Proof of Coverage Data

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’ Compensation Agency (WCA). Currently, carriers must submit paper filings 400, 401 & 403 with the WCA.  CAOM accepts all policy data (policies, change endorsements, cancellations & reinstatements) on paper or 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 Michigan Workers’ Compensation Agency and CAOM, there is no data being sent to the state.

Currently only new and renewal policies and cancellation/reinstatement transactions are being converted and forwarded to the WCA.  Change transactions (endorsements) are not included for POC.  The carrier would still be required to file paper form 403's to the state.

In order to be eligible for POC testing through CAOM, a carrier must be reporting WCPOLS data in a production setting.  There are various reporting requirements to be met before the state would approve electronic POC.    Because electronic POC is not automatic in Michigan, these requirements are not indicated in the WCIO Data Specifications Manual.  The POC Implementation Guide which is found on the state’s website will illustrate how the name and address data needs to be reported in order to pass the state’s requirements.

During the test process,  communication is required between the carrier and CAOM, the carrier and the state and CAOM and the state.  You will need to contact WCA to determine when they will be able to work with you.

When you are ready we can begin performing the Test POC edits on your WCPOLS data.  In Test, CAOM will provide you with a report for every production file submitted.  Nothing actually goes to the state during this test phase.  The reports will show the errors that would not pass edits if you were in production.  Since nothing is actually sent to the state during the first stage of testing, there will be no feedback from the state.  During this test phase, errors do not need to be resubmitted to CAOM. (Once in production, transactions that error would need to be corrected and resubmitted.) 

Once you have made the necessary system or data entry adjustments to resolve the common recurring errors, and when the state is ready, you will move to the next phase of testing which is CERTIFY.  This takes your production file and sends it to the WCA test system.  At this time the state will provide acknowledgement reports to CAOM which will be forwarded on to you.  (Transactions that error at the state level will need to be corrected and resubmitted once you are in production.)

The WCA will advise us when you are approved for production.  See item #4 of the WCA Carrier Test Plan.

All reports are deployed to CAOM’s FTP server which you will need to retrieve.  Contact jpaquet@caom.com for instructions, username and password.

CAOM – POC TEST PROCESS

Testing with CAOM for Electronic POC Reporting

Electronic POC reporting will include the following WCPOLS transactions: 
Transaction Type Code 01 – New Policy
Transaction Type Code 02 – Renewal Policy
Transaction Type Code 05 – Cancellation / Reinstatement

Testing for electronic POC will consist of the following:

1.  Carrier reconciliation with WCA.
Carriers will be required to participate in a database cleanup effort with the WCA in order to ensure that all filings are up-to-date, the correct Federal Employer Identification Number is being used, and the WCA records are updated with the most current policy number.

This step can occur anywhere during the process however it must be completed before approval will be received.

Contact Cheryl Cornellier (517-284-8923) or Kelly Boyer (517-284-8928) at the WCA.

2.  Review 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 WCA, very specific reporting requirements must be met.

The documents on the WCA’s website titled POC Implementation Guide can provide specific requirements and examples of name formatting and name / address linking as well as specific edits that will be made.

Certain valid WCPOLS data cannot be mapped to an acceptable record for the WCA.  In these cases the data will be rejected to the carrier for correction and resubmission.  Data that cannot be corrected will require a paper filing to the WCA. 

Carriers should note that a rejection for POC purposes does not equate to a rejection for CAOM purposes or vice versa.

3.  Obtain CAOM Test POC Audit / Error Report

This will be known as the Test Phase.  The “test” POC edits will be provided on all WCPOLS production submissions.  The reports will be stored on CAOM’s FTP server.  This will allow carriers to address certain issues before they begin testing with the WCA.  The POC data will not be transferred to the WCA.

Contact Vickie Lakatos(734-462-9600 ext 214 or vlakatos@caom.com) to begin receiving the Test POC edits.


4.  Change necessary WCPOLS reporting Issues

Issues that will require significant programming changes for WCPOLS 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 the carrier and CAOM.  It is highly recommended that CAOM testing of WCPOLS data is included in your test plans.  

Live data is preferred for testing, as fictitious data does not produce reliable results.  Paper copies of each transaction tested may be required.  Contact Vickie Scroggs at CAOM to arrange for testing.

Continue to submit regular production files for CAOM purposes.

5.  Data sent to WCA on test basis

This will be known as the Certify Phase.  When the WCA is ready, they will request CAOM to provide the IAIABC file on a test basis.  The WCA will provide error and acknowledgement reports to CAOM.  CAOM will provide the error and acknowledgement information to the carrier.  The reports will be stored on CAOM’s FTP server.  

CAOM will require not more than a 5% error ratio in the Test Phase before moving a carrier to the Certify Phase.

The carrier will continue to file all required forms on paper with the WCA during this process.

6.  WCA will advise when the carrier is approved for production

The WCA will advise the carrier and CAOM what transactions will be approved for electronic POC.  Once production begins, the carrier will discontinue separate paper filings to the WCA for the approved transactions that pass the edits.  

Legal Nature oF Entity Code for Record Type Code 02

The WCA 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.

Cancellation/Reinstatement Reason Code

The WCA does not accept Reason for Cancellation code 99 (other). The WCA requires a Reason for Cancellation code for non-renewals (Cancellation / Reinstatement ID Code 3)

Retrieving of POC Error Reports

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 jpaquet@caom.com for your user name and password.

The report files will be pdf’s with the names of CAOMERROR and SOMACK with a timestamp on them.  You have only read access to those files.

We keep approximately 30 days of files on our web server in your primary folder.  There is an Archive folder that will keep up to 1 year’s worth of reports.

We suggest that 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 that 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 Gary Zeder at gzeder@caom.com.


WCA Carrier Test Plan

  1. Kickoff meeting with the carrier and CAOM to discuss overview of EDI 
    • Carrier will supply the WCA with the names, phone numbers and e-mail addresses of contact persons that will be participating in the testing process.
    • WCA will provide all supporting documentation to the carrier, including 
      • Record layout for Policy Number Reconciliation (LW02592)
      • Record layout for Carrier Reconciliation (LW02601)
      • Record layout for Carrier Active Policies  (LW02401)
      • Sample of new report that will be generated if the provided policy number on a cancellation is found on the WCA database but not all employers could be terminated.
      • Sample of Acknowledgment Report that the WCA will be sending to CAOM.
    • WCA will provide a spreadsheet outlining valid Triplicate Codes and their WCPOLS equivalents for carriers to indicate which transactions they want to file electronically.
      • Depending upon the Triplicate Codes the carriers intend to file, the carrier must be prepared to submit examples of the following scenarios correctly in WCPOLS to CAOM so they can be mapped to the IAIABC format:
        • Single FEIN policies
          • With multiple address records
          • With multiple name records 
        • Multiple FEIN policies
          • With multiple address records
          • With multiple name records for each FEIN
  2. Carrier clean-up.
    • Carrier sends Policy Number Reconciliation file (LW02592) to WCA so database can be updated prior to reconciliation process.  
    • Carrier will submit Carrier Reconciliation file (LW02601) to WCA.  
      • Inconsistent FEIN’s will be reconciled with the carrier.
      • If the report indicates an incorrect FEIN for an employer (based on the Department of Treasury records), the WCA will generate e-mails to the carrier contact person to supply them with the correct FEIN’s. The carrier does not have to make corrected filings. They just have to make the corrections internally. If the carrier can supply proof that their FEIN is correct, the WCA will accept their number.
      • If the FEIN cannot be confirmed (based on the Department of Treasury records), the WCA will update their database with the FEIN supplied by the Carrier.
      • WCA will generate e-mails to the carrier contact person indicating the process to reconcile all other errors. This might entail new or corrected filings or verification of information that must be completed timely.
      • The WCA will identify the carrier’s common errors to the contact person. 
      • The carrier’s procedures may need to be adjusted to avoid these errors on future electronic filings.
      • The carrier must also resolve any outstanding correspondence issues with the WCA. All letters from the WCA should be resolved in a timely manner.
      • Steps i through vii are repeated until the WCA is satisfied that records are in sync and common errors have been resolved in both electronic and paper filings.
    • The WCA will run Carrier Active Policies (LW02401) and send to carrier. 
      • Carrier will file terminations for any employer on the Carrier Active Policies report that they no longer insure. If the policy information is old and has been purged from the Carrier’s system, a termination should be submitted to flat cancel their issuance using the information on the Carrier Active Policies report.  
      • Carrier will file issuances for any employer they insure that was not found on the Carrier Active Policies report.
      • Carrier will file Form 403’s to add or delete locations and/or divisions as needed so the WCA database accurately reflects the carrier’s policies. 
      • Carrier will supply FEIN’s for all employers with a TP or JV number on the Carrier Active Policies report that they currently insure. The Carrier should e-mail the TP number, name of employer, policy number and FEIN to the contact person at the WCA. The WCA contact person will verify each FEIN with the Department of Treasury. Discrepancies will be reconciled between the carrier and WCA.
      • Some employers are not required to obtain a FEIN. They are allowed to use their Social Security number. If one of these employer’s SS# matches another employer’s FEIN on the WCA’s database, the first 2 digits in the SS# will be replaced with WC.  
    • Carrier will supply the complete name and corresponding FEIN of each member in their group. 
      • WCA will verify the FEIN’s and resolve any discrepancies with the contact person. 
  3. WCA requests another Policy Number Reconciliation file (LW02592), if needed, from the carrier in order to update policy numbers on WCA database prior to testing with CAOM.
  4. The final test before a carrier receives permission to go to production will consist of the successful completion of the following:
    • The carrier must submit to CAOM at least 20 of each transaction type (issuances, cancellations, etc.), including single and multiple entity policies that will be submitted electronically.  
    • The WCA must receive a minimum of 3 consecutive transmission days of files from CAOM on behalf of the carrier with 100% accuracy of mandatory data elements and structuring of records.  
    • Ensure that the carrier receives the Acknowledgment Report from CAOM immediately upon receipt from the WCA.
    • Ensure that carriers are able to resolve errors on a timely basis (both electronically and on paper, depending on the type of error).
  5. The WCA requests a final Policy Number Reconciliation file (LW02592), if needed, from the carrier.
  6. All parties sign Trading Partner agreement.
  7. All parties agree upon a scheduled implementation date.

CAOM – POC File Process Order

When CAOM receives your WCPOLS file, if the entire file is rejected you are notified via CDX.  If your file is accepted by CAOM it is loaded to our processing area.  The Michigan Manage Policy System will allow a carrier to view CAOM’s processing status of each transaction as well as view any CAOM crit messages.  (The POC process will continue to be a separate process with separate reports generated for and from the state.) 

For carriers who are involved in electronic POC reporting two separate things happen when CAOM receives the WCPOLS file:
(Note:  The CAOM & POC processes are independent of each other.  One does not affect the other.)

  1. File is loaded to CAOM processing area. 
    • If there are reporting issues with the file or a specific transaction that we cannot process you are notified via email or crit via MPS.
  2. The WCPOLS data is converted to the format required by the state for POC reporting and a series of “pre-edits” is performed on the data as prescribed by the WCA.
    • If a transaction does not pass the edits it is rejected back to the carrier for correction.
      • The CAOM/POC Audit Trail report is generated by CAOM to communicate which transactions were not sent to the state and the reason.
    • If a transaction passes the edits it is forwarded to the state for POC purposes.    
      • The WCA POC Audit Trail report is generated to communicate which transactions were not accepted by the state and the reason.

 * Note:  A rejection for POC does not mean there is a rejection for CAOM and vice versa.