMIUM COLLECTION TYPE is a mandatory field P053 P053.M INITIAL DEPOSIT PREMIUM CHARGED Mandatory Mandatory field REJECT INITIAL DEPOSIT PREMIUM CHARGED is a mandatory field Claim Rules and Validations Data Element Rule No Field Name Condition Rule Record State when fail Error Message C001 C001.3 INSURER NUMBER Mandatory Must be one of the insurer numbers for an insurer entity REJECT Incorrect Insurer Number C002 C002.3 INSURER CLAIM NUMBER Mandatory Must be a unique number for that insurer. This only applies for manual claim creation REJECT Claim number already exists
C009 C009.2 SHARED CLAIM CODE Mandatory Must be a valid code REJECT Shared code invalid. C011 C011.4 REVISED INSURER CLAIM NUMBER Optional Must be a unique number for that insurer REJECT Claim number already exists C017 C017.3 WORKER RESIDENTIAL ADDRESS SUBURB Mandatory Must match a postal suburb description in Australia Post’s Postcode listing REJECT Worker residential address suburb entered is not valid C018 C018.3 WORKER RESIDENTIAL ADDRESS Mandatory Must be a valid code REJECT Worker residential state/territory code entered is not valid C019 C019.3 WORKER RESIDENTIAL ADDRESS POSTCODE Mandatory Must be a valid postcode for C017 REJECT Worker residential address postcode entered is not valid for the suburb selected C019 C019.4 WORKER RESIDENTIAL ADDRESS POSTCODE Mandatory If the Worker Residential Address State Territory (C018) = "OTH" Postcode must equal 0099 REJECT The Worker Residential Address State Territory is equal to "OTH" therefore the Worker Residential Address Postcode must equal 0099 C022 C022.2 WORKER POSTAL ADDRESS SUBURB Mandatory Must match a postal suburb description in Australia Post’s Postcode listing REJECT Worker postal suburb entered is not C023 C023.2 WORKER POSTAL ADDRESS STATE/TERRITORY Mandatory Must be a code REJECT Worker postal entered is not valid C024 C024.2 WORKER POSTAL ADDRESS POSTCODE Mandatory Must be a valid postcode for C022 REJECT Worker postal postcode entered is not valid for the suburb selected
C024 C024.3 WORKER POSTAL ADDRESS POSTCODE Mandatory If the Worker Postal Address State Territory (C023) = "OTH" Postcode must equal 0099 REJECT The Worker Postal Address State Territory is equal to "OTH" therefore the Worker Postal Address Postcode must equal 0099 C025 C025.1 WORKER HOME NUMBER Conditional One of the worker fields – C025, C026 or C027 must contain a value REJECT At least one phone number must be supplied C029 C029.2 WORKER DATE OF BIRTH Optional If supplied age must be between 15 and 70 inclusive as at the Date of Occurrence (C048). Run this rule whenever Date of Occurrence or Date of Birth is updated FLAG The workers age is outside the normal age range. C030 C030.3 WORKER GENDER Optional Must be a valid code REJECT Workers gender entered is not valid C031 C031.2 WORKER PREFERRED LANGUAGE Mandatory Must be a valid code REJECT Workers preferred language entered is not valid C124 C124.2 WORKER DEPENDANTS Conditional If Extent of Incapacity Code (C055) is equal to 01 cannot be NULL REJECT The Extent of Incapacity indicates Death this field cannot be blank C032 C032.4 DUTY STATUS CODE Mandatory Must be a valid code REJECT Duty status code entered is not valid C033 C033.3 EMPLOYMENT STATUS CODE Mandatory Must be a code REJECT Employment status code entered is not valid C034 C034.3 EMPLOYMENT TYPE CODE Mandatory Must be a valid code REJECT Employment type code entered is not valid C035 C035.3 FULL/PART TIME CODE Mandatory Must be a valid code REJECT Full/part time code entered is not valid C037 C037.3 WORKER OCCUPATION CODE Mandatory Must be a valid code REJECT Workers occupation code entered is not valid
C066 C066.5 WORKPLACE ANZSIC 1993 Conditional If the Date of Occurrence (C048) is less than or equal to 30 June 2014 then this field is Mandatory REJECT Because this claim has an occurrence date on or prior to 30 June 2014 an ANZSIC 1993 Workplace code is required C128 C128.1 WORKPLACE ANZSIC 2006 Optional Must be a valid ANZSIC 2006 code REJECT The workplace industry code entered is not valid. An ANZSIC 2006 Workplace code is required C128 C128.2 WORKPLACE ANZSIC 2006 Optional If the Date of Occurrence (C048) is greater then 30 June 2014 then this field is Mandatory REJECT Because this claim has an occurrence date after 30 June 2014 an ANZSIC 2006 Workplace code is required C069 C069.3 WORKPLACE ADDRESS SUBURB Mandatory Must match a postal suburb description in Australia Post’s Postcode listing REJECT The workplace of injury suburb is not valid C070 C070.3 WORKPLACE ADDRESS Mandatory Must be a valid code REJECT The postcode of the workplace of the injury entered is not C071 C071.3 WORKPLACE ADDRESS POSTCODE Mandatory Must be a valid postcode for C069 REJECT The state/territory of the workplace of the injury entered is not valid C071 C071.4 WORKPLACE ADDRESS POSTCODE Mandatory If the Workplace Address State Territory (C070) = "OFF" Postcode must equal 7999 REJECT The Workplace of Injury Address State/Territory is equal to "OFF" therefore the Worker Postal Address Postcode must equal 7999 C073 C073.3 MECHANISM OF INJURY/DISEASE CODE Mandatory Must be a valid Mechanism of injury/disease code REJECT Mechanism of injury/disease entered is not a valid code
C093 C093.2 DATE OF DETERMINATION Conditional If whole person impairment type (C091) is not equal to 00 then a date of determination must be entered REJECT Whole person impairment type is not equal to "00" - Nil therefore a date of determination is required C093 C093.3 DATE OF DETERMINATION Conditional Must be greater than equal to date of occurrence (C048) REJECT The date of determination of impairment is prior to the date of occurrence C094 C094.2 PERCENTAGE OF DEAFNESS Conditional If whole person impairment type (C091) is equal to 02 then a number between 0 and 100 (inclusive) is required REJECT Whole person impairment type is equal to 02 it cannot be blank, a value between 0 and 100 imust be entered C094 C094.3 PERCENTAGE OF DEAFNESS Conditional If whole person impairment type (C091) is equal to 02 then percentage of deafness should be greater than or equal to whole person impairment percentage (C092) REJECT The WPI percentage must be less than or equal to the deafness percentage C094 C094.4 PERCENTAGE OF DEAFNESS Conditional If person impairment type (C091) is not equal to 02 then this must be NULL REJECT Percentage of Deafness can only be populated when Whole person impairment type is equal to "02" C097 C097.3 TOTAL TIME LOST ESTIMATED Mandatory If Works Status (C087) is not equal to 01, 05, 06 or 09 then it must be greater than 0 REJECT An estimate of time lost is required Claims Mandatory Rules Data Rule No Field Name Condition Rule Record State when fail Error Message C002 C002.M INSURER NUMBER Mandatory Mandatory field REJECT INSURER CLAIM NUMBER is a mandatory field
lost value greater than 0 must be entered . C102 C102.3 TIME LOST Conditional If Payment Type code (C100) is equal to 01 and Weekly Payment Adjustment Code (C101) is equal to 03 then the time lost value must be 0. REJECT Time lost value is not required for make up payments C102 C102.6 TIME LOST Conditional If Payment Type code (C100) is not equal to 01 Weekly Payment, Time Lost must be 0 REJECT Payment Type is not Weekly Payments therefore Time Lost must be 0. C103 C103.2 DATE PAID FROM Conditional The Date Paid From (C103) must be equal to or greater than the Date of Occurrence (C048) REJECT Date Paid From must be equal to or greater than the Date of occurrence C103 C103.3 DATE PAID FROM Conditional If Payment Type code is equal to 01 Weekly Payment then a date paid from must be entered REJECT Date paid from is required as the Payment Type code is equal to weekly payment C103 C103.4 DATE PAID FROM Conditional If Payment Type code is not equal to 01 Weekly Payment then a date paid from must be blank REJECT Date Paid from is invalid unless Payment Type code is equal to weekly payment C104 C104.2 DATE PAID TO Conditional If Payment Type code is equal to 01 Weekly Payment then a date paid to must be entered REJECT Date Paid to is required as the Payment Type code is equal to weekly payment C104 C104.3 DATE PAID TO Conditional The Date Paid To must be greater than or equal to the Date Paid From (C103) REJECT Date Paid To must be later than Date Paid From C104 C104.4 DATE PAID TO Conditional The Date Paid To must be equal to or greater than the Date of Occurrence (C048) REJECT Date Paid To must be equal to or greater than the Date of occurrence
C112 C112.2 SERVICE CODE Conditional If Payment Type Code (C100) is equal to [05, 06, 08,09] a service code is required, cannot be NULL REJECT Payment type code is equal to [payment type code desc] and therefore a service code is required. C113 C113.2 SERVICE DATE Conditional If Payment Type Code (C100) is to [05, 06, 07, 08, 09] a service date is required. REJECT [Payment Type Code Desc] requires a service date C113 C113.6 SERVICE DATE Conditional C113 Service Date must be greater than or equal to the (C048) Date of Occurrence REJECT Service Date is less the Date of Occurrence for the claim C113 C113.7 SERVICE DATE Conditional If C057 Date Finalised is >C059 Date Reopened or C059 Date Reopened is null then C113 Service Date must be <= C057 Date Claim Finalised. REJECT Service Date is greater than the Date Finalised for the claim C113 C113.8 SERVICE DATE Conditional C113 Service Date must be less than or equal to transaction date REJECT Service Date is greater than the transaction date for the payment Payment Mandatory Rules Data Element Rule No Field Name Condition Rule Record State when fail Error Message C099 C099.M INSURER PAYMENT ID Mandatory Mandatory REJECT INSURER PAYMENT ID is a mandatory field C100 C100.M PAYMENT TYPE CODE Mandatory Mandatory field REJECT PAYMENT TYPE CODE is a mandatory field C106 C106.M TRANSACTION DATE Mandatory Mandatory field REJECT TRANSACTION DATE is a mandatory field