Code of Maine Rules
90 - INDEPENDENT AGENCIES
351 - WORKERS' COMPENSATION BOARD
Chapter 3 - FORM FILING
Section 351-3-4 - Electronic Data Interchange Filing
Universal Citation: 90 ME Code Rules ยง 351-3-4
Current through 2024-38, September 18, 2024
1. General
A.
First Reports
of Injury. Unless a waiver has been granted pursuant to subsection
(1)(D)(1) or (2) of this section, all First Reports of Injury and all changes
or corrections to First Reports of Injury shall be filed by using the
International Association of Industrial Accident Boards and Commissions
(IAIABC) Claims Release 3 format.
B.
Notices of Controversy.
Except as otherwise provided in this paragraph, effective July 1, 2006, unless
a waiver has been granted pursuant to subsection (1)(D) (1) or (2) of this
section, all Notices of Controversy and all corrections to Notices of
Controversy shall be filed using the International Association of Industrial
Accident Boards and Commissions (IAIABC) Claims Release 3 format. Changes to
Notices of Controversy that have been filed electronically must be made by
filing WCB-9 (1/12/06) (Notice of Controversy). Changes to Notices of
Controversy filed prior to July 1, 2006 using WCB-9 (10/98) (Notice of
Controversy) must be made by filing an amended WCB-9 (10/98) (Notice of
Controversy).
C. Waivers
(1)
Waivers due to hardship. The
Board, at its discretion by majority vote of its membership, may grant an
employer, insurer or third-party administrator a waiver of the filing
requirements of this section if the employer, insurer or third-party
administrator establishes to the satisfaction of the Board that compliance with
these requirements would cause undue hardship. For purposes of this section,
undue hardship means significant difficulty or expense. Requests for waivers
should be submitted in writing and addressed to the Chair of the Workers'
Compensation Board, 27 State House Station, Augusta, Maine
04333-0027.
(2)
Waiver in an
individual case. A First Report of Injury or a Notice of Controversy can
be filed by paper or fax in an individual case if the Executive Director or the
Executive Director's designee finds that the employer or claim administrator
was prevented from complying with this section because of circumstances beyond
the control of the employer or claim administrator. A decision by the Executive
Director or the Executive Director's designee may be appealed to the Board of
Directors. The appeal must be in writing; must set forth the reasons why the
appealing party believes the decision should be reversed; and must be filed
within 7 (seven) days of the date of the decision appealed from.
D.
Board file. The
Board file shall include all accepted electronic transactions regardless of
whether a paper copy is physically in the file.
2. Definitions for filing using IAIABC Claims Release 3
A.
Application
acknowledgement code. A code used to identify whether or not a
transaction has been accepted by the Board. A sender will receive one of the
following codes after submitting a transaction:
(1)
TA (Transaction accepted).
The transaction was accepted and the First Report of Injury or Subsequent
Report of Injury is filed.
(2)
TE (Transaction accepted with errors). The transaction was
accepted with errors and the First Report of Injury or Subsequent Report of
Injury is filed. The error or errors will be identified in the acknowledgement
transmission that is sent by the Board. All identified errors must be corrected
within 14 days after the date the acknowledgement transmission was sent by the
Board or prior to any subsequent submission for the same claim, whichever is
sooner.
(3)
TR (Transaction
rejected). The entire transaction has been rejected and the First Report
of Injury or Subsequent Report of Injury is not filed.
B.
Claim administrator. An
insurer, self-insured employer, group self-insurer, third-party administrator
or guaranty association.
C.
Data element. A single piece of information (for example, date of
injury). Each data element is assigned a name and a number. Except as modified
in this rule, data element names and numbers are as defined in IAIABC Claims
Release 3.0 Standards, Data Dictionary January 1, 2010 Edition (Appendix
V).
D.
Data element
requirement code. A code used to designate whether or not a data element
has to be included in a transaction. Each data element is assigned one of the
following data element requirement codes:
(1)
M (Mandatory). The data element must be present and must be in a
valid format or the transaction will be rejected.
(2)
MC (Mandatory/Conditional).
The data element is mandatory if the conditions defined in the Maine Workers'
Compensation Board Claims Release 3 First Report Conditional Requirement Table
(Appendix II) or the Maine Workers' Compensation Board Claims Release 3
Subsequent Report of Injury Conditional Requirement Table (Appendix IV)
exist.
(3)
E
(Expected). The data element is expected when a transaction is
submitted. The transaction will be accepted without the data element and the
First Report of Injury or Subsequent Report of Injury is filed but is
incomplete. The entity submitting the transaction will receive a message
indicating the transaction was accepted with errors and identifying the missing
or incorrect data element or elements. The First Report of Injury or Subsequent
Report of Injury must be completed by submitting the missing or corrected data
element or elements within 14 days after the error message is sent by the Board
or prior to any subsequent submission for the same claim, whichever is
sooner.
(4)
EC
(Expected/Conditional). The data element is expected if the conditions
defined in the Maine Workers' Compensation Board Claims Release 3 First Report
Conditional Requirement Table (Appendix II) or the Maine Workers' Compensation
Board Claims Release 3 Subsequent Report of Injury Conditional Requirement
Table (Appendix IV) exist. The transaction will be accepted without the data
element and the First Report of Injury or Subsequent Report of Injury is filed
but is incomplete. The entity submitting the transaction will receive a message
indicating the transaction was accepted with errors and identifying the missing
or incorrect data element or elements. The First Report of Injury or Subsequent
Report of Injury must be completed by submitting the missing or corrected data
element or elements within 14 days after the error message is sent by the Board
or prior to any subsequent submission for the same claim, whichever is
sooner.
(5)
IA (If
Available). The data element should be sent if available. If the data
element is sent, the Workers' Compensation Board may edit the data to ensure
valid value and format. A filing will not be rejected if the only error is a
missing data element designated IA.
(6)
NA (Not Applicable). The
data element does not apply to the maintenance type code and does not have to
be sent. The Board will not edit these data elements.
(7)
F (Fatal Technical).Data
elements that must be sent. If a data element designated F is not present and
in a valid format, the filing will be rejected.
(8)
X (Exclude). The data
element does not apply to the maintenance type code and does not have to be
sent. The Board will not edit these data elements.
(9)
FY (Fatal Yes Change). If a
data element designated FY changes after a First Report of Injury or Subsequent
Report of Injury has been filed, the claim administrator must report the change
to the Board within 14 days after the data element changes.
(10)
N (No Change). This data
element cannot be changed, but it must be reported, if applicable.
(11)
Y (Yes Change). Data
elements designated Y may be changed.
(12)
FC (Fatal/Conditional).
This data element must be populated with previously reported values if the
segment has previously been reported on the claim.
(13)
YC (Yes
Change/Conditional). The data element must be changed if the conditions
defined in the Maine Workers' Compensation Board Claims Release 3 First Report
of Injury Conditional Requirement Table (Appendix II) or the Maine Workers'
Compensation Board Claims Release 3 Subsequent Report of Injury Conditional
Requirement Table (Appendix IV) exist.
E.
Maintenance type code.
Maintenance type codes define the specific purpose of individual records within
the transaction being transmitted.
F.
Record. A defined group of
data elements that is identified by the transaction set identifier.
G.
Report. A report is
equivalent to a transaction.
H.
Transaction. The communication of data that represents a single
business event. A transaction consists of one or more records.
I.
Transaction set identifier. A
code that identifies the transaction being sent.
(1) 148 - First Report of Injury
(2) R21 - First Report Companion
Record
(3) A49 - Subsequent
Report
(4) R22 - Subsequent Report
Companion Record
(5) AKC - Claims
Acknowledgement Detail Record
(6)
HD1 - Transmission Header Record
(7) TR2 - Transmission Trailer
Record
J.
Transmission. One or more sets of records sent to the
Board.
3. Requirements for filing using IAIABC Claims Release 3.
A.
Maintenance type codes for First
Reports of Injury. One of the following maintenance type codes shall be
used when transmitting a First Report of Injury:
(1)
00 (Original): Used to file
an original First Report of Injury or to re-transmit a First Report of Injury
that was previously rejected or cancelled.
(2)
01 (Cancel): Used to cancel
an original First Report of Injury that was sent in error.
(3)
02 (Change): Used to change
a data element.
(4)
04 First
Report Of Injury (First Report of Injury/Full Denial): Used to file an
original First Report of Injury and simultaneously deny a claim in its
entirety.
(5)
CO
(Correction): Used to correct a data element or elements when a filing
is accepted with errors ("TE").
(6)
AQ (Acquired Claim): Used to report that a new claim administrator
has acquired the claim.
(7)
AU (Acquired/Unallocated): Used to file an initial First Report of
Injury by a new claim administrator when an AQ transaction has been rejected
because the claim was not previously reported, or when the acquiring claim
administrator is reopening a claim that was previously cancelled.
(8)
UR (Upon Request): Submitted
in response to a request from the Board. Responses must be filed no later than
14 days after the request is made by the Board.
B.
Maintenance type codes for
Subsequent Reports of Injury. One of the following maintenance type
codes shall be used when transmitting a Subsequent Report of Injury.
(1)
04 (Notice of Controversy - Full
Denial): Used when a claim is being denied in its entirety after any
First Report of Injury or Subsequent Report of Injury has been filed.
(2)
PD (Notice of Controversy --
Partial Denial): Used to file a Notice of Controversy denying a specific
benefit or benefits. A Notice of Controversy -- Partial Denial may not be filed
unless a First Report of Injury has been filed.
(3)
CO (Correction): Used to
correct a data element or elements when a Subsequent Report of Injury has been
accepted with errors ("TE").
C.
Data element requirements and
modifications.
(1)
Data element
requirements are as set forth in the Maine Workers' Compensation Board,
Claims Release 3 First Report of Injury Element Requirements Table contained in
Appendix I of this rule, and the Maine Workers' Compensation Board, Claims
Release 3 Subsequent Report of Injury Element Requirements Table contained in
Appendix III of this rule.
(2)
Modifications.
(a) Data number
270, Employee ID Type Qualifier. When submitting a First Report of Injury, data
number 270 is mandatory conditional. However, if the claim administrator is
unable to obtain an employee identification number from an employer prior to
transmitting a First Report of Injury, the claim administrator must obtain an
employee ID assigned by jurisdiction number from the Board. The claim
administrator shall file the First Report of Injury using the employee ID
assigned by jurisdiction number obtained from the Board. A First Report of
Injury submitted with an employee identification number obtained from the Board
is filed but is incomplete. The claim administrator must either establish that
it is unable to obtain an employee identification number from the employer or
complete the First Report of Injury by submitting an employee identification
number obtained from the employer within 14 days after the First Report of
Injury was filed or prior to any subsequent submission for the same claim,
whichever is sooner. Unless the claim administrator obtains and submits an
employee identification number obtained from the employer, the employee ID
assigned by jurisdiction number obtained from the Board must be used on all
future filings regarding the same claim.
(b) Data number 200, Claim Administrator
Alternative Postal Code. Data number 200, Claim Administrator Alternative
Postal Code shall be M (Mandatory) effective April 1,
2007.
4. Paper distribution of forms filed electronically
A.
First Report
of Injury
(1) Form WCB-1 (First Report
of Injury) shall be used when a copy of the First Report of Injury is mailed
pursuant to this subsection.
(2)
Form WCB-1 shall be mailed to the employee and the employer within 24 hours
after the First Report of Injury is transmitted to the Board.
(3) Unless a waiver has been granted pursuant
to subsection (1)(D) of this section, a First Report of Injury sent to the
Board in a paper as opposed to electronic format shall not be considered
filed.
B.
Notices
of Controversy
(1) Form WCB-9 (1/12/06)
(Notice of Controversy) shall be used when a copy of the Notice of Controversy
is mailed pursuant to this subsection.
(2) Form WCB-9 (1/12/06) (Notice of
Controversy) shall be mailed to the employee, the employer and, if required by
W.C.B. Rules Ch. 5 §7(2) or Ch. 8 §
2, the health care provider, within 24
hours after the Notice of Controversy is transmitted to the Board.
(3) Except as provided in subsection (1)(B)
of this section, unless a waiver has been granted pursuant to subsection (1)(D)
of this section, a Notice of Controversy sent to the Board in a paper as
opposed to electronic format shall not be considered
filed.
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