In 1993 the California legislature directed the Division of Workers’ Compensation to put together comprehensive information about workers’ compensation in California. The result is the Workers’ Compensation Information System (WCIS). The WCIS has 4 components: the First Reports of Injury (FROI) reporting guidelines were implemented March 1, 2000. The Subsequent Reports of Injury (SROI) reporting guidelines were implemented July 1, 2000. Reporting of annual summary of benefits began January 31, 2001. Medical bill payment reporting regulations were adopted on March 22, 2006.

Regulations require medical services with a date of service on or after September 22, 2006 and a date of injury on or after March 1, 2000 to be transmitted to the DWC. Medical services are required to be reported to the WCIS by all claims administrators handling 150 or more total claims per year.

Electronic data interchange (EDI) is the computer-to-computer exchange of data or information in a standardized format. In California workers’ compensation, medical EDI refers to the electronic transmission of detailed medical bill payment records information from senders to the DWC. Medical bill payment data are transmitted in a format standardized by the American National Standards Institute (ANSI). The International Association of Industrial Accident Boards and Commissions (IAIABC) adapted the ANSI file standard to workers’ compensation.

The Division of Workers’ Compensation (DWC) is planning to transfer the Workers’ Compensation Information System (WCIS) from International Association of Industrial Accident Boards and Commissions (IAIABC) Medical Release 1.1 to IAIABC Medical Release 2 in the fall of 2014. This migration has significant transaction improvements that address the industry’s needs. In general it is believed to be efficient and easier to implement. Moreover, it puts in synch the CA WCIS data collection with the Divisions electronic billing regulation that went into effect on October 2012. It will also bring the WCIS data collection to the current industry standard of doing business between providers and insurers.

The California Electronic Data Interchange (EDI) Implementation Guide for Medical Bill Payment Records for Release 2 and the programming logic for validating incoming data for the new release are posted to the online forum, so that members of the public may review and comment on the proposal. This Guide is adopted by the Administrative Director of the Division of Workers’ Compensation pursuant to the authority of Labor Code sections §138.6, and §138.7. The Guide contains the California – specific protocols and excerpts from the IAIABC EDI Implementation Guide for Medical Bill Payment Records Release 2, explains the technical design and functionality of th e WCIS system, testing options for the trading partners, instructions regarding the medical billing data elements, and reporting standards and requirements.

The forum has been posted online the DWC forums web page under “current forums.” Comments will be accepted on the forum until 5 p.m. on Aug. 5.