The electronic data information (EDI) system that all workers' compensation claims professionals use to interface with the Pennsylvania Bureau of Workers' Compensation will change on June 24, 2016. If you have not already taken advantage of the training available, please make sure to go to the web address we have listed below to ensure everyone in your organization is equipped to use this new system.
The major change going forward is that the claims professional no longer creates the Pennsylvania state forms (Notice of Compensation Payable, Notice of Temporary Compensation Payable or Notice of Denial). Instead, the claims professional will enter the information in the appropriate field on the EDI system and the Bureau will generate the appropriate form. We have some concerns.
We have all seen the situation where the intention is to create a Notice of Workers' Compensation Denial, but the Bureau generates a letter indicating that a Notice of Temporary Compensation Payable has been filed. In the claims professionals' eyes, the claim has always been in a denial status due to the creation of a Notice of Workers' Compensation Denial. However, after 90 days have elapsed, the Bureau then issues another letter stating that the Notice of Temporary Compensation Payable has converted to a Notice of Compensation Payable. We have always been successful in arguing that the operative Bureau document was a Notice of Workers' Compensation Denial. With this pending EDI change, it will be difficult to make this type of argument as there will be a TNCP in WCAIS.
We are working with the Bureau to have the updated EDI system generate inquiries such as, "the EDI transaction you have entered will create a Notice of Temporary Compensation Payable. Do you want to continue?" If we can have that implemented, we believe it will eliminate or reduce the problem noted above. We will provide further updates as they become available closer to the June 24 date.
EDI Implementation Guide
Department of Labor & Industry (Workers' Compensation home page)
Sara L. De Long