The Office of Administrative Law (OAL) has approved the Division of Workers’ Compensation’s (DWC) final version of the Workers’ Compensation Information System (WCIS) regulations regarding Medical Billing Reporting.
The California legislature enacted sweeping reforms to California’s workers’ compensation system in 1993. The legislature directed the DWC to put together comprehensive information about workers’ compensation in California. The result is the WCIS. The WCIS has four 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. The regulations require medical bill payment records for services with a date of service on or after September 22, 2006 and a date of injury on or after March 1, 2000.
California workers’ compensation medical bill payment records are processed by diverse organizations: large multi-state insurance companies, smaller specialty insurance carriers, self-insured employers or insurers, third-party administrators handling claims on behalf of self-insured employers, as well as bill review companies. The organizations have widely differing technological capabilities, so the WCIS is designed to be as flexible as possible in supporting EDI medical transmissions.
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 trading partners, i.e., senders, to the California DWC. For collecting medical bill payment records data, the WCIS adopts the IAIABC Workers’ Compensation Medical Bill Data reporting Implementation Guide Release 2.0.
The regulations include release of California Electronic Data Interchange (EDI) Implementation Guide for Medical Bill Payment Records, Version 2.0, which brings California reporting requirements into compliance with IAIABC standards for medical bill payment reporting, as set forth in the IAIABC Workers’ Compensation Medical Bill Data Reporting Implementation Guide, Release 2.0 (February 1, 2014). The effective date of the new regulations, including the California EDI Guide for Medical Bill Payment Records, Version 2.0, is April 6, 2016.
The updated regulations will allow WCIS to collect more robust and useful data that will assist with research regarding workers’ compensation issues. The notice and text of the regulations can be found on the WCIS regulations page.