| (a) Insurance carriers must submit timely and accurate
claim EDI records to the division. For the purpose of this section,
a claim EDI record is considered accurately submitted when the record:
(1) receives an accepted application acknowledgment
code;
(2) contains accurate claim EDI data, which may be
obtained from all sources, including the report of incident or injury
and the insurance carrier's claim file; and
(3) to the extent supported by the format, contains
all data elements necessary to identify activity on a claim.
(b) Insurance carriers are responsible for correcting
and resubmitting claim EDI records accepted with errors within 30
days of the acknowledgement or other action that required reporting.
The resubmitted claim EDI record must contain the same insurance carrier
claim number as the previously accepted claim EDI record.
(c) The insurance carrier's receipt of a rejection
does not modify, extend, or otherwise change the date the transaction
is required to be reported to the division. The resubmitted rejected
claim EDI record must contain the same insurance carrier claim number
as the previously rejected claim EDI record.
|
