Updating npi information

We anticipate stakeholder input either through the annual WCIS Advisory Committee meeting or scheduled public forums.

The hope is that an acceptable penalty structure will be in place by June 2013.

The assessment of administrative penalties for non-compliant WCIS reporting constitutes a major shift in the manner by which the WCIS operates.

From 2002 to the present, DWC solely relied upon its trading partners to submit complete and accurate data to WCIS, as there was no express statutory authority to directly penalize claims administrators for a failure to submit data or a failure to submit accurate data.

A: All corrected medical bills should be reported immediately after the correction is completed.

Q: What is the nature of penalties regarding medical bill reporting?

A: No, there is only one communication mode for medical billing data: FTPS.

Q: Are "First Aid" bills subject to reporting to the California WCIS? If a medical provider bills for treatment, services, or medical supplies related to first aid and a FROI is filed with the DWC/WCIS.

Q: Are medical bills for injuries to longshoremen (Longshore and Harbor Workers’ Compensation Program) and seamen (Jones Act) to be reported to the California WCIS? Claims that are exclusively administered under the Federal Workers' Compensation Statues, such as the Longshore and Harbor Workers' Compensationprogram, are exempt from WCIS reporting.

Q: What is the California DWC/WCIS nine-digit zip code to be utilized in the medical billing trading partner profile? A: There are five steps used for testing: (1) complete the medical EDI trading partner profile; (2) sender send FTP connectivity;; (3) sender transmits numerous ANSI 837 bill types; (4) production structural testing; (5) Detail testing.

See pages 29-37 of the California EDI Implementation Guide for Medical Bill Payment Records, Version 1.1, November 15, 2011.

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