Red Oak E-Commerce Solutions Inc. (ROES), an EDI and E-Commerce workers’ compensation solution provider, and Guidewire Software Inc., a provider of solutions to property and casualty and workers’ compensation insurers, announced a partnership to streamline claim reporting.
With the joint solution, workers’ comp insurers, using Guidewire ClaimCenter, can electronically file state-mandated claim reports. The reports are submitted to the states through WorkComp.NET, an EDI clearinghouse managed by Red Oak E-Commerce Solutions Inc.
Workers’ comp carriers are required to file information with state regulatory agencies during the lifecycle of a claim, including First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI). Traditionally, the required forms were filled out manually, through a laborious and error prone process, before being sent to the state. States are reportedly better able to monitor activity and compliance efforts and perform statistical analysis of their workers’ comp programs by using EDI because the data is accurate, easily stored, and readily available to them.
A growing number of states are reportedly making electronic submission a requirement, with several states issuing fines for non-compliance with EDI requirements. Today, 15 states require electronic submission and an additional 11 states accept voluntary electronic filing.
While electronic submission offers potentially lower costs to insurers, it also reportedly presents new challenges. The electronic claim file must capture all required data elements in relation to the reason for filing, and submissions that fail state-specific edits must be processed through an error correction process. Multi-state carriers must also conform to the differing requirements of each state in which they do business.
Now, instead of requiring adjusters to manually fill out paper forms or key data into electronic forms, ClaimCenter captures all required data elements and transmits this information to WorkComp.NET, ROES’ EDI clearinghouse, for transmission to states that require FROI/SROI reporting. WorkComp.NET handles the work of reformatting the claim to meet the reporting requirements of different states, and then transmits that data to those states via a secure network.
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