6538690, 69L-56.001 - Florida Administrative Rules, Law, Code, Register

Home

Florida Department of State and Division of Library and Information Services

Notice: 6538690

Notice of Proposed Rule

Department:

DEPARTMENT OF FINANCIAL SERVICES

Division:

Division of Workers' Compensation

Chapter:

Electronic Data Interchange (EDI) Requirements for Proof of Coverage and Claims (Non-Medical)

Overview

RULE:

69L-56.001	Forms and Instructions
69L-56.002	Definitions
69L-56.100	Proof of Coverage (POC) Electronic Reporting Requirements
69L-56.110	Technical Requirements for POC EDI Transmissions
69L-56.200	Policy Cancellation or Non-Renewal Requirements
69L-56.210	Time Periods for Filing Electronic Policy Information
69L-56.300	Claims EDI Reporting Requirements and Implementation Schedules
69L-56.301	Electronic First Report of Injury or Illness
69L-56.3012	Electronic Notice of Denial and Rescinded Denial
69L-56.3013	Electronic Periodic Claim Cost Reports
69L-56.304	Electronic Notice of Action or Change, Including Change in Claims Administration, Required by the Insurer's Primary Implementation Schedule
69L-56.3045	Electronic Notice of Action or Change, Suspensions, and Reinstatement of Indemnity Benefits Required by Insurer's Secondary Implementation Guide
69L-56.307	Electronic Cancellation of Claim
69L-56.310	Technical Requirements for Claims EDI Transmissions
69L-56.330	Electronic Formats for Reporting the Employee's 8th Day of Disability and the Claim Administrator's Knowledge of 8th Day of Disability (Repealed)

PURPOSE:

Rule Chapter 69L-56, F.A.C., is being amended to incorporate by reference the revised Form DFS-F5-DWC-EDI-1, “EDI Trading Partner Profile”, and the revised Form DFS-F5-DWC-EDI-4, “Secure Socket Layer (SSL)/File Transfer Protocol (FTP) Instructions”. The revised Florida Division of Workers’ Compensation Proof of Coverage (POC) Electronic Data Interchange (EDI) Implementation Manual (1/01/08), which contains revisions to the Element Requirement Table and Edit Matrix, and requires insurer reporting of total payroll and number of employees, is also incorporated by reference. The rule is also being amended to incorporate by reference the revised national standard International Association of Industrial Accident Boards and Commissions (IAIABC) EDI Implementation Guide for Proof of Coverage Release 2.1 (6/01/07) and the IAIABC EDI Release 3 Implementation Guide for Claims (1/01/08). Rule 69L-56.205, F.A.C., is being added to specify the insurer requirements of reporting proof of coverage information to the Division of Workers’ Compensation for a professional employer organization or employee leasing company and its client companies. The proposed rule also adds a definition regarding the meaning of “Cancellation/Non-Renewal Effective Date”, which clarifies that such an event occurs at 12:01 a.m. on that Transaction Set Type Effective Date reported to the Division of Workers’ Compensation, or as derived by the Division of Workers’ Compensation as determined in Rule 69L-56.200, F.A.C. Additionally, the proposed rule deletes redundant language from Rule 69L-56.100, F.A.C., changes the title to fully reflect the scope of the rule, and makes clerical revisions where necessary. Rule 69L-56.330, F.A.C., which has become obsolete, is to be repealed concurrently upon adoption of these proposed amendments.

SUMMARY:

Amends the rule chapter to incorporate by reference revised forms, instructions, manuals and implementation guides for use by insurers in the electronic reporting of proof of coverage and claims information to the Division of Workers’ Compensation. Rule 69L-56.205, F.A.C., is added to specify insurer requirements of reporting proof of coverage information to the Division for a professional employer organization or employee leasing company and its client companies. Also, adds a definition for “Cancellation/Non-Renewal Date”, deletes redundant language from Rule 69L-56.100, F.A.C., and changes the rule chapter’s title. Rule 69L-56.330, F.A.C., which has become obsolete, is to be repealed concurrently upon adoption of the proposed amendments.

RULEMAKING AUTHORITY:

440.185(7), 440.42(3), 440.591, 440.593(5), 627.4133(4) FS.

LAW:

440.185(7), (9), 440.42(3), 440.593, 627.4133(4) FS.

PRINT PUBLISH DATE:

12/19/2008 Vol. 34/51

COMMENTS:

From 12/19/2008 To 1/9/2009 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

Under Florida law, E-mail addresses are public records. If you do not want your E-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.