True or False. The 00 MUST BE filed before the 04.
False. The 00 (initial report) does not need to be filed before the 04 (denial).
100
Which PLN is filed with the SROI IP?
PLN-2
SROI IP Initial Payment
PLN-2 Notification of First Temporary Income Benefit Payment
100
How long do you have to file: 00?
7 days
100
How long could it take a "Stop Payment" to become visible?
Up to 48 hours
200
What does FROI stand for?
First Report of Injury
200
What two submissions are needed before a claim is considered denied by TDI-DWC?
PLN-01 & 04
200
Which PLN is filed with the SROI CA?
PLN-8
SROI CA Change in Benefit Amount
PLN-8 Notification of Change in Amount of Indemnity Benefit Payment
200
How long do you have to file: 4?
Fifteenth (15) day after notice received (injury on or after 9/1/04)
200
In an indemnity claim, how long do you have to contact the claimant, client, and health provider?
2 business days
300
What does PLN stand for?
Plain Language Notice
300
Who is CCMSI's vendor partner for transferring data through EDI?
Ebix
300
Which PLN is filed with the 04?
PLN-1
04 Denial
PLN-1 NOTICE OF DENIAL OF COMPENSABILITY/LIABILITY AND REFUSAL TO PAY BENEFITS
300
How long do you have to file: CO?
Within Ninety (90) days of receipt of the notification of the acceptance with errors through the acknowledgment
300
Which code protects an entity turned "holder in due course" in regards to payment instruments?
Uniform Commercial Code
400
What does SROI stand for?
Subsequent Report of Injury
400
How does the EDI Team know which payments is IP and which is WP?
The first payment entered is tagged as the IP.
Therefore, enter IP before WP.
400
Which PLN is filed with the SROI S1, S3, S4, S5, S6, S7, S8 or SJ?
PLN-9
SROI S1, S3, S4, S5, S6, S7, S8 or SJ Suspension of Benefits
PLN-9 NOTIFICATION OF SUSPENSION OF INDEMNITY BENEFIT PAYMENT
400
How long do you have to file: CD?
Within ten (10) days after determination is made
CD
(Compensable Death No Beneficiaries Payees)
400
What two things should be done if it is determined that a "stop payment" check needs to be reissued?
A letter should be sent to the employee: The adjuster would complete the special processing field and then e-mail the letter to Treasury Check Printing to attach to the check.
And attached to the file: The adjuster would also attach the letter to the note section in iCEBAR
500
What does MTC stand for?
Maintenance Type Code
500
When does the clock start and stop according to EDI?
Starts at CCMSI receiving claim
Stops at MTC transmission to EDI
500
Which PLN is filed with the SROI RE?
PLN-8
SROI RE Reduced Earning
PLN-8 Notification Of Change In Amount Of Indemnity Benefit Payment
500
How long do you have to file: S1, S3, S4, S5, S6, S7, S8, or SJ?
Within ten (10) days of making the last payment of benefits
500
Name 4 of the 8 items that are contained in a compensability statement.
Accident description
Is it a typical function of the job?
Was it reported timely?
Are there any contradictions in EE/ER/Med records?
Are there any ISO matches?
Are there any previous injuries/health conditions that could’ve caused pain?
Is there subro potential?
COMPENSABILITY STATEMENT (THIS IS/IS NOT COMPENSABLE)