Industry experts for workers compensation data collection and assigned risk placement in Michigan
Note: The WDCA is not accepting any new POC carriers until at least 1/1/2024. The reconciliation step described below may change and if so, we will update the information accordingly. Any questions, contact WDCA at LEO-WC-EDI-POC@michigan.gov.
ELECTRONIC PROOF OF COVERAGE OVERVIEW
In Michigan, carriers must file all policy data with CAOM and they must file POC information with the State of Michigan Workers’ Disability and Compensation Agency (WDCA). Currently, carriers must submit paper filings WC-400 (Insurer’s Notice of Issuance of Policy), WC-401 (Notice of Termination of Liability) and WC-403 (Insurer’s Notice of Name or Address Change) with the WDCA. CAOM accepts all policy data (policies, change endorsements, cancellations & reinstatements) electronically in the WCPOLS format.
The WCPOLS data sent to CAOM can be converted to the IAIABC specifications required by the state for insurance filings, thus eliminating the need for the carrier to send paper forms. Unless a carrier has completed an Electronic Partnering Insurer Agreement with the WDCA and CAOM, there is no data being sent to the state.
Currently new and renewal policies, cancellation/reinstatements and change transactions are converted and forwarded to the WDCA.
Electronic POC is not automatic in Michigan. Various reporting requirements must be met before the WDCA will approve electronic POC. These requirements are not found in the WCIO Data Specifications Manual, but are located in the POC Implementation Guide on the WDCA website.
If a carrier is approved for electronic POC reporting, forms 400, 401 and 403 will be generated from the WCPOLS data submitted to CAOM, thus eliminating the need for the carrier to send the 400, 401 and 403 to the WDCA. CAOM will convert the WCPOLS data to the IAIABC format and forward it to the WDCA. Transactions 06 (policy replacement due to a key field change) and 15 (policy replacement due to add/deleted state change), however, are not sent. The carrier is still required to file paper forms to the WDCA for those transactions.
During the test process, communication is required between the carrier and CAOM, the carrier and the WDCA, and CAOM and the WDCA. You will need to contact WDCA to determine when they will be able to work with you.
When a carrier is ready, CAOM will begin performing test POC edits on a carrier’s WCPOLS data. In this Test Phase, CAOM will provide a report for every production file submitted. Nothing actually goes to the WDCA during this phase. POC data is not sent to the WDCA during this test phase. During the testing phase, carriers do not need to resubmit errors to CAOM. (Once in production, transactions that error will need to be corrected and resubmitted.)
Once the carrier has made the necessary system or data entry adjustments to resolve the common recurring errors, and when the WDCA is ready, the carrier moves to the next phase of testing which is the Certify Phase. This phase takes the carrier production file and sends it to the WDCA test system. At this time the WDCA will provide acknowledgement reports to CAOM. (Transactions that error with the WDCA need to be corrected and resubmitted once in production.)
The WDCA will advise CAOM when a carrier is approved for production. See item #4 of the WDCA Carrier Test Plan.
All reports are deployed to CAOM’s FTP server which a carrier needs to retrieve.
Testing with CAOM for Electronic POC Reporting
Electronic POC reporting includes the following WCPOLS transactions:
Carriers that want CAOM to electronically report their carrier POC data to the WDCA must follow specific steps:
1. Policy Data Reconciliation between Carrier and WDCA (“Reconciliation”).
You must participate in a database cleanup effort with the WDCA in order to ensure all policy data filings are up-to-date, the correct Federal Employer Identification Number is being used, and the WDCA records are updated with the most current policy number.
This step can occur any time during the testing process, however, it must be completed before approval is received. Email LEO-WC-EDI-POC@michigan.gov to schedule reconciliation. You are responsible for notifying CAOM when reconciliation is complete.
For details on the specific steps in the test plan with the WDCA, click here.
2. Carrier Compliance with WCPOLS Filing Guidelines.
Certain WCPOLS fields allow for more than one way to report data. In order for CAOM to convert the WCPOLS data to the IAIABC format required by the WDCA, specific reporting requirements must be met. See the Proof of Coverage-EDI Guide (michigan.gov) for details.
Certain valid WCPOLS data cannot be mapped to an acceptable record for the WDCA. In these cases, the data will be rejected and sent back to you for correction and resubmission. All corrections must be electronically resubmitted to CAOM. Data that cannot be electronically corrected will require a paper filing to the WDCA.
3. Carrier Testing with CAOM (“Test Phase”).
The purpose of this phase is to verify your WCPOLS data can be cleanly converted. In Test, CAOM will provide you with a report of POC edits for every WCPOLS production file you submit. The reports will show the errors that would not pass edits if you were in production (once in production, transactions that error would need to be corrected and resubmitted). The reports will be stored on CAOM’s FTP server and will not be transferred to the WDCA. This allows you to address certain issues before you begin testing with the WDCA.
During testing, you will continue to submit regular production files for CAOM purposes. Rejection for POC purposes does not equate to rejection for CAOM purposes or vice versa.
Issues that require significant WCPOLS programming changes must be tested with CAOM prior to implementing in production. Failure to provide test submissions prior to moving upgrades into production can severely impact both you and CAOM. You must make necessary entry and or system changes to meet POC requirements. CAOM requires no more than a 5% error ratio in this phase before moving you to the next phase. See the MI-POC-R30 Edit Matrix for more information.
We highly recommend you include CAOM testing of WCPOLS data in your test plans. Contact 734-462-9600 ext. 265 or email@example.com to arrange for WCPOLS testing.
4. CAOM Testing with WDCA (“Certify Phase”).
When the WDCA is ready, it will request CAOM provide the IAIABC file on a test basis. The WDCA will provide error and acknowledgement reports to CAOM and CAOM will forward those reports to you. The reports will be stored on CAOM’s FTP server.
You must successfully complete three consecutive submissions from CAOM to WDCA.
You will continue to file all required forms on paper with the WDCA during this phase.
5. WDCA Approves Carrier for Production (“Production Phase”).
The WDCA will advise you and CAOM when you are approved for electronic POC. All parties sign a Trading Partner (EDI) agreement. The agreement specifies CAOM will electronically report a list of triplicate codes for POC to the WDCA on behalf of the insurance company(ies) named in the agreement. Once production begins, you will discontinue separate paper filings to the WDCA for the approved transactions that pass the edits.
All reports are deployed to CAOM’s FTP server which you will need to retrieve. Let us know when you are ready so we can produce the reports. A FEIN will be required for each carrier in the group that will be involved.
As part of the Proof of Coverage process, CAOM creates a report for each file CAOM receives. These reports are stored on CAOM’s FTP server.
Contact IT_Dept@caom.com for your user name and password.
The report files will be PDFs with the names of CAOMERROR and SOMACK with a timestamp on them. You have only read access to those files.
We keep approximately 15 days of files on our web server in your primary folder.
We suggest you use WS_FTP from Ipswitch. CAOM uses WS_FTP Server from Ipswitch. You can download and purchase the software at http://www.ipswitch.com/products/ws_ftp/index.asp.
If you want to just test the FTP Interface to our site you could use COREFTP, a shareware program that we have found works.
Other FTP programs may also work but CAOM will only support the above products.
Our FTP server requires SSH protocol.
WS_FTP supports synchronized folders. By running on any server or workstation, it will regularly go out to our server and synchronize a folder on your network with the folder on our server. When we add a file to the list, then only that file will be added onto your network folder. When we delete a file from the list, then the sync program will delete the file from your network. This is a very easy setup.
The file names have a timestamp on it in the format of mmddyyyyhhmmsstt with the guarantee that the timestamp is always 16 characters long.
If there are any technical questions, please contact Jay Subramanian at firstname.lastname@example.org.
If CAOM receives your WCPOLS file through CDX and rejects the entire file, CDX will notify you.
If CAOM accepts your WCPOLS file, two things happen:
If there are reporting issues with the file or a specific transaction CAOM cannot process, CAOM will notify you via email or crit via Michigan’s Manage Policy System (MPS). MPS allows a carrier to view CAOM’s processing status of each transaction as well as view any CAOM crit messages.
Keep in mind, CAOM’s POC process is separate and independent of POC reports generated for the WDCA and by the WDCA.
Communication is required between the carrier and CAOM, the carrier and the WDCA, and CAOM and the WDCA.
How do I comply with the Legal Nature of Entity requirements for Record Type Code 02?
The WDCA requires the Legal Nature of Entity for every name record reported. In order to comply with the requirement Record Type Code 02, field 11 must be filled with the appropriate code.
Which Cancellation/Reinstatement Reason Codes are accepted?
The WDCA does not accept Reason for Cancellation code 99 (other). The WDCA requires a Reason for Cancellation code for non-renewals (Cancellation / Reinstatement ID Code 3)
If CANCELLATION/REINSTATEMENT ID CODE (Position 48) is 2 (Reinstatement), report the REASON FOR REINSTATEMENT CODE.
See the Proof of Coverage-EDI Guide (michigan.gov) for details.
To read how CAOM currently processes Proof of Coverage, click here
To read how CAOM currently processes Policy Data, click here
To read general data reporting rules, click here
To access State of Michigan Workers Compensation EDI section, click here.
* While contacting CAOM, please provide the Insurance carrier code(s). Also confirm if you are the POC contact for your company. If you have already done this, thank you.