With paper-based transactions becoming a thing of the past, electronic data has become the norm for information sharing across organizations. However, this data sharing can be difficult without overarching standards, as firms typically use a myriad of software applications from different vendors. Electronic data interchange (EDI) is the process that enables firms to share data electronically, instead of on paper, using a standard format.
In this article, we’ll explore EDI in the context of workers’ compensation, and discuss the role of the International Association of Industrial Accident Boards and Commissions (IAIABC) and the EDI Council in creating standards for exchanging worker’s compensation data.
EDI and Workers’ Compensation
Ideally, workers' compensation data should be seamlessly collected and processed from the initial reporting source—be it the employer, claimant, or insurance/medical provider—for accurate and timely workers’ compensation. However, several problems exist in the traditional data collection process. For example, different forms across states and a lack of uniform terminology make it difficult to compare/measure reform efficacy. Paper forms are easily lost, prone to error, and difficult to manage and store.
EDI enables the sharing of accurate, reliable data for workers’ compensation administrators and policymakers. This capability is essential for identifying the causes of workplace injuries/illnesses and assessing their effects on workers, as well as determining appropriate workers’ compensation coverage; in turn, employers can take measures to mitigate the risk and severity of future incidents. EDI also enables workers' compensation data to be readily integrated into claims management software and other related systems.
Who is the IAIABC?
Founded in 1914, the IAIABC is an international consortium of workers’ compensation administrators and the pre-eminent North American trade association representing workers' compensation jurisdictional agencies. The association’s goal is to reduce work-related harm and assist workers in their recovery from occupational injuries and illnesses; to this end, the IAIABC is responsible for establishing and managing standards for reporting industrial accidents and workplace-related incidents
The IAIABC aims to identify best practices and develop/implement standards for information sharing. To support these efforts, it creates and disseminates information, education, and guidance regarding workers' compensation policy, regulation, and administration.
What is the EDI Council?
The IAIABC created the EDI Council to develop and manage standards for properly sharing workers’ compensation data. In supporting the IAIABC’s goal of administering and regulating workers’ compensation acts in its jurisdictions, the EDI Council plays a critical role as an information and insights-sharing oversight body for IAIABC members and the workers' compensation community. This includes the development and maintenance of voluntary consensus standards for the electronic exchange of data. The EDI Council is made up of 24 IAIABC president-appointed members: 12 representatives from jurisdictional member organizations and 12 representatives from EDI member organizations. EDI Committees are made up of industry regulators, insurance providers, employers, vendors, and association staff. Each member serves a three-year term, with eight rolling appointments made each year
The EDI Council is primarily responsible for:
- Providing general oversight for EDI standards and committees
- Protecting stakeholders’ needs and establishing ownership/accountability
- Promoting consistency across standards and process/rule transparency
- Implementing proper cost-benefit analysis for changes (e.g., ensuring resulting benefits support the development/administration costs)
In fulfilling these responsibilities, the EDI Council plays a critical role in ensuring that workers’ compensation claims data formats are harmonized across states. For example, the EDI Council has developed Claims Standards for use by claims administrators to report workers' compensation upon the first report of injury (FROI) and subsequent reports of injury (SROI) claims to U.S. jurisdictions.
Published on January 1 of each year and maintained on an ongoing basis, the current Claims Standards document package—EDI Claims Release 3.1—consists of an implementation guide, user guide, business scenarios, data schemas, and other resources.
Ventiv Technology and the EDI Council
Workers' compensation claims can become costly and complex due to the manual efforts required to address compliance and regulatory concerns. To support the EDI Council’s Claims Standards, Ventiv has developed claims management software that includes FROI and SROI automation for triggering Maintenance Type Codes with immediate, real-time data validation. Claims administration software applies this validation to each transaction, this real-time validation is crucial for timely reporting and preparation/processing at the state level.
Ventiv was also recently appointed to the EDI Council, allowing the company to better represent its hundreds of claims administration customers’ interests in the following IAIABC Working Committees:
- EDI Claims Committee - designs or modifies transactions and develops common definitions and coding structures to meet business requirements.
- EDI Systems Committee - ensures that reporting requirements and business needs of EDI trading partners can be satisfied with feasible technical solutions.
- EDI Medical and EDI Propay Committee - designs and maintains the jurisdictional reporting of medical billing/payment transactions and develops the common definitions and coding structures
As a leading provider of advanced analytics for risk, claims and underwriting solutions, Ventiv Technology is committed to representing our clients’ needs and concerns as an industry ambassador. Interested to learn how being part of the EDI council helps Ventiv and its software serve our clients even better? Read the press release or contact us today.
