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CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING

CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING. WCIS Medical Data Collection. Workers’ Compensation Information System. WCIS . Division of Workers’ Compensation. www.dir.ca.gov. Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for

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CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING

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  1. CALIFORNIA DIVISION OF WORKERS’ COMPENSATIONMEDICAL DATA TRAINING WCIS Medical Data Collection

  2. Workers’ Compensation Information System WCIS Division of Workers’ Compensation

  3. www.dir.ca.gov Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for Medical Bill Payment Records Version 1.0 December 2005

  4. California Implementation GuideTable of Contents • EDI service providers • Events that trigger required medical EDI reports • Required medical data elements • Data edits • System specifications • IAIABC information • Code lists and state license numbers • Medical EDI glossary and acronyms • Standard medical forms Page 3

  5. Section LRequired medical data elementsPage 69

  6. Step 1 Mandatory Segments (BSRC = 00) BHT*0080*00*0123*19960618*0932~ NM1*10*2******FI*123456789~ N4***751230064~ NM1*40*2******FI*987654321~ N4***751230064~ DTP*582*RD8*19970201-19970228~ NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~ H DTP*558*D8*19920101~ NM1*CC*1*DOE*SALLY*J***34*012345678~ REF*Y1*528779999~ CLM*A37YH556*500**MO*11:B*Y**********P***00~ DTP*050*D8*19970115~ DTP*666*D8*19970115~ REF*DD*13579~ REF*2I*TJ98UU321~ NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~ PRV*PE*S3*203BP0400Y~ N4***751230064~ REF*OB*PSY00001574~ LX*1~

  7. Step 2 Hierarchical Segments (BSRC = 00) BHT*0080*00*0123*19960618*0932~ NM1*10*2******FI*123456789~ N4***751230064~ NM1*40*2******FI*987654321~ N4***751230064~ HL*1**20*1~ DTP*582*RD8*19970201-19970228~ NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~ HL*2*1*EM*1~ MN1*36*2~ HL*3*2*CL~ DTP*558*D8*19920101~ NM1*CC*1*DOE*SALLY*J***34*012345678~ REF*Y1*528779999~ CLM*A37YH556*500**MO*11:B*Y**********P***00~ DTP*050*D8*19970115~ DTP*666*D8*19970115~ REF*DD*13579~ REF*2I*TJ98UU321~ NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~ PRV*PE*S3*203BP0400Y~ N4***751230064~ REF*OB*PSY00001574~ LX*1~

  8. Step 3 (continued)Conditional Data Elements/Segments (BSRC = 00) • Professional 837 Office visit with drugs dispensed • Institutional 837 Hospital/Surgical Scenario • Other Bill Types • Pharmaceutical utilizing a Professional 837 • Pharmaceutical utilizing a NCPDP • Durable Medical Equipment • Dental utilizing a Professional 837 • Various Generic Bill Adjustment Scenarios • Capitated treatment • Previous Provider Over payment • Provider Refund

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