Industry experts for workers compensation data collection and assigned risk placement in Michigan
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) 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.
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 firstname.lastname@example.org for instructions, username and password.
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 Lynn Griffith(734-462-9600 ext 222 or email@example.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 Lynn Griffith 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.
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.
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)
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 firstname.lastname@example.org 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.
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 Jay Subramanian at email@example.com.
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.)
* Note: A rejection for POC does not mean there is a rejection for CAOM and vice versa.