What is Electronic Data Interchange (EDI)?

How does this change existing reporting requirements?

How do I get started?

How do I request an extension?

Are there penalties for not complying?

Contact Information

WHAT IS ELECTRONIC DATA INTERCHANGE (EDI)?

The goal for the Division of Workers' Compensation is to seamlessly process workers' compensation information from its initial reporting source, whether that is the employer, insurance company, claimant or medical provider.

EDI is the computer-to-computer exchange of data or information in a standardized format.  Claim Administrators submitting the data must format the data according to approved file layouts and data standards.  Data must pass pre-defined edits; transactions that file must be re-sent.  Reports must be sent in a specific order based upon the business events to which they correspond.  The receiver of the data sends electronic acknowledgment to the sender for all transactions. All data is sent electronically through Value Added Networks or other approved secure networks.

Electronic filing eliminates an expensive, time consuming, paper-driven process and improves information flow and oversight by the Division of Workers’ Compensation.

 

HOW DOES THIS LAW CHANGE EXISTING REPORTING REQUIREMENTS?

This law is important news for employers who are not self-administered self-insurers or governmental agencies as they will no longer be required to file workers’ compensation accident reports with the Division of Workers' Compensation.  These employers should simply report work related injuries/illnesses directly to their WC carrier or Third Party Administrator who in turn must file the necessary forms with the Compensation Rating & Inspection Bureau (CRIB) in an electronic format.  CRIB will then forward the accident data to the Division for oversight and compliance enforcement responsibilities.

Insurance carriers, Third Party Administrators and self-administered employers also benefit as the five forms previously required by the Division have been replaced by two electronic forms:

First Report of Accident (FROI/IA-1),  which replaces the L&I1, RM-2, WC-1 and WC-2 forms , must be filed within three weeks after learning of an accident, or obtaining knowledge of the occurrence of a compensable occupational disease.  A copy of this report is sent to the employer;

Subsequent (Final) Report of Accident (SROI /SA/ IA-2), which replaces the WC-3, must be filed within 26 weeks after employee has recovered so as to be able to resume work or has reached maximum medical improvement.  Information on this report must be sent to the employee via the issuance of a Benefit Status Letter.

Benefit Status Letter - Medical Only   (r.10/07/2004)
Benefit Status Letter - Indemnity   (r.10/07/2004)
Benefit Status Letter Usage Directions (r.10/07/2004 )

The information from the First and Subsequent Reports of Injury will allow the Division to carry out its oversight responsibilities in ensuring that workers' receive fair and timely benefits from work related injuries.

HOW DO I GET STARTED?

Each Claim Administrator must assess the best way to modify their claim handling process to implement the technical EDI components. Possible solutions include using in-house technical staff, using a vendor product, subscribing to an Internet solution or using a mixture of in-house and vendor services.

Detailed information about implementing an electronic accident report filing system can be found in the NJ EDI Implementation Guide.  Information on how to file a Variance Petition, which extends the filing deadline, obtaining a vendor, data elements and FAQ’s are also available in this guide. 

Original Implementation Guide 

Revised Implementation Guide -   effective 7/05/2002

HOW DO I REQUEST AN EXTENSION?

This law went into effect July 5, 2002. 

Companies that were unable to meet this deadline are being provided with an opportunity to file a Petition for Variance, which would extend the filing deadline.  This extension period is effective through January 5, 2003. After this date, we expect all trading partners to be in full compliance.

The Petition should be submitted to the Division of Workers’ Compensation, P.O. Box 381, Trenton, NJ 08625-0381, attn:  EDI Coordinator.  The documentation should include detailed information as to why an extension is necessary, an outline of the plan to become EDI compliant, contact names and anticipated monthly filing volume.

ARE THERE PENALTIES FOR NOT COMPLYING?

34:15-101. Penalty for noncompliance
Every employer, insurer or other person failing to comply with the terms of this article shall, for each offense, be liable to a penalty of not less than ten nor more than fifty dollars, the amount thereof to be determined by and paid to the Commissioner of Labor and Workforce Development. Upon refusal to pay such fine, the same shall be recovered in an action at law by the Commissioner of Labor and Workforce Development in the name of the State of New Jersey.

CONTACT INFORMATION: