Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS 342.0011(1), (6), (7),
(22), (26),
342.038,
342.039,
342.260,
342.340
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
342.260 requires the commissioner to
promulgate administrative regulations necessary to carry on the work of the
department.
KRS
342.038 requires an employer to keep a record
of all injuries received by the employer's employees and to report to the
department any injury causing the employee's absence from more than one day of
work.
KRS
342.039 requires insurance carriers, each
self-insured group, and each employer authorized to carry its own risk to file
detailed claim information with the department.
KRS
342.340 requires information to be filed when
a workers' compensation policy is issued, modified, cancelled, lapsed, or
terminated. This administrative regulation establishes the procedure to become
an approved Electronic Data Interchange vendor.
Section 1. Definitions.
(1) "Applicant" means a vendor seeking to
become an approved vendor.
(2)
"Approved vendor" means a vendor approved and certified by the commissioner of
the Department of Workers' Claims in accordance with this administrative
regulation.
(3) "Electronic Data
Interchange" or "EDI" means the electronic transmission of data to and from the
Department of Workers' Claims by use of EDI Claims Release, 3.0 version, and
Proof of Coverage Release, 2.1 version, of the International Association of
Industrial Accident Boards and Commissions.
(4) "Vendor" means an entity that formats
electronic data for transmission to the Department of Workers' Claims,
transmits electronic data to the Department of Workers' Claims, and responds to
any technical issues related to the content or structure of an electronic data
interchange file.
Section
2. Application and Qualifications.
(1) An application for approval as an EDI
vendor shall be submitted to the commissioner on Form EDIVEN-01, EDI Vendor
Application.
(2) An applicant
shall:
(a) Submit EDI transactions from
trading partners and claim administrators to the Department of Workers' Claims
using only EDI Claims Release, 3.0 version, and Proof of Coverage Release, 2.1
version, of the International Association of Industrial Accident Boards and
Commissions (IAIABC). Kentucky-specific edits for EDI may be found at
http://www.labor.ky.gov/workersclaims/Pages/EDI.aspx;
(b) Be capable of transmitting and receiving
data through secure file transfer protocol (SFTP);
(c) Be able to send and receive data on a
daily basis;
(d) Provide and
identify a contact person capable of providing quick resolution of issues that
arise during attempted data delivery. The contact information shall include the
contact's name, phone number, email address, and physical address;
(e) Submit a list of all insurance carriers
for which it will be delivering and receiving data. The list shall include the
name of the insurance carrier, the insurance carrier's federal employer
identification number, the name of a contact person for the insurance carrier,
and that person's email, phone number, and mailing address;
(f) Submit data for no less than eight (8)
insurance carriers;
(g) Be and
remain a member of the IAIABC; and
(h) Comply with the provisions of KRS Chapter
342 and 803 KAR Chapter 25.
Section 3. Application Process.
(1) Upon notification that the application
has been accepted, the applicant shall contact the Data Management Branch of
the Division of Information Technology and Support Services of the Kentucky
Labor Cabinet to schedule two (2) test data transmissions.
(2) If both transmissions are successfully
completed, trading partner information from the vendor shall be added to the
database of the Department of Workers' Claims. The vendor may begin submission
of data once notified that it has been certified as an approved EDI vendor by
the Department of Workers' Claims.
Section 4. Certification.
(1) A person or entity shall not act as or
hold itself out as an approved EDI vendor unless that person or entity has been
approved by the commissioner of the Department of Workers' Claims in accordance
with this administrative regulation.
(2) Certification that a vendor has been
approved by the commissioner shall remain in effect until revoked by the
commissioner pursuant to Section 5 of this administrative regulation or
voluntarily surrendered. A vendor that voluntarily surrenders its certificate
shall notify the commissioner in writing.
(3) If a vendor desires to deliver and
receive data for an insurance carrier not previously reported to the
department, an email shall be sent to the department seeking approval to
deliver and send data for the new insurance carrier.
(a) The email shall contain the name and FEIN
of the new insurance carrier.
(b)
Attached to the email shall be an updated carrier list that includes that new
insurance carrier.
(c) Upon
confirming with the Department of Insurance that the new insurance carrier is
authorized to transact the business of workers' compensation in Kentucky, the
Department of Workers' Claims shall send an email to the vendor approving the
transmittal of data for the new insurance carrier, and the vendor may begin
transmitting data for the new carrier.
Section 5. Revocation of Certification. The
commissioner may revoke a vendor's certification as an approved EDI vendor if
the vendor:
(1) Resigns or is removed from
membership in the IAIABC;
(2) Is
unable to be contacted for resolution of transmission issues;
(3) Does not actively take steps to assist in
the resolution of EDI related issues ; or
(4) No longer meets the requirements
contained in Section 2(2) of this administrative regulation.
Section 6. Incorporation by
Reference.
(1) "Electronic Data Interchange
Vendor Application", EDIVEN-1, August 10, 2021 edition, is incorporated by
reference.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Department of Workers' Claims, Mayo-Underwood Building, 3rd Floor, 500 Mero
Street, Frankfort, Kentucky 40601, Monday through Friday, 8 a.m. to 4:30 p.m.
and may also be found at
https://labor.ky.gov/comp/Forms/Pages/default.aspx.
STATUTORY AUTHORITY:
KRS
342.038,
342.039,
342.260,
342.340
