Unit Reporting and Validation for Part of Body

© 2007 National Council on Compensation Insurance, Inc.

Objectives ƒ Understand the reporting requirements for the Part of Body Code ƒ Learn about the editing and validation enhancements for Part of Body ƒ Understand the process for responding to results from receipt of notification to responding via DCA Access® Online Notification

Unit Reporting and Validation for Part of Body (Page 2) © 2007 National Council on Compensation Insurance, Inc.

1

Agenda ƒ Background and Ratemaking ƒ Part of Body Changes—Reporting instructions (Corrections vs. Going Forward) ƒ 5 New Part of Body Data Validation Tests ƒ Notifications via DCA Access® Online ƒ Available Resources

Unit Reporting and Validation for Part of Body (Page 3) © 2007 National Council on Compensation Insurance, Inc.

Background ƒ Future Loss Cost/Ratemaking Need ƒ Class ratemaking uses unit statistical data, for which various data elements are reported for all claims ƒ Part of Body = strong predictor of future claim development ƒ Part of Body Code will be used in NCCI’s state loss cost and rate filings (starting in 2009) ƒ Utilize the industry to develop reporting requirements

Unit Reporting and Validation for Part of Body (Page 4) © 2007 National Council on Compensation Insurance, Inc.

2

Current Class Ratemaking Claims Claims Injury Injury Type Type Serious Serious

Non-Serious Non-Serious

Fatals Fatals Permanent PermanentTotals Totals Major Permanent Major Permanent Partials Partials

Indemnity Indemnity

Medical Medical

Minor MinorPermanent Permanent Partials Partials Temporary TemporaryTotals Totals

Indemnity Indemnity

Medical Medical

Medical Medical Only Only No Nolost losttime time

Medical Medical

Unit Reporting and Validation for Part of Body (Page 5) © 2007 National Council on Compensation Insurance, Inc.

Revised Class Ratemaking Claims Claims Part Part of of Body Body Injury Injury Type Type Open Open or or Closed Closed

Likely Likely to to develop develop

Indemnity Indemnity

Medical Medical

Not Not likely likely to to develop develop

Indemnity Indemnity

Medical Medical

Unit Reporting and Validation for Part of Body (Page 6) © 2007 National Council on Compensation Insurance, Inc.

3

Revised Class Ratemaking Claims Claims Part of Body Injury Type Open or Closed Likely Likely to to develop develop

Part Part of of Body Body Code: Code: 10 10 Multiple Multiple Head Head Injuries Injuries

Indemnity Indemnity

Medical Medical

Unit Reporting and Validation for Part of Body (Page 7) © 2007 National Council on Compensation Insurance, Inc.

Revised Class Ratemaking Claims Claims Part of Body Injury Type Open or Closed

Part Part of of Body Body Code: Code: 57 57 Toes: Toes: Other Other than than great great toe toe

Not Not likely likely to to develop develop

Indemnity Indemnity

Medical Medical

Unit Reporting and Validation for Part of Body (Page 8) © 2007 National Council on Compensation Insurance, Inc.

4

Part of Body: Unit Statistical Reporting Instructions ƒ Part of Body Code Assignment ƒ Unclassified Part of Body (Code 65) ƒ Part of Body Errors ƒ Part of Body Loss Development

Unit Reporting and Validation for Part of Body (Page 9) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Code Assignment ƒ Data providers are required to report the appropriate Injury Description Code on all unit statistical data losses (Loss Records) ƒ Injury Description Code is a six digit code that includes three components: ƒ Part of Body Code ƒ Nature of Injury Code ƒ Cause of Injury Code

ƒ Part of Body codes and their descriptions can be found in NCCI’s Workers Compensation Statistical Plan (Part 7—Coding Specifications) Unit Reporting and Validation for Part of Body (Page 10) © 2007 National Council on Compensation Insurance, Inc.

5

Part of Body Code Assignment Code Assignment: Specific Specific part part of of body body affected affected by by injury injury + + Most significant Most significant contributor contributor ƒ If the most significant contribution to the cost cannot be isolated to the specific Part of Body, then code according to the applicable value for multiple body parts.

Unit Reporting and Validation for Part of Body (Page 11) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Code Assignment Example Claim scenario #1: Carpet installer goes into a business and slips on coffee that spilled on the tile floor as he walks in. How would we code this?

PART PART

NATURE NATURE

CAUSE CAUSE

Code: Code: 34 34

Code: Code: 28 28

Code: Code: 27 27

Wrist Wrist

Fracture Fracture

Slipped Slipped

Unit Reporting and Validation for Part of Body (Page 12) © 2007 National Council on Compensation Insurance, Inc.

6

Part of Body Code Assignment Example Claim scenario #2: A window washer falls off a scaffolding from the 2nd floor. Luckily he lands on the grass - unluckily he injures both his shoulder and elbow. How would we code this?

PART PART Code: Code: 30 30 Multiple Multiple Upper Upper Extremities Extremities

NATURE NATURE Code: Code: 49 49 Sprain Sprain

CAUSE CAUSE Code: Code: 26 26 Fall, slip or Fall, slip or trip trip from from ladder or scaffolding ladder or scaffolding Unit Reporting and Validation for Part of Body (Page 13)

© 2007 National Council on Compensation Insurance, Inc.

Part of Body Code Assignment

ƒ For most claims, the Part of Body code remains unchanged for the 1st unit report and for future subsequent unit reports ƒ The originally reported Part of Body code identifies the most significant contributor to the overall claim cost

Unit Reporting and Validation for Part of Body (Page 14) © 2007 National Council on Compensation Insurance, Inc.

7

Part of Body Errors Correction Reports ƒ Part of Body is considered in error if the code reported was not appropriate—based on the information available at the unit report valuation date ƒ When Part of Body is submitted in error, correction report(s) are required for all applicable unit reports ƒ Report corrections for all applicable report levels (1st through 10th)

Unit Reporting and Validation for Part of Body (Page 15) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Correction Reports Example ƒ Part of Body reported on the 1st, 2nd and 3rd unit reports was 56 (foot) ƒ This was in error as Part of Body should have been 55 (ankle) ƒ Report corrections to the 1st, 2nd and 3rd units—1C1, 2C1 and 3C1 ƒ Report Part of Body code 55 on a going forward basis—unless Part of Body changes due to loss development

Unit Reporting and Validation for Part of Body (Page 16) © 2007 National Council on Compensation Insurance, Inc.

8

Changes in the Part of Body (Loss Development) ƒ Part of Body may change due to normal loss development—from one unit report level to the next ƒ The revised code is the Part of Body that most significantly contributes to the overall cost of the claim ƒ The updated Part of Body code should be reported on the appropriate subsequent unit statistical report(s) ƒ This occurs on a going forward basis—Corrections to previous report levels must not be submitted Unit Reporting and Validation for Part of Body (Page 17) © 2007 National Council on Compensation Insurance, Inc.

Loss Development Example ƒ Part of Body correctly reported on the 1st and 2nd unit reports was 52 (upper leg) ƒ At the 3rd unit report valuation (42 months), it was determined that Part of Body should be 50 (multiple lower extremities) ƒ Revised Part of Body code 50 should be reported on the 3rd unit report on going forward basis—unless Part of Body changes again due to further loss development

Unit Reporting and Validation for Part of Body (Page 18) © 2007 National Council on Compensation Insurance, Inc.

9

Using Unclassified Part of Body (Code 65) ƒ Part of Body Code 65— Insufficient information to identify part affected ƒ On the 1st unit report, use Code 65 if the Part of Body for the injury is not able to be specifically classified

Unit Reporting and Validation for Part of Body (Page 19) © 2007 National Council on Compensation Insurance, Inc.

Using Unclassified Part of Body (Code 65) At a later date, it was determined that the most significant contributor was the heart. The previously reported code 65 requires correction Company Action:

Correction—Submit a correction report (1C1) to update the Part of Body from 65 to 49 (Heart) Subsequents—Continue to use Part of Body code 49, unless there is further loss development that changes the Part of Body at a future valuation date Unit Reporting and Validation for Part of Body (Page 20)

© 2007 National Council on Compensation Insurance, Inc.

10

Part of Body No Physical Injury Did you know that there is a Part of Body code for No Physical Injury? 66 Example: Mental Disorders

Unit Reporting and Validation for Part of Body (Page 21) © 2007 National Council on Compensation Insurance, Inc.

Part of Body—Course Recap #1 ƒ The appropriate Part of Body code: 9 Identifies the most significant contributor to the overall claim cost 9 Based on information available at the unit report valuation date ƒ Part of Body errors require correction reports—back to all appropriate report levels ƒ Part of Body changes due to loss development are reported on a going forward basis ƒ Use code 65 for “unclassified” Part of Body, but if Part of Body becomes known—submit correction reports going back, and report going forward

Unit Reporting and Validation for Part of Body (Page 22) © 2007 National Council on Compensation Insurance, Inc.

11

Unit Statistical Data Editing and Validation

Unit Reporting and Validation for Part of Body (Page 23) © 2007 National Council on Compensation Insurance, Inc.

Unit Statistical Data Editing and Validation ƒ In preparation for the future class ratemaking usage of Part of Body, several front-end editing and data validation enhancements have been implemented ƒ New edits ƒ Additional Part of Body code edits ƒ All Edits In Production in the online Unit Statistical Reporting Guidebook

Unit Reporting and Validation for Part of Body (Page 24) © 2007 National Council on Compensation Insurance, Inc.

12

Unit Statistical Data Editing and Validation ƒ Current edits: ƒ Identify whether Part of Body is missing or invalid (Data Grade 5—priority/critical error) ƒ Supplemental edits: ƒ Three additional (Data Grade 2—suspect errors) edits will be implemented in the near future

Unit Reporting and Validation for Part of Body (Page 25) © 2007 National Council on Compensation Insurance, Inc.

Future Unit Edit Matrix

Unit Reporting and Validation for Part of Body (Page 26) © 2007 National Council on Compensation Insurance, Inc.

13

Purpose of Part of Body Validation Tests ƒ NCCI’s data validation process helps ensure the quality of unit statistical data prior to its use in state loss cost and rate filings ƒ Identifies suspect data patterns that touch on the Part of Body field ƒ Issues impact ratemaking data under the new methodology

Unit Reporting and Validation for Part of Body (Page 27) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Validation Test: Missing Part of Body ƒ Part of Body is blank or 00 ƒ Total incurred losses are at least $50,000 ƒ Injury Type Codes of 03, 04, 05 and 09 (Permanent Partial and Temporary Total injuries) ƒ Claims with a Data Grade less than a 5 only

Unit Reporting and Validation for Part of Body (Page 28) © 2007 National Council on Compensation Insurance, Inc.

14

Part of Body Validation Test: Suspect Combinations of Part of Body with Nature of Injury ƒ Potentially invalid combinations of Part of Body and Nature of Injury ƒ Only claims with greater than $50,000 total incurred losses will be validated

Unit Reporting and Validation for Part of Body (Page 29) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Validation Test: Suspect Combinations of Part of Body with Nature of Injury - Example NATURE NATURE

PART PART

=

Invalid Invalid Combination Combination

+

Unit Reporting and Validation for Part of Body (Page 30) © 2007 National Council on Compensation Insurance, Inc.

15

Part of Body Validation Test – Suspect Death Claims ƒ Injury Type Code = ’01’ (death) ƒ Part of Body/Nature of Injury combinations that are unlikely to result in death Example: ƒ Death claim due to: PART PART Code: Code:57 57

Toe Toe

+

NATURE NATURE Code: Code:28 28

=

Unlikely Unlikely

Fracture Fracture

Unit Reporting and Validation for Part of Body (Page 31) © 2007 National Council on Compensation Insurance, Inc.

Part of Body Validation Test Large Claim Volumes (Bulk Coding) ƒ Identifies policies where a high percentage of claims are all coded with the same Part of Body, Nature of Injury and Cause of Injury: ƒ Must be at least 10 claims on the policy for a given state ƒ Excludes catastrophes ƒ Excludes the following nature of injury codes: 6066,70,71,73 – occupational disease where it would be unusual to have only 1 claim ƒ Excludes the following part of body codes: 13 (ears), 14 (eyes)

Unit Reporting and Validation for Part of Body (Page 32) © 2007 National Council on Compensation Insurance, Inc.

16

Part of Body Validation Test Consistency Test ƒ Part of Body changes between likely to develop and not likely to develop from one report level to the next ƒ Excludes medical only claims ƒ Three scenarios: ƒ Part of Body changes more than once and total incurred losses are at least $1,000 ƒ Part of Body changes only once, part of body code is not ’90’ or ’91’, and total incurred losses are at least $100,000 at any single report level ƒ Part of Body changes only once, part of body code is either ’90’ or ’91’, and total incurred losses are at least $500,000 at any single report level

Unit Reporting and Validation for Part of Body (Page 33) © 2007 National Council on Compensation Insurance, Inc.

Part of Body—Course Recap #2 ƒ 3 New Unit Reporting Edits (Data Grade 2— suspect errors) ƒ 5 New Validation Tests 9 Missing Part of Body code or “00” coding 9 Potentially invalid combinations of Part of Body and Nature of Injury codes 9 Suspect death claims 9 Large claim volumes with the same Injury Description Code combinations 9 Inconsistent Part of Body code Reporting

Unit Reporting and Validation for Part of Body (Page 34) © 2007 National Council on Compensation Insurance, Inc.

17

DCA Access® Online Notification

Unit Reporting and Validation for Part of Body (Page 35) © 2007 National Council on Compensation Insurance, Inc.

Notification Process Overview Data Provider responds Via Notifications or e-mail

Data Provider opens/reviews the Excel spreadsheet located in Notifications Comments section

Data Provider clicks on Notifications tab & enters Unit Notification ID # identified in e-mail

Process Process Begins Begins

Data Quality analysis/review performed New Notification created

Process Process Flow Flow

Data Provider opens E-mail & clicks blue link to open DCA Access® Online

Notification submitted to data provider via E-mail

Unit Reporting and Validation for Part of Body (Page 36) © 2007 National Council on Compensation Insurance, Inc.

18

DCA Access® Online Notification ƒ Monitor and track status of validation requests ƒ Respond to validation requests ƒ View comments and detailed explanations ƒ Requests sent from and received by one platform ƒ Maintain a history of requests and explanations

Unit Reporting and Validation for Part of Body (Page 37) © 2007 National Council on Compensation Insurance, Inc.

Types of Email Notifications ƒ Initial : Sent Sent to to one one primary primary contact contact Only Only 11notification notificationper perday day System System generated generated Link Link included included in inemail email

ƒ Follow-up emails : May May be besent sentto to others others in inthe thegroup group

Unit Reporting and Validation for Part of Body (Page 38) © 2007 National Council on Compensation Insurance, Inc.

19

Email Notification - Example

Link to DCA Access® Online’s Main Page

Notification ID#

Other ncci.com Notifications in one e-mail

Unit Reporting and Validation for Part of Body (Page 39) © 2007 National Council on Compensation Insurance, Inc.

DCA Access® Online Main Page

Unit Reporting and Validation for Part of Body (Page 40) © 2007 National Council on Compensation Insurance, Inc.

20

Unit Reporting and Validation for Part of Body (Page 41) © 2007 National Council on Compensation Insurance, Inc.

Unit Reporting and Validation for Part of Body (Page 42) © 2007 National Council on Compensation Insurance, Inc.

21

Notification Search Results

Unit Reporting and Validation for Part of Body (Page 43) © 2007 National Council on Compensation Insurance, Inc.

New New New

Unit Reporting and Validation for Part of Body (Page 44) © 2007 National Council on Compensation Insurance, Inc.

22

PLEASE VERIFY IF THE ATTACHED UNIT INFORMATION IS CORRECT AS REPORTED. IF IT HAS BEEN INCORRECTLY REPORTED, PLEASE LOSS CORRECTION (REFER PART SUBMIT 7 - CODING SPECIFICATIONS REPORT(S) THE CORRECT PART OF OF THE TO UREREFLECT WORKERS COMPENSATION BODY, NATURE OF INJURY AND/OR INJURY STATISTICAL PLAN FOR THE LISTING OF TYPE CODE FOR THE NOTED CLAIM(S) AT EACH PART OF BODY CODES AND THEIR REPORT LEVELDESCRIPTIONS.) BY THE ABOVE DUE DATE. IN ADDITION, WE ASK THAT YOU PROVIDE INDIVIDUAL RESPONSES TO EACH LINE WITHIN THE SPREADSHEET IN THE CARRIER RESPONSE COLUMN AND SEND IT TO [email protected].

Unit Reporting and Validation for Part of Body (Page 45) © 2007 National Council on Compensation Insurance, Inc.

Unit Reporting and Validation for Part of Body (Page 46) © 2007 National Council on Compensation Insurance, Inc.

23

Notification Excel Spreadsheet Specific to issue of the test

Unit Reporting and Validation for Part of Body (Page 47) © 2007 National Council on Compensation Insurance, Inc.

Respond here

Unit Reporting and Validation for Part of Body (Page 48) © 2007 National Council on Compensation Insurance, Inc.

24

Unit Reporting and Validation for Part of Body (Page 49) © 2007 National Council on Compensation Insurance, Inc.

Notification Follow-Up Procedures

ƒ Standardization of follow-up procedures ƒ Response expected by requested due date ƒ If no response received, a follow-up courtesy notification will be issued ƒ If no response received after follow-up, issue may be escalated

Unit Reporting and Validation for Part of Body (Page 50) © 2007 National Council on Compensation Insurance, Inc.

25

Available Resources ƒ Circulars (UNITS-2007-02) ƒ Assigned Unit Data Validator ƒ Data Reporting Workshop—January 24 and 25, 2008 ƒ Unit Statistical Reporting Guidebook—By yearend 2007 the Guidebook will provide the Part of Body code reporting instructions ƒ Workers Compensation Statistical Plan Manual

Unit Reporting and Validation for Part of Body (Page 51) © 2007 National Council on Compensation Insurance, Inc.

Part of Body—Course Recap #3 ƒ Identifies the most significant contributor to the overall claim cost—based on information available at the unit report valuation date ƒ Errors require correction reports—back to all appropriate report levels ƒ Changes due to loss development are reported on a going forward basis ƒ Front-end edits and validation tests are being used to improve the overall quality ƒ Validation test results will be sent to you via the DCA Access® Online Notification process ƒ Review circular UNITS-2007-02, and Unit Statistical Reporting Guidebook

Unit Reporting and Validation for Part of Body (Page 52) © 2007 National Council on Compensation Insurance, Inc.

26

Thank you for viewing the Unit Reporting and Validation for Part of Body presentation For For questions questions or or additional additional information, information, please contact our Customer please contact our Customer Service Service Center Center at: at: -- 800-NCCI-123 800-NCCI-123 -- [email protected] [email protected] -- Online Online form form at at ncci.com ncci.com

© 2007 National Council on Compensation Insurance, Inc.

27