Claims Process Overview

Workers' compensation claims are handled by diverse organizations: large multi-state insurance companies, smaller specialty insurance carriers, self-insured employers, and third-party administrators handling claims on behalf of insured and self-insured employers. These organizations have different information systems and capabilities. The NH Department of Labor (DOL) Electronic Data Interchange (EDI) process has been designed to be flexible in the support of a variety of EDI systems.

File Transfer Protocol (FTP) is the transmission method used to send data files to New Hampshire, Department of Labor. The NHDOL is supporting a file format, known as IAIABC Release 3, a "flat-file" format. This method is described more fully in Section H-File Formats and Supported Transactions and Section I-Transmission Modes.

Claim administrators can avoid the details of EDI by selecting among several firms that sell EDI-related software products, consulting, and related services.

The Three Step Process of EDI - From Testing to Production

Full production EDI reporting status is a three step process. Each step of the process is described in more detail in Section G- Test and Production Phases of EDI. These steps should be repeated each time the claims administrator is ready to move into a new transaction type, i.e., the First Reports and Subsequent Reports.

Step 1. EDI Trading Partner Profile

The claims administrator first provides an EDI Trading Partner Profile to the Division at least 30 (thirty) days before its first submission of EDI data. The Trading Partner Profile form is provided in Section F-Trading Partner Profile. The Trading Partner Profile is used to prepare NHDOL for your data transmission: what file format to expect, where to send an acknowledgment, and similar information. The trading partner also completes a Sender's transmission profile sheet presenting detailed information about the transmission. We also require a list of insurers for whom a trading partner will be sending data. Once we receive the Trading Partner Profile forms a FTP mailbox and account will be set up for the drop off and pick up of data files. The FTP mailboxes are located on a State of New Hampshire FTP server. We have created two folders in the mailbox; TONHDOL and FromNHDOL. The ToNHDOL folder is where you will place the files to be processed. The department will be responsible for clearing the ToNHDOL folder after processing. Acknowledgments will be placed in the FromNHDOL folder for you to pick up, you will be responsible for clearing the FromNHDOL folder after picking up the acknowledgments. The data transmitted to New Hampshire may be encrypted, should you have that as a requirement. Encryption keys will be exchanged after the setup of the FTP account and mailbox.

Step 2: Testing

The claims administrator runs a preliminary test by transmitting a test file to ensure that the NHDOL system can read and interpret the data. The claims administrator has passed the test when minimum technical requirements are met: NHDOL recognizes the sender, the file format is correct, and the claims administrator can receive electronic acknowledgments from NHDOL. During the Testing step, data submissions are analyzed for completeness, validity, and accuracy. The data should meet minimum data quality requirements in order to complete the testing state.

Step 3: Production

In Production, data transmissions will be monitored for completeness, validity, and accuracy. Each Trading Partner will be routinely monitored for their data quality. You will be contacted should your data quality begin to fall out of our expected data quality standards. Those in Production status for EDI First Reports will no longer be required to send paper copies of the Employer's Report (Form 8WC) to the Department of Labor, Division of Workers' Compensation.

Acknowledgements

The Department of Labor (NHDOL) will pick up files from the FTP mailboxes daily at around midnight. Processing takes place overnight and an acknowledgement is generated. The acknowledgement reports back to the sender the status of the transmissions sent to the department. The reported status, as per IAIABC are:

TA - Transaction Accepted

The transaction was accepted by the department and no errors were detected in the data provided. This First Report is considered filed and no other actions are required.

TE - Transactions Accepted with Errors

The transaction was accepted by the department, errors were detected however the errors were not severe enough to not file the report in our system. You may consider the report filed. When the department returns a TE, the errors are reported in the acknowledgement. In New Hampshire it is not mandatory to send corrections to correct reported errors however we will accept changes and corrections should you desire to correct the First Report.

TR - Transaction Rejected

The transaction had errors such that the department could not properly process the transaction. The transaction is not added to our system and is NOT considered filed. In these cases the transaction will have to be resent to the department. Rejections should be addressed immediately because you run the risk of the report being filed late should you get a rejection. The acknowledgement will indicate the reason for the rejection should that be possible.

Acknowledgments will be sent to the mailboxes the next day at about 9:00 am and will contain the Jurisdiction claim number for the claim.