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ORDER NO. 03-064

DEPARTMENT OF CONSUMER AND BUSINESS SERVICES

WORKERS’ COMPENSATION DIVISION

ELECTRONIC DATA INTERCHANGE

Hist:  Adopted 3/17/03 as Admin. Order 03-052, eff 4/1/03

436-160-0080Acknowledgements  

(1) The director will respond to the sender with an electronic transaction accepted or transaction rejected acknowledgement of the insurer's transactions.

(2) The insurer shall correct and resubmit any transactions rejected for which law or rule require filing, reporting, or notice to the director.

Stat. Authority:  ORS 656.726(4)

Stat. Implemented:  ORS 656.264

Hist:  Adopted 3/17/03 as Admin. Order 03-052, eff 4/1/03

436-160-0090Address Reporting  

The sender will follow the standard United States Postal Service guidelines in reporting all addresses, as follows:

(1)

The physical (street) address, or an attention line, must be in address line one.  The attention line, if used, must be in line one.

(2)

If the physical address is used in address line one, the mailing address may be used in address line two. If address line one was used as the attention line, then the physical (street) address must be in address line two.

(3)

Physical (street) address and attention line must be on separate address lines.

Stat. Authority:  ORS 656.726(4)

Stat. Implemented:  ORS 656.264

Hist:  Adopted 3/17/03 as Admin. Order 03-052, eff 4/1/03

Proof of Coverage

436-160-0300Proof of Coverage Definitions  

(1) Unless otherwise provided in these rules, the definitions and standards identified in OAR 436-160-0004 and OAR 436-160-0005 apply.

(2) For the purpose of OAR 436-160-0300 through OAR 436-160-0360 “establishing documents” is a term used in the IAIABC EDI Implementation Guide for Proof of Coverage to denote certain transaction types.  The establishing document transaction types listed in OAR 436-160-0350(2)(c) can be used to file a guaranty contract under that rule.  In Oregon, a reinstatement, an add location, and an add employer transaction type can also be an establishing document.  A change policy number transaction type is not an establishing document.     

Stat. Authority:  ORS 656.726(4)

Stat. Implemented:  ORS 656.419, ORS 656.423 and ORS 656.427

Hist:  Adopted 3/17/03 as Admin. Order 03-052, eff 4/1/03

436-160-0310Proof of Coverage Electronic Filing Requirements  

(1) The chart in Appendix "A" shows all proof of coverage data elements accepted via EDI in Oregon, and whether the data element is mandatory (M), conditional (C), or optional (O) for each transaction type.

(2) Unless otherwise provided in these rules, the data elements shall have the meaning provided in the data dictionary pursuant to OAR 436-160-0004.

436-160-0360Page 6436-160-0360

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