Regulatory Update: IAIABC Forum 2017


IAIABC is an association of workers’ compensation jurisdictional regulators and industry professionals. Each spring, the association holds The Forum that brings together workers’ compensation leaders to collaborate and connect on major industry issues. Members of ClearSight’s Regulatory Compliance Team are actively involved in IAIABC as members and co-chairs of committees. They participated in in-depth discussions about policy and regulatory issues and help develop industry standards. Here is a roundup of IAIABC committee actions at The Forum 2017:

The Industry Jurisdiction Committee meeting provided an update on Claim, Medical and Proof of Coverage (POC) EDI statuses.

  • New states adopting the R3 standard include Idaho (mandatory on November 3, 2017) and Oklahoma (mandatory on January 1, 2018).
  • States continue to monitor the acceptance of claims EDI transactions and communicate those rates back to the trading partners to increase data quality and acceptance rates.

The Claims Committee worked on EDI Claims Release 3.1 due in August. Discussion centered around:

  • New Claims 02 Change rules are being modified to be clearer. This includes changes to the Element Requirement Tables, clarifications to the Processing Rules for the 02 Maintenance Type Code, and updating scenarios related to the 02 Change for the FROI and the SROI document types and the addition of variable segments to accommodate 02 changes in the file layout.
  • The ability to identify by state which data element is changing and how – i.e., add, update, remove. (In the past, jurisdictions couldn’t tell if a trading partner intentionally added or removed data.)

The Systems Committee also focused on EDI Claims Release 3.1. The committee worked to assign data numbers to each of the 35 new elements required. Documentation also was updated for the new release including:

  • Data number lists by name and number
  • Map of Claim Record format
  • Migration documents
  • System rules

The XML Committee provided updates on the current status of the XML project, which allows the option of an XML format of the current Release 3 Flat File Standard, and the feasibility of making future releases in the XML format only rather than flat file. At present:

  • Kansas is in the lead on the XML project.
  • Alaska, Louisiana, New Jersey, North Carolina, Rhode Island, and West Virginia are ready to move to production.
  • Oregon and Nebraska (among others) are considering moving to XML in the future.

The International Committee highlighted the workers’ compensation program of the province of Ontario, Canada.

For more information on how your organization might be impacted by these discussions, please contact ClearSight’s Regulatory Compliance Team. For more information on IAIABC or upcoming events, please visit .