Workers Compensation EDI: A Snap Poll for the Celent Executive Panel

Snap polls reflect questions posed by members of the Celent Executive Panel, a group of C level executives in the insurance industry. This question came about from a member who was looking for insights on how others are handling workers compensation EDI. This deck provides a summary of the responses to a Snap Poll conducted in July 2023. 6 insurers responded to this survey over the course of 5 days.

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The question that was posed was:

Background:

This insurer does EDI reporting to states (FROI/SROI) through several different means: manual on state website, manually upload claims through a third party, and automatically report to some states via SFTP. They’re interested in understanding what other companies are using for EDI reporting. They’re interested in consolidating and automating EDI reporting through a vendor but they’re a small carrier and are concerned about costs.Before they go further down the strategy of automating EDI reporting, they’d like some understanding of what others are doing.

They believe such automation happens in stages. A carrier identifies and selects claims per state that need to be reported. The carrier compiles claim data in a particular format and uploads it to an EDI vendor. The vendor does validation checks (aka edits) and informs the carrier whether claim records need to be cleaned up or whether they are good to be submitted. The carrier does any necessary cleanup to ensure the edits look clean. Then the carrier asks the EDI vendor to submit claims for EDI reporting. The vendor does that. The state provides acknowledgement. If the state identifies any issues, they let the vendor know. The vendor informs thecarrier. This process continues until EDI transactions are accepted. They are interested in this process – if they can afford it.

Questions: