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ORDER NO. 03-064

DEPARTMENT OF CONSUMER AND BUSINESS SERVICES

WORKERS’ COMPENSATION DIVISION

ELECTRONIC DATA INTERCHANGE

(3) Transactions will be rejected if mandatory or required conditional data elements are omitted or submitted in a format that is not capable of being processed by the division's information processing system designated for proof of coverage transactions.

(4) Optional data element(s) in a transaction will be ignored if the optional data element is either omitted, or submitted in a format that is not capable of being processed by the division's information processing system designated for proof of coverage transactions.

(5) Unless otherwise provided in these rules, an insurer approved for production transmissions will transmit proof of coverage via EDI, and will not submit like paper documents to the director except as provided in OAR 436-160-0340.

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

Amended 12/3/03 as Admin. Order 03-064, eff. 1/1/04

436-160-0320Proof of Coverage Acknowledgement  

(1) The division will respond to transmissions submitted with either a transaction accepted or a transaction rejected acknowledgement.

(2)

A transaction rejected acknowledgement will be sent for all transactions incapable of being processed by the division’s information processing system, including, but not limited to:

(a) An omitted mandatory data element;

(b) An improperly populated data element field, e.g. numeric data element field is populated with alpha or alphanumeric data, or is not a valid value;

(c) Transactions or electronic records within the transaction which require matching and cannot be matched to the division's database;

(d) Illogical data in mandatory or required conditional field, e.g. termination date is before  coverage effective date;

(e) Duplicate transmission or duplicate transaction within the transmission;

(f) Invalid triplicate code; or

(g) Illogical event sequence relationship between transactions, e.g. endorsement transaction submitted before a policy transaction is submitted.

(3)

A transaction accepted acknowledgement will be sent for all transactions that are in a format capable of being processed by the division's information processing system and are not rejected pursuant to section (2) of this rule.

(4) An insurer’s obligation to file proof of coverage for the purposes of this rule is not satisfied unless the director acknowledges acceptance of the transaction.

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

Amended 12/3/03 as Admin. Order 03-064, eff. 1/1/04

436-160-0330Proof of Coverage Effective Dates  

(1) For all binder or new policy establishing document transactions submitted pursuant to OAR 436-160-0350, the coverage effective date will also be the guaranty contract effective date.

436-160-0360Page 7436-160-0360

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