| (a) Insurance carriers must submit claim EDI records
when the insurance carrier:
(1) takes action on or events occur in a claim as described
in §124.2 of this title (concerning Insurance Carrier Notification
Requirements);
(2) corrects division-identified errors in a previously
accepted electronic record as provided in §124.104(b) of this
title (concerning Reporting Requirements);
(3) corrects insurance carrier-identified errors in
a previously accepted electronic record as provided in §124.2(b)(4)
of this title;
(4) discovers that a claim EDI record should not have
been submitted to the division, and the division had previously accepted
the claim EDI record; or
(5) receives a request from the division for claim
EDI records.
(b) Regardless of the application acknowledgment code
returned in an acknowledgment, claim EDI records are not considered
received by the division if the claim EDI record:
(1) contains data, which does not accurately reflect
the code value or actions taken when the insurance carrier processed
information or acted on the claim; or
(2) fails to contain a conditional data element and
the mandatory trigger condition existed at the time the insurance
carrier acted on the claim.
(c) Claim EDI records submitted in the test environment
are not considered received and do not comply with the reporting requirements
of this section.
(d) Claims with a date of injury on or after January
1, 1991, must be reported in accordance with the requirements of this
chapter (concerning Insurance Carriers: Notices, Payments, and Reporting).
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