Kan. Admin. Regs. § 51-9-17

Current through Register Vol. 43, No. 49, December 5, 2024

Section 51-9-17 - Release 3.1 standards for trading partner profiles; submission of data; first reports of injury

(a) Each insurer, group-funded workers compensation pool, and self-insured employer shall participate in the electronic data interchange (EDI) program and shall submit to the director a completed EDI trading partner profile at least 30 days before submitting claim information pursuant to the international association of industrial accident boards and commissions' (lAIABC's) release 3.1 standards, as provided in K.S.A. 44-557a and amendments thereto. The EDI trading partner profile shall be completed according to the "Kansas EDI release 3.1 guide for reporting first (FROI) and subsequent (SROI) reports of injury" as revised on July 16, 2018 by the Kansas department of labor and hereby adopted by reference. This document shall be referred to as the "Kansas EDI release 3.1 guide" in this regulation.

(b) Each insurer, group-funded workers compensation pool, and self-insured employer shall report to the director within five days any changes to information submitted in the EDI trading partner profile.

(c) All claim information submitted pursuant to K.S.A. 44-557a, and amendments thereto, by electronic data interchange shall be submitted according to the Kansas EDI release 3.1 guide.

(d) All claim information submitted pursuant to K.S.A. 44-557a, and amendments thereto, and the Kansas EDI release 3.1 guide's first report of injury, commonly called "FROI 00," shall be considered the filing of an accident report pursuant to K.S.A. 44-557, and amendments thereto. This information shall not be open to public inspection, except as provided in K.S.A. 44-550b and amendments thereto.

(e) All claim information submitted pursuant to K.S.A. 44-557a, and amendments thereto, shall be considered a medical record to the extent that the information refers to an individual worker's identity. No references in the claim information to an individual worker's identity shall be open to public inspection, except as provided in K.S.A. 44-550b and amendments thereto. For purposes of this regulation, the claim number used by an insurance carrier, self-insured employer, or group-funded workers compensation pool to identify an individual worker's claim shall be considered a reference to the individual worker's identity.

(f) On or before the compliance date specified in subsection (g), each insurer shall file claim information for all "lost time/indemnity" and "denied" cases through EDI rather than by submitting paper forms. The insurer shall file the electronic form in accordance with the Kansas EDI release 3.1 guide.

(g) Each insurer shall comply on or before the implementation date of November 29, 2018 for reporting electronic FROI or SROI. Each claim administrator submitting claims as EDI filings in production status using the IAIABC's release 3 national standard shall convert to release 3.1 and shall be in production status by the implementation date. Jose Castillo Acting Director

Kan. Admin. Regs. § 51-9-17

Authorized by K.S.A. 44-573 and K.S.A. 74-717; implementing K.S.A. 2018 Supp. 44-550b, K.S.A. 2018 Supp. 44-557, K.S.A. 2018 Supp. 44-557a, and K.S.A. 74-716; effective Jan. 1, 2004; amended June 17, 2005; amended Feb. 8, 2013; amended, T-51-11-15-18, Nov. 15, 2018; amended by Kansas Register Volume 38, No. 09; effective 3/15/2019.