Success Stories
First Report of Injury System (FRIS), Connecticut, Workers’ Compensation Commission (CT WCC)
The State of Connecticut, Workers' Compensation Commission (CT WCC), First Report of Injury System (FRIS) is a web-based information system for the submission of data to the Commission related to the Employer's First Report of Injury (FRI). The system receives, manages and sends the first report of injury data to/from trading partners both in batch upload for high volume (Trading Partners) and form-based entry for low volume (Trading Partners).
WHAT YOU NEED TO KNOW
The State of Connecticut, Workers' Compensation Commission required an improved system to receive, manage and send data to/from Trading Partners (TPs) in reference to the First Report of Injury. A Trading Partner is a business entity that has established a relationship with the State of Connecticut to electronically report claim data. This entity may be an Insurance Carrier (Insurer), Self-Insured Employer, Third Party Administrator (TPA), or Servicing Agent/Vendor).
CASE STUDY
Business Challenges
The State of Connecticut, Workers' Compensation Commission (CT WCC) was looking for a First Report of Injury System (FRIS) to replace the existing Electronic Data Interface (EDI) system, which had major deficiencies (improper validations, non-scalability).
The existing environment consisted of an IBM Information Exchange Communications package and a Mercator Translation component. The IBM Information Exchange system is a modem package that transfers EDI incoming and outgoing transactions. The Mercator component translates the ANSI file to flat file, and performs record validation. Mercator also performs stored procedure calls to produce required reports: (Acknowledgement report [824], printed error report, daily operating report). These packages were currently running on a standalone PC/server.
Objective
The objectives of FRIS are:
- Receive First Report of Injury (FRI) files from vendors in EDI IAIABC format, validate the EDI records, upload the received files to Sybase and Oracle/UDB database. The International Association of Industrial Accident Boards and Commissions (IAIABC) is the national standards entity for EDI relating to workers' compensation, and has published several iterations of these standards for the guidance of state agencies, carriers, and others involved in the implementation of EDI.
- Generate reports such as acknowledgement, error and EDI processing
- Ability to archive incoming and outgoing files
- Provide an internet based platform for web-based entry with login authentication, including web-based entry with batch upload for high volume Trading Partners, and web based FRI form entry with real-time processing for low volume Trading Partners.
- Provide a web interface for maintaining vendor master and parameter screen and viewing reports and inquiry screens
- Support SROI (Subsequent Report Of Injury) process, if required
System Architecture and Process Flow
The diagram below illustrates network architecture of the FRIS. First Report of Injury Electronic System (FRIS) is based on Microsoft .NET.
The diagram below depicts the flow of the process:
Approach
The system is based on following assumptions:
- The scope of the FRIES Solution includes handling of only the First Report of Injury (Claims) data and no Coverage data.
- EDI processing does not involve any Subsequent Report of Injury (SROI) data. However, there will be a facility to upload the FROI data to SROI system as required.
- Internet based
- Expedited Data Submission and Acknowledgement
- Data Validation for Accuracy Prior to Submission to State
- Secured FROI information accessible by trading partners
The system will lead to faster resolution of cases, on account of electronic transfer of information, as the First Reports do not have to be manually entered into the system. All Vendor specific data files can be uploaded onto Vendor specific FTP Folders for incoming as well as outgoing files (acknowledgements etc.). These can be uploaded onto the EDI Server and also archived.
Data is processed via uploading this flat file data into intermediate EDI Sybase tables. All necessary validation and transformation of data is handled through these tables. Additionally, specific business process validations and handling can be included into the automated process as per the requirements of the state. Acknowledgement text files are then generated from the intermediate EDI acknowledgement tables listing the various errors for each file, which can then be uploaded back to the Vendor specific FTP area.
Platform: Sybase, .Net, PL/SQL, Crystal Reports
Results- The entire EDI Process is an automated process (not requiring human intervention) right from the stage of downloading files from the FTP server to the final state of uploading valid data into the Sybase database as well as sending acknowledgment files. The automated process is enabled / disabled via an automated flag. The log file is generated which maintains the details of the entire process beginning from the files download to uploading of the acknowledgement files.
- The acknowledgement file generated is as per the IAIABC EDI Implementation Guide. It consists of errors generated for each element.
- The solution deploys transfer of files via FTP instead of Email or any other electronic transmission.
| CT | Connecticut |
| EDI | Electronic Data Interface |
| FRI | First Report of Injury |
| FRIS | First Report Injury System |
| SROI | Subsequent Report of Injury |
| TP | Trading Partners |
| TPA | Third Party Administrator |
| WCC | Workers' Compensation Commission |
