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Florida Administrative Code (Last Updated: June 27, 2024) |
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69. Department of Financial Services |
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69L. Division of Workers' Compensation |
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69L-56. Electronic Data Interchange (Edi) Requirements For Proof Of Coverage And Claims (Non-Medical) |
1(FROI MTC 01 4as found in the IAIABC Implementation Guide for Claims: First, Subsequent, Header, Trailer 17and 18Acknowledgement Detail Records, Release 3, J24anuary 251, 200279 28Edition)
29(1) The claim administrator shall send FROI 36MTC 01 38(Cancel) immediately upon the claim administrator’s knowledge of the need to cancel if any of the following occur:
56(a) An Electronic First Report of Injury or Illness was accepted by the Division and the claim administrator subsequently determined the claim was filed in error because it was actually a Medical Only Case. The FROI MTC 01 shall reflect the Claim Type as “B” (Became Medical Only).
104(b) An Electronic First Report of Injury or Illness was accepted by the Division and the claim administrator subsequently determined the claim was filed with inaccurate identifying information and was a duplicate of another accepted claim.
140(2) If a claim has been cancelled via FROI MTC 01 (Cancel) after an Electronic First Report of Injury or Illness was previously filed with the Division and the claim administrator determines the claim should not be cancelled after all, the claim administrator shall re-file a subsequent Electronic First Report of Injury or Illness using the applicable MTC(s) specified in this rule for reporting an Electronic Firs207t Report of Injury or Illness. 213The original Electronic First Report of Injury or Illness sent to the Division shall be disregarded and considere231d not filed with the Division. 237The due date for filing the subsequent Electronic First Report of Injury or Illness shall correspond to the filing timeframes specified in this rule for the applicable MTC(s) required for an Electronic First Report of Injury. If un-canceling a claim to file a full or partial denial of indemnity benefits, the claim administrator shall provide to the employee and employer, Form DFS-F2-DWC-12 adopted in Rule302s 30369L-3.012 304and 30569L-3.025, 306F.A.C.
307Rulemaking 308Authority 309440.591, 310440.593(5) FS. 312Law Implemented 314440.593 FS. 316History–New 1-7-07, 318Amended 5-17-09.
