American Technical Services, Inc.

ATS 2019™

USER MANUAL

FOR

ATS/COMP™

WORKERS’
COMPENSATION CLAIMS ADMINISTRATION MODULE

ATS 2019™
User Manual for ATS/COMP™ Workers’
Compensation Claims Administration Module

First Edition                July, 2019

© 2019 by American Technical
Services, Inc. All rights reserved. No part of this publication may be
reproduced or transmitted by any means without the prior written permission of
the publisher:

American
Technical Services, Inc.

2134 Palm
Harbor Blvd, Suite A

Palm Harbor, FL 34683

Phone: (800) 654-7611

Fax:                 (727) 431-0150

Email:              [email-masked]

Web Site:        http://www.atsrmis.com

Published and printed in the
United States of America.

ATS 2019™ is
a trademark of American Technical Services, Inc.

Windows™ is
a trademark of Microsoft Corporation.

Word for Windows®
is a registered trademark of Microsoft Corporation.

SAP® Crystal
Reports® is a trademark of SAP
SE, Inc.

Table
of Contents

1.           Getting Started.. 1

ATS Documentation.. 1

Documentation Conventions. 1

LOGGING IN To ATS 2019. 1

The ATS Console.. 2

Menu Bar 2

Toolbar 3

Work Area. 3

Status Bar 4

Tiles. 4

ADA Compliance.. 8

Using the ATS Input Screens. 8

Moving Around the Screen. 9

Special Data Entry Features. 9

Numeric Fields. 9

Date Fields. 9

Phone Fields. 10

Zip Code Fields. 10

Check Boxes. 10

List Fields. 10

Required and Read-Only Fields. 10

Searching for Existing Records. 11

Lookup Features. 12

Result Lists. 12

2.           Employees. 14

Entering a New Record.. 14

Saving a New Record. 17

Editing an Existing Record.. 17

Adding an Employer’s Report of Injury or a Claim... 18

Adding an AKA Name.. 18

Entering a New Dependent.. 19

3.           Vendors. 22

Entering a New Vendor Record.. 22

1099 Reporting.. 25

Editing an Existing Record.. 25

4.           Employer’s Report of Injury.. 27

Entering a New Employer’s Report.. 27

Saving an Employer’s Report.. 32

The Print Options. 32

The Notes and Diary Options. 32

New First Report Option. 33

Open First Report Option. 33

Editing an Existing Report.. 33

Batching the Employer’s Report Data.. 34

Promoting a Report of Injury.. 35

5.           Claims. 37

Entering a New Claim... 37

Printing a Claim... 51

Saving a Claim... 51

Opening another Claim... 52

Editing a Claim... 52

Closing a Claim... 53

Using the Claim Tools. 53

AutoPay. 53

Dependents. 54

Diary. 55

Editing Diary Entries. 56

Marking Diary Entries as Reviewed. 56

Forms/Letters. 56

General Payments. 57

ISO Claim Search Export Utility. 57

Medical Fee Payments. 58

Notes. 58

Editing Notes. 59

Creating New Notes. 59

Inserting Attachments. 60

Changing the Filter 61

History. 61

Payment History. 61

Recovery History. 62

Reserve History. 62

Letter History. 63

Audit 63

Reserve Worksheet 64

Decreasing the Reserves. 66

Replacing the Reserves. 66

Special Considerations. 66

Close Claim.. 66

EDI Export Utility. 66

Jurisdiction State. 67

Policy. 67

Restricted Days. 67

Multiple Body Parts. 68

TPOC.. 68

CMS Batch. 68

The Action Types. 68

Add. 68

Delete. 68

Update. 69

EFC.. 70

6.           Finance.. 71

Making General Payments. 71

Saving a Payment 74

Scheduling Auto Payments. 74

Using the Auto Setup of Compensation Button. 75

Using the New Button to Schedule Payments. 76

Saving a Payment Schedule. 77

Calculating the Last Payment 77

Batching Auto Payments. 78

Setup Procedure. 78

Changing the Reserves. 79

Reserve Change Limits. 79

Issuing Credits. 80

A Standard Credit 80

Credit No Check. 80

Entering a Recovery. 81

Voiding Transactions. 82

Checks and Vouchers. 82

Recoveries. 82

Editing Batched Payments. 82

Mode Filters. 83

(Not) Approved. 83

(Not) Exported. 83

Region. 83

Selected Claims. 84

Due Date. 84

Operations. 84

Approve. 84

Delete. 84

Post 84

Release. 84

View.. 85

Reports. 85

Medical Fee Module.. 85

Setup Considerations. 86

Making a Payment 86

Saving the Record. 88

The Bundling and Unbundling Feature. 89

Using Custom Fee Schedules. 89

Printing the Explanation of Benefits. 89

The process home page.. 91

Batch. 91

Mode Filters. 92

(Not) Approved. 92

(Not) Exported. 92

Criteria. 92

Advanced Filter 93

Operations. 93

Approve/Un-Approve. 93

Delete. 93

Post 93

Release. 94

View Button(s) on the grid. 94

Report 94

Export 94

Rebatch. 95

Export 95

7.           History.. 96

Payment History.. 96

Select Button. 97

Report Button. 98

Letter History.. 98

Reserves History.. 99

Recoveries History.. 100

Audit.. 100

8.           Diary.. 101

The ATS Diary.. 101

Changing the Display Order 101

Using the Filters. 102

Viewing Diary Entries. 102

The Supervisor’s Views. 102

Creating Diary Entries. 103

Selecting a Form/Letter 104

Button Actions Menu. 104

Editing Diary Entries. 105

Marking Diary Entries as Reviewed. 105

Printing Diary Entries. 105

Reassigning Diary Entries. 105

Rescheduling Diary Entries. 105

The ATS Calendar.. 105

Diary Setup Considerations. 105

9.           Forms and Letters. 107

10.       Reports. 109

Producing a Report.. 110

Entering the Selection Criteria. 110

Region Code. 110

Level 1 Code. 111

As Of. 111

Entering the Output Specifications. 111

Display Totals Only. 111

Print Level 2. 112

Valued As-of Reporting. 112

The Sort Order 113

Previewing a Report 113

Printing a Report 113

Exporting to Another Format 113

Using the Report Image Option. 113

11.       Dashboards. 114

Viewer.. 114

Designer.. 115

12.       System Tables. 116

TABLE Maintenance.. 117

Organization Maintenance. 119

Region. 119

Levels 1 to 3. 120

Level Type Feature. 124

Sub 2 / Sub 3. 125

Loss Maintenance. 125

Reserves/Payment/Recovery Maintenance. 127

Cost Center Codes. 128

The Grouper Field. 129

Reserve Types. 129

Reserve Change. 129

Recovery Type. 130

Void Types. 130

Late Payment Reasons. 131

Federal/State Withholding. 131

Medical Fee Maintenance. 132

Override. 132

DRG Codes (ICD-9) 132

Initial Treatment 132

HMO/PPO.. 133

Managed Care Organizations. 133

UCR Percentile. 133

Referral Reasons. 134

Provider’s Specialty. 134

Industry Maintenance. 134

SIC – Standard Industry Classification. 134

NAIC – North American Industry Classification System.. 134

NCCI – National Council on Compensation Insurance. 134

NDC – National Drug Code. 134

Occupation. 134

Other Maintenance. 135

Employment Status. 135

Relationship. 136

Location. 136

Litigation Codes. 136

Restricted Duty. 137

State Codes. 137

13.       Index.. 139

Table of Figures

Figure 1‑1: ATS
Console.. 2

Figure 1‑2: Key Map.. 8

Figure 1‑3: Sample Data Input Screen.. 9

Figure 1‑4: Cause Code List.. 10

Figure 1‑5: Claim Search Criteria.. 11

Figure 1‑6: Active Claims List.. 12

Figure 2‑1: Employee Data Input Page.. 14

Figure 2‑2: Employee Search Criteria.. 17

Figure 2‑3: Employee Search Result List.. 18

Figure 2‑4: Employee Also Known As List.. 19

Figure 2‑5: Employee Also Known As Dialog.. 19

Figure 2‑6: Employee Dependent List.. 20

Figure 2‑7: Employee Dependent Data Input.. 20

Figure 3‑1: Vendor Page - General Section.. 22

Figure 3‑2: Vendor Page - Finance Section.. 24

Figure 3‑3: Vendor Result List.. 26

Figure 4‑1: Employer’s Report Page - General
Section.. 28

Figure 4‑2: Employer’s Report Page - Employer
Section.. 28

Figure 4‑3: Employer’s Report Page - Detail
Section.. 29

Figure 4‑4: Employer’s Report Page – Loss
Description Section.. 30

Figure 4‑5: Employer’s Report Page – Loss Codes
Section.. 30

Figure 4‑6: Employer’s Report Page – Medical
Section.. 30

Figure 4‑7: Employer’s Report Page –
Administrator Section.. 31

Figure 4‑8: Employer’s Report Page – Carrier
Section.. 31

Figure 4‑9: Employer’s Report Page – Summary
Section.. 31

Figure 4‑10: Employer’s Report Search Criteria.. 33

Figure 4‑11: Employer’s Report Result List.. 34

Figure 4‑12: Employer’s Report EDI Batch Dialog.. 35

Figure 5‑1: Claim Search Criteria.. 37

Figure 5‑2: State of Jurisdiction Dialog.. 38

Figure 5‑3: Claim Page – General Section (New) 38

Figure 5‑4: Claim Page – Details Section.. 42

Figure 5‑5: Claim Page – Reserves Section.. 47

Figure 5‑6: Reserves Change Reason Dialog.. 47

Figure 5‑7: Claim Page – Medical Section.. 48

Figure 5‑8: Claim Page – Legal Firms Section.. 49

Figure 5‑9: Claim Page – Litigation Section.. 49

Figure 5‑10: Claim Page – Rehab Section.. 51

Figure 5‑11: Claim Selection Screen.. 52

Figure 5‑12: Selected Claims List.. 53

Figure 5‑13: Auto Pay Screen.. 54

Figure 5‑14: Auto Pay Setup Screen.. 54

Figure 5‑15: Claim Diaries List.. 55

Figure 5‑16: Claim Diary.. 56

Figure 5‑17: ISO Export Utility.. 57

Figure 5‑18: Claim Notes List.. 58

Figure 5‑19: Claim Notes Report Format.. 59

Figure 5‑20: Note Entry Dialog.. 60

Figure 5‑21: Note Attachment Dialog.. 61

Figure 5‑22: Claim Payment History.. 62

Figure 5‑23: Claim Recovery History.. 62

Figure 5‑24: Claim Reserve History.. 63

Figure 5‑25: Claim Letter History.. 63

Figure 5‑26: Claim Audit.. 64

Figure 5‑27: Reserve Worksheet.. 65

Figure 5‑28: EDI Batch Screen.. 67

Figure 5‑29: EFC – Document Manager.. 70

Figure 6‑1: AutoPay Screen.. 75

Figure 6‑2: AutoPay Setup.. 75

Figure 6‑3: Sample Explanation of Benefits. 90

Figure 6‑4: Process Home Page.. 91

Figure 6‑5: Batch Mode Filters. 92

Figure 6‑6: Advanced Filter.. 93

Figure 6‑7: Operation Buttons. 93

Figure 6‑8: Grid View Buttons. 94

Figure 6‑9: Rebatch Payments Screen.. 95

Figure 6‑10: Payments Grid.. 95

Figure 7‑1: Claim History - Payments. 97

Figure 7‑2: Claim History - Payment Detail.. 97

Figure 7‑3: Claim History - Payment Report.. 98

Figure 7‑4: Claim History - Letters. 99

Figure 7‑5: Claim History - Reserves. 99

Figure 7‑6: Claim History – Recoveries. 100

Figure 7‑7: Claim History – Audit.. 100

Figure 8‑1: Diary Activity List.. 101

Figure 8‑2: Diary List Filter.. 102

Figure 8‑3: Diary Entry Screen.. 103

Figure 8‑4: Diary Attachment Dialog.. 104

Figure 9‑1: Forms and Letter List.. 107

Figure 9‑2: Sample Generated Form... 108

Figure 9‑3: Form Output Options. 108

Figure 10‑1: Reports – Home.. 109

Figure 10‑2: Reports – Account Selection.. 110

Figure 10‑3: Reports – Activity Summary Report
Sample.. 110

Figure 10‑4: Reports –Activity Summary Parameter
Entry Example.. 111

Figure 11‑1: Dashboard Viewer.. 114

Figure 11‑2: Dashboard Designer.. 115

Figure 12‑1: Table Maintenance – Table Selection.. 118

Figure 12‑2: Table Maintenance – Table Contents
List.. 118

Figure 12‑3: Table Maintenance – Sample Editor
Screen.. 119

Figure 12‑4: Organization Maintenance – Level 1
Entry.. 122

Figure 12‑5: Loss Maintenance – Cause Code Entry.. 126

Figure 12‑6: Payment Maintenance – Cost Center
Code Entry.. 128

1.
Getting Started

This chapter covers the common
features in ATS 2019. It explains how to use the various items you see in the
main window, the ATS input screens, and the selection dialogs. Other chapters
will guide you through the specific tasks you will be performing.

The ATS Workers’ Compensation
Claim Administration module (ATS/COMP) is one of the most powerful applications
on the market for administrating workers’ compensation claims, yet it’s easy to
use. Data entry screens have been tailored to meet your requirements. On-line
help is available if you have a question. Whatever your job entails, you will
find that the system streamlines your workflow so that tasks get done quickly
and efficiently.

ATS Documentation

This manual provides a complete
description of the tasks that you can perform in the ATS/Comp system. Use it as
a reference when you want to know how to use a specific feature.  Technical information for the system
administrator is documented separately.

Documentation Conventions

The ATS manuals are designed to help you learn how to use
the system quickly and efficiently. Each chapter begins with a brief overview
of its contents. The remainder of the chapter discusses the features in depth.

The following conventions are used to identify special
information:

Italics

Specialized
terms and titles of other books, chapters or sections in this manual.

Arial

Specific
names of pages and dialogs.

Open

Specific
names of buttons.

New Claim

Specific
menu item selections, dialogs .

<Ctrl>+X

Keys
that are used together as shortcuts to perform a specific operation. For
example, <Ctrl>+P means hold down the Control key while pressing P.

<Key>

Special
keys such as the Tab key which is shown as <Tab>.

Important
information related to the current topic.

LOGGING IN To ATS 2019

ATS/COMP is a browser-based
application so you can launch the system by selecting the option from your list
of Favorites in your browser or double-clicking the ATS 2019 icon on your
desktop.

The ATS Login page provides secure access to the system.
Each user must enter a Username and Password to gain access. In addition, if
your organization has multiple instances of ATS 2019 running, you will need to
select the Server too.

When all items are entered or
selected, clicking the Log In button will validate your credentials and, if
valid, log you into the system and will usually display the Console page. If your system is configured to require
password changes on a regular basis, you may be directed to a password change
page when you log in.

It
is important to note that your login account could be configured to bypass
the Console and display a different page.

The ATS Console

The main window that appears
after login is referred to as the ATS Console because console is a synonym for "control
panel".  Regardless of whether you
use one or all of the ATS products, the ATS Console will appear as the primary
access point for the system.

Figure 1‑1: ATS Console

The Console page consists of four (4) major components;
the Menu Bar, the Toolbar, the Work Area, and the Status Bar.

Menu Bar

The Menu Bar is located at the top of the page and provides
access to major sections of the system, depending on your security settings.

The available menu options are as follows:

Menu Option

Description

Dashboards

Provides
access to interactive dashboards that provide analytical information about
the contents of the database(s).

Diaries

Displays
the workflow diary items for the user and, if a supervisor, the diary items
of subordinates.

Processes

The
functions that generally affect multiple claims simultaneously, such as
reviewing payments in batch and/or printing them.

Reports

Provides
access to a wide variety of reports that include claims analysis,
statistical, financial, and more. It also provides access to a general
purpose tool for performing ad hoc queries against the ATS database(s).
Knowledge of SQL is required to use this feature.

Documents

A
repository for documents related to claims, incidents, first reports, etc.
Documents can be in a wide variety of formats, such as; Word (.doc/.docx),
Excel (.xls, .xlsx), Adobe (.pdf), Text (.txt), Graphics (.jpg, .gif, .png,
etc.) and many more.

Maintenance

Allows
users to maintain the look-up tables that the system uses for organization
codes, loss codes, etc.

Administration

The
features that allow administrators to configure the system-wide options that
affect how the system will look and function, and features that are used to
maintain the security settings for Users and Groups.

When you click any of the options on the Menu Bar it will
open a new tab or window (depending on your settings) with the selected component.

Toolbar

Toolbars in ATS 2019 contain tools, represented by icons and/or
text, that provide access to processes and features associated with the current
page or that act upon a selected item on the current page. The name of the
current page is also displayed on the left side of the toolbar.

The following tools are available on the Console toolbar:

Icon

Tool

Purpose

Manage Tiles

Opens
the tile selection screen to add or remove tiles from
the work area.

Settings

Opens
the settings dialog for the current screen.

Help

Opens
the Help file associated with the current page.

Work Area

The Work Area of the Console page displays one or more Tiles. Each tile provides access to different information and
functionality, such as; menus, claim lists, recently accessed items, diaries,
email, system notices, graphs, statistics, and more.

The Work Area is fully configurable and you can modify it to
meet your specific work requirements. The layout of the Work Area is like a
grid. It can have from one (1) to five (5) columns and any number of rows. You
can also set the width of each column.

Status Bar

The Status Bar displays messages on the left side. The right
side displays the name of the database that you are connected to and the name
of the user that logged in.

Tiles

A
Tile is a small
window that provides access to a particular set of functions. For example, Menu
Tiles contain menu options that allow you to easily access a particular
feature, such as entering a New Claim record or running a report. All tiles can
be expanded to a full screen for easier viewing and, in some instances,
additional capabilities.

The following lists various Tiles available with ATS/COMP that
are available at the time of this writing; however, new Tiles are being
developed as time goes on.

Tile

Tile Description

The System Notices Tile displays general interest messages that have
been created by authorized users and/or informational messages from the
system, such as workflow task assignments and other reminders.

The
expanded page allows you to view all recent messages or notifications.

The Open Claims Tile shows a list of all open claims that are
assigned to the current user. Clicking on an item will open the associated
claim record.

The number of entries displayed can be set
by the user.

The
expanded page shows the entire list of open claims assigned to the user.

The Recently Accessed Tile shows a list of the most recently opened
claims for the current user, in reverse chronological order. Clicking on an
item will open the associated claim record.

The number of entries displayed can be set
by the user.

The
expanded page shows the entire list of recently accessed claims.

The WC Reserves Dashboard Tile provides a quick view of the overall
reserves set for the Workers’ Compensation claims in
the system.

The
expanded page displays an interactive graphical dashboard that provides more specific information on
the reserves.

The WC Claim Types Dashboard Tile provides a quick view of the breakdown
of claims by type for the Workers’ Compensation claims in the system.

The
expanded page displays an interactive graphical dashboard that provides more specific information for
each claim type.

The Open Claims Dashboard Tile provides a quick view of the overall
number of currently open claims in the system, of each type.

The
expanded page displays an interactive graphical dashboard that provides more specific information on
the breakdown of each type of claim.

The Email Tile integrates with your email
system to provide a list of current items in your inbox. Individual items can
be opened and read. New email messages can also be created.

The
expanded page provides access to a fully functional email manager that
includes a calendar, task list and more.

The Diaries Tile provides a list of Diary/Workflow entries
that are assigned to the current user. Entries are listed in chronological
order by due date. Diaries can be opened, reviewed, marked as complete from
the tile and new Diary entries can be created.

The
expanded page provides a complete list of all diaries for the current user
and, if authorized, show diaries for members of a group.

The WC Average Claim Cost Tile displays a
graph that compares current, recent and historical cost data.

The
expanded page shows a larger view of the graph.

The WC Injury Date Tile displays a graph that shows the
frequency of injuries by month.

The
expanded page shows a larger view of the graph.

The WC Indemnity Reserves Tile displays a graph that compares
Reserves, Paid-to-Date, and Future Reserves for all open claims.

The
expanded page shows a larger view of the graph.

The User Menu Tile allows you to create a
menu that contains only the menu items you select. You can add as many or as
few items as you choose, in order to make your job as efficient as possible.

The
expanded page displays the menu in a larger area.

The Workers’ Compensation Menu Tile
contains all available menu items for the module.

The
expanded page displays the menu in a larger area.

The WC Events Menu Tile contains only those
menu items that are located on the Events tab of the Workers’ Compensation
menu.

The
expanded page displays the menu in a larger area.

The WC Processing Menu Tile contains only
those menu items that are located on the Process tab of the Workers’
Compensation menu.

The
expanded page displays the menu in a larger area.

The WC Report Menu Tile contains only those
menu items that are located on the Reports tab of the Workers’ Compensation
menu.

The
expanded page displays the menu in a larger area.

The WC Maintenance Menu Tile contains only
those menu items that are located on the Maint tab of the Workers’
Compensation menu.

The
expanded page displays the menu in a larger area.

The WC Administration Menu Tile contains
only those menu items that are located on the Admin tab of the Workers’
Compensation menu.

The
expanded page displays the menu in a larger area.

ADA Compliance

ATS products are ADA compliant
so the menu options can be selected using the keyboard instead of the mouse.
The list of keys available in the current window may be displayed with the Key
Map button in
the right pane by pressing <Ctrl>+K.  There are actually two lists.

Figure 1‑2: Key Map

The first one lists the keys
that may be used to access the options in the Navigation pane. The Page keys
are the ones that may be used in the Selection pane.  Since the items on the screen change
depending on where you are in the system, the keys on the list will also
change. Those listed below are available from the Explore window.

Some menus and commands appear
only in certain parts of the system. The options on the menus that are unique
to the Navigation pane in ATS .Net are described below.

Using the ATS Input Screens

This section will cover the
common features found in the ATS .Net input screens. The sample below is the
standard screen used to enter Vendor information.
Since ATS screens may be customized, there will be times when the screen
on your system looks different than the one in this manual

Figure 1‑3: Sample Data Input Screen

Moving Around the Screen

To move through the fields or edit boxes on the screen, use
the <Tab> or <Shift>+<Tab>
keys or go directly to a specific field by clicking it with the mouse. Screens
with multiple sections will have a special banner for each section to assist
you in finding and/or entering information. To move to a specific section, scroll
up or down the page or press <Alt>+<n> where n is the number of the section.

Special Data Entry Features

Normally, the input fields
appear as white boxes on the screen. The majority of these are text fields such
as those used to enter an address. Any printable character is considered valid.
Depending on the field’s properties, letters will either appear as they are
typed or transformed to upper case.

Numeric Fields

Numeric fields such as the employee’s wage will only accept
numbers, commas, and periods (decimal points). All other characters are
ignored.

Date Fields

Dates may be entered in a MMDDYY or MMDDYYYY format.  Typically, the program will assume dates in
the MMDDYY format are in the 21st century unless the date would be more than 25
years in the future.  The slashes are
automatically displayed as you enter the date.  You may also click the key next to the field
to pick the desired date from a calendar.

Phone Fields

When phone or fax numbers are entered as ten digits such as
4101234567, the program will automatically display the formatted number as 1+
(410) 123-4567 where “1+” is the international dialing code for the United
States. Enter the appropriate code if the number is for a foreign country.

Zip Code Fields

ATS programs will recognize zip codes in the United States
and fill in the corresponding city, county, and state.

Check Boxes

Check boxes have replaced the Yes/No fields. Simply click
the box to check it and indicate “Yes”.

List Fields

Since data entry speed and accuracy is important, selection
lists are provided when a code is to be entered. Click the button next to the
field to display a selection list like the one for cause codes shown
below.  The list will display the
name/description of the item on the screen, followed by the code in parentheses.
(It’s the code that is saved, not the description.) (Pages for maintaining lookup
tables are accessible through the Maintenance option on the Menu
Bar.)

Figure 1‑4: Cause Code
List

Required and Read-Only Fields

Normally, required fields are displayed in yellow or red. In
the sample input screen, the vendor’s search name field is
required. A message will appear in the title bar if the name is missing when
you try to save the record.

In some cases, the program will update certain fields on the
screen. These are referred to as read- only fields. There are some of these on
the Vendor’s Detail page. If you use ATS to produce the MISC-1099 forms, the program will write the amounts paid
in the claim. Users can not modify these values.

Searching for Existing Records

Note the Search In section on the right side of the screen
shown below.  If you have multiple
datasources, this feature allows you to indicate the one(s) you want to use.
When “All Datasources” is selected and you pick a claim (on the list of possible
matches), the program will automatically make the datasource active that is associated
with the claim. Only one datasource (DEMO) has been activated in our example.

Your
company’s hierarchy may be divided into regions for tracking and reporting
purposes. In that case, you may only have the right to access the claims in
one or more of them. The program will display “Region Restrictions”.

The ATS .Net system provides you with a variety of ways
to find an existing record.  The screen
below illustrates how you might enter the criteria to search for a claim. Each
item has a drop-down list of operations that can be used to qualify your search
criteria. For example, selecting Starts With from the drop-down and entering
the letter “A” in the Claimant Name field will return a list of all claimants
with names that begin with the letter “A”. However, if you had selected
Contains from the drop-down will list all claimants that have an “A” anywhere
in their name. Note that the more criteria you use, the shorter the list of
matches is likely to be.

Figure 1‑5: Claim Search Criteria

When you are ready, click the Search button or press <Enter>.
Unless you have entered a specific claim number, the program will display a
list of choices that match your search criteria.

Lookup Features

You can look up existing records by entering:

1.
A specific value for an item.  Selecting “Is Equal To” and typing “ATS” as
the adjuster will display a list of claims for that user.

2.
Characters that start, end, or exist somewhere
in the data.

3.
A wildcard. The percent symbol (%) may be used
to indicate one or more characters. For example, entering “%” as the claimant
name will list all claims regardless of the name. The underscore (_) represents
a single character. For example: M%N will search for names that start with M
and end with N; however, M_N will look for names that begin with M and end with
N with one character in the middle.

4.
A loss between two dates as shown above.

Result Lists

The program will search through the datasource(s) using the
selection criteria and display a list of records that match your specifications
as illustrated by the example shown below.

Figure 1‑6: Active Claims List

The arrow keys underneath the File menu allow you to
look at other pages of possible matches when there is more than one.  This snapshot shows that you are on page one
of sixteen.

Click on any of the column headings to sort the list by the
data in that column.

You can enter a value into the textbox at the top of a
column to filter the records. Only records that match the value entered will be
displayed.

Page navigation controls are located at the bottom of the
page. You can go to the next or previous page by clicking the buttons on either
side of the page numbers or you can click on one of the page numbers to go
directly to that page.

You can use the Page Size control to set the number of
entries to display on a page.

2.
Employees

The employee must have a record in the ATS System before a
claim or an employer’s report of injury can be entered for the individual.  The
Employee  program
is available  after  selecting
the  Explore  menu
and  clicking  the
Employee  tab  on
the  Worker’s Compensation menu.

Note that if your company has
another software package that tracks employee information, a custom interface may be
provided to import relevant data into the ATS System in order to save time and
ensure that the data is accurate.

Entering a New Record

Users
with appropriate access rights may enter employee records. You can use the New Employee item on a menu or the Open button on
the Employee
List to open the Employee data input page.

The standard screen used to
track employee information is shown below with a sample
record. Since the ATS System allows screens to be tailored to meet your organization’s
requirements, your screen may look slightly different.

Note the fields related to the
direct deposit feature will be hidden unless the user has the
authority to use this feature.

Figure 2‑1: Employee Data
Input Page

The individual fields on the
form are described as follows. Note that as soon as you enter the SSN, the program will search for
an existing record with that SSN and display “Processing” at the top of the
screen. If one is found, that record will be displayed.

Field Name

Description

SSN

This is a required field. New employees will automatically be assigned a number such
as UNK00000028. When you type over this number, the program will insert
dashes if necessary, check to see if a record with that SSN already exists and, if so, display it on the
screen.

If you are not sure of the SSN, we recommend that
you use the “UNK” number and edit the record when you have the
information.  Any existing claims will
be updated when the record is saved.

Note
that during a data conversion, a “UNK” number is assigned when the SSN is missing or invalid. This feature makes it
easy to find the records that need to be updated.

Last Name

The
employee’s first and last
names are required. This should be the name the person is known as. There are
other fields for their legal name.

First Name

If
a person changes his or her name, use the AKA feature to keep track of the previous
name(s) so the claim and employee records can be looked up by either one. For
details, refer to the AKA section. Note that is feature is in development so
it may not be available in your current version.

Middle

A
middle initial if any.

Address

Enter
the address and the zip code. The program will automatically fill in the
correct city, county, and state if the zip code is in the United States.

Phone

Phone
numbers entered as 10 digits such as 4101234567 will be displayed as 1+ (410)
123-4567 where the “1+” is the international dialing code for the United
States.

Birth Date

The
employee’s date of birth. Enter the date in
an MMDDYYYY format. The program will insert the slashes.

Sex

The
employee’s gender.

Marital Status

The
employee’s marital status
may be selected from the drop-down list or entered using the appropriate code
where M=married, S=single, D=divorced, and W=widowed.

Hire Date

The
date of employment.

Term Date

The
employee’s termination date
if any.

Last Transaction

The
ATS system will track changes made to fields in the employee record if a system administer has set them
up as transactional. The program will display the last date one of the
transactional fields was changed for informational purposes.

Wage

The
employee’s wage during the
specified pay period.

Pay Period

The employee’s pay cycle may be
selected from the drop-down list or entered using the appropriate code where
H=hourly, D=daily, W=weekly, B=bi- weekly, M=monthly, and A=annual.

Note:
When a claim or First Report of Injury is entered for the employee, the program will
calculate the average weekly wage and write it into the record so it can be
used to determine the employee’s benefit rate.

Exemptions

The
number of exemptions is an optional field used to calculate any taxes
withheld  when making benefit payments
in the A&S Disability product. (The same employee screen is used for both.)

Dependents

The ATS
System will update this field and
display the total number of dependents for the employee as records are added and/or removed. The
number may not be edited. (See the Dependents section.)

Note: The Dependents module may be used when

1.  The employee's wages have been
garnished and a lien needs to be set up (e.g. child
support).

2.  The number of dependents affects the
Workers' Comp benefit rate.

3.  There is an additional claimant for a
Medicare beneficiary who is deceased.

# Claims

The
program will increment this value as claims are entered for the employee. This field may
not be edited.

CMS Beneficiary

A check in this box indicates that the
employee is a Medicare beneficiary.

Normally,
the check is entered by the program that processes the CMS Query Response file.

HICN

The
Medicare health insurance claim number will be filled in with the data in the CMS Query Response file.

Last Name (SSA)

First Name (SSA)

Middle Initial

The
employee’s name as known by
the Social Security Administration if
it’s different than the one used in the rest of the Worker’s
Compensation system. If the employee is a Medicare beneficiary, this name will be sent when
submitting a report to the CMS (Centers for Medicare and Medicaid
Services).

Division

Dept

Sub

The levels that indicate where the employee works within the company’s hierarchy are
called Division, Dept, and Sub by default. These labels have probably been
changed on your screen.

Levels may be entered in the following ways
depending on how your system has been set up:

1.
Pressing the Ellipsis button in any level field will display a list of
all the available entries. This is the default.

2.
If the Level 1 and 2 fields are blank, you may be able to enter a Level 3 to
have the program automatically fill in the associated levels.

Occupation

The
employee’s occupation.
Press the Ellipsis button for a list of choices.

Employment Type

The
employee’s status such as
full-time and part-time. Press the Ellipsis button for a list of choices.

Employee #

The number assigned to the employee by the company. It may be entered in the
Employee Selection dialog to look up a record.

This
ID number may be used to ‘identify’ the employee in certain cases where the SSN may not be displayed for privacy reasons.

Supervisor

The
name of the employee’s supervisor.

Notes

A
short note pertaining to the employee. For example,
“Employee hired for project number J3466”.

Direct Deposit

Direct deposit is an optional,
add-on module. A check in this box indicates that the employee wants his/her benefit payments deposited
directly in the bank. Depending on the user’s security settings, these fields
may not be visible.

Routing Number

The bank’s routing number.

Bank Account

The employee’s bank account
number.

Saving a New Record

The program will display a message
indicating that the record has been saved successfully. At that time, the
employee’s name and SSN or ID will be displayed in the window’s title
bar. If you have skipped over any of the required fields, the “Required fields
missing” message will appear. Enter the data. When you are done, save the
record again.

Editing an Existing Record

The Employee menu provides a number of options to find the
record you want to view and/or modify. The first option, the Selected Employees
search, lists a variety of criteria you can use to quickly find the record. The
standard list is shown below. The criteria on your system may be different.

Figure 2‑2: Employee Search Criteria

There are other ways to look up
records. The options are as follows:

Menu

Function

Claimants

Lists
all claimants with claims where the Adjuster is the current user. Current Employees Lists
all employees that are currently working for the organization.

Current
Employees

Lists
all employees that currently work for the organization.

Inactive
Employees

Lists
all employees that have left the organization (i.e. a Termination Date
exists).

All
Employees

Lists  all
employees  whether  or
not  they  are
currently  working  for
the organization.

Figure 2‑3: Employee Search Result
List

Note that if the Region by Level feature has been implemented and Region View has been set, you will only be able to see a
list of the employees in your specific region.

However you find the employee, make the desired changes.
When you are done, save the record and exit the program.

If a system administrator has
set the Query Employee Changes flag using the Module Parameters screen, the
program will check the employee’s name, address, phone,
supervisor, birth, and/or termination date. If any information has changed, you
will be asked if the individual’s claims and reports of injury should be
updated.

When
an employee’s social security number is changed, all the appropriate tables
will be updated automatically.

Adding an Employer’s Report of
Injury or a Claim

Some
employees sustain a number of injuries while they work for a company.  If you need to enter a report for a person
that already has an existing employee record, we recommend that you edit the record
to make sure that the information is current. When you are finished, you may use
the New Employer’s Report button to continue.

The
same suggestion applies when you need to enter a claim. When you are finished
verifying that the employee’s data is up to date, you may
use the special New Claim button to continue.

Adding an AKA Name

People are often known by more
than one name. The name in the employee’s record and their open
claim(s) should be the same as it is the one that will appear on all payments
issued to the employee.

Any other name the employee uses should be entered as an alias using the
AKA feature.  For example, a woman often takes her husband’s
name when she gets married.  In that
case, you should enter her new name in the Last Name field and her maiden name
as the alias.  After that you will be
able to find the employee and the associated claim records using either name.

The
Employee data entry
page contains an AKA button.
Clicking the button opens the Also Known As list. The list
shows all of the AKA entries for the employee.

Figure 2‑4: Employee Also
Known As List

Click the new
button to open the AKA data input
dialog.  Enter the alias and save
the record.  Now you can search by both
current and alias names.

Figure 2‑5: Employee Also
Known As Dialog

Entering a New Dependent

There are a number of reasons
for creating dependent records. Some of them are:

1.
The employee was a Medicare beneficiary and is now deceased.  Dependent records must be entered for any
“Additional Claimants”
that need to be submitted to the CMS (Centers for Medicare and Medicaid Services).

2.
The individual wants to attach a lien to the
employee’s payments or be considered when calculating the
benefit amount for a claim.

3.
The individual is the employee’s beneficiary and entering
the person as a dependent will simplify the payment process for a fatality claim.

To
enter a new record or modify an existing one, click the Dependents button to display the Dependents
List.

Figure 2‑6: Employee Dependent List

Click on the new
button.  The following screen will
appear.  Enter all pertinent data and then
click Save.  The
dependent record is now available to use.

Figure 2‑7: Employee Dependent
Data Input

The fields on this screen are
described as follows:

Field Name

Description

SSN

A
valid SSN should be entered for the individual.

Last Name

First Name

M.I

The complete name if the dependent is an individual.  If the dependent is an estate, enter “The
Estate of <employee>”, “the Family
of <employee>” or “The Trust of <employee” depending on the entry in
the Relationship field. In any case, leave the other name
fields empty.

Address

The
individual’s address, city, state, and zip code

Phone

The
individual’s phone number.

Birth
Date

The
individual’s birth date is important if the state of jurisdiction for the employee’s claim has an age
limit for tacking deductions for dependents (when calculating the benefit
rate).

Gender

The
individual’s gender if relevant.

Relationship

The dependent’s relationship to
the employee.  The valid options are:

F
= Family Member, Individual Name Provided

O
= Other, Individual Name Provided

X
= Estate, Entity Name Provided (e.g. "The Estate of John Doe")

Y
= Family, Entity Name Provided (e.g. "The Family of John Doe")

Z
= Other, Entity Name Provided (e.g. "The Trust of John Doe")

Student

A
check indicates that this individual is a student.

100% Dependent

A
check indicates that the dependent is to continue being on a claim’s eligible
list regardless of age.

Additional CMS Claimant

This
number from C1 to C4 must exist in the record in order for the dependent’s data to be
submitted to the CMS.

Type
of Rep

The type of representative for the
dependent.  Valid choices are:

·
Guardian/ Conservator

·
Attorney

·
Power of Attorney

·
Other

Name

Address...

The
rest of the fields for the representative are self-explanatory.

Saving a new record (or deleting an existing one) will
update the # of Dependents for the associated employee.

3.
Vendors

Any individual or company that
provides a service associated with a claim is considered a vendor in the ATS system. If you use some other
software package that tracks vendors, your system may be customized to import
the relevant data to save time and ensure accuracy.

Entering a New Vendor Record

Operators with the appropriate
access rights may use the Vendor tab to enter a new record. The first of the
two sections is shown below.

Figure 3‑1: Vendor Page - General Section

The first section (General) contains
general information on the vendor. The fields are described as
follows:

Field Name

Description

Tax
ID

Although any code may be entered for
tracking purposes, a valid federal ID or social security number must be
entered if a 1099 will be filed.

The
ATS system often refers to a vendor code which is the tax ID, an asterisk, and
the location code if any. In the example above, the vendor code is
77-7878787* since the location code is blank.

Location Code

A code should be entered when a vendor has multiple locations that use the same tax
ID. For example, a medical clinic with several offices may have one tax ID
and a unique location code for each office.

When looking up an existing record, enter
the tax ID into the Vendor Selection dialog and all of the locations with
that number will be listed.

Note:
This field is also referred to as the Alternate Vendor Code.

Search Name

The
name to be used for lookup purposes. If the vendor is an individual such as John Brown, we
recommend entering a Search Name as “Brown, John” so that the record is
easier to find. In that case, the person’s real name should be specified as
the Print Name to be displayed on a check or voucher.

Address

The
complete mailing address. A second line may be used if necessary.

City

The
vendor’s city.

State

The
vendor’s state code.

Zip

The
zip or postal code.

District

The
district or region where the vendor is located.

Country

The
code for the country where the vendor is located if outside the US.

Phone

Fax

The
vendor’s phone and fax
numbers.  Enter 10 digits such as
4101234567 and the program will display 1+ (410) 123-4567 for a US number.

E-mail

The
vendor’s e-mail address.

Contacts

The
name of a contact person or two.

Active

A check indicates that the vendor is active. If the box is unchecked, the
Payment program will not allow payments to be issued to the vendor.

Since
vendor records are normally kept in the system for
historical purposes, we recommend that you use this feature to indicate that
the vendor is inactive instead of deleting the vendor’s record.

Reason

The
reason why the vendor is considered inactive may be entered when
needed.

Rsv
Category

Pay
Code

The
default reserve category and pay code to use when making payments to the
vendor. For example, if
the vendor is a hospital, enter “2” or Medical as the reserve category and
the appropriate pay code. The fields will be automatically filled in when
making payments to the hospital.

Filter

The
Claims program will use this code to generate the
lists that appear when selecting vendors. If an “A” (attorney) is entered,
the vendor will only appear when selecting a legal firm
for the claimant or defense.  When an
“P” is entered, the vendor will only be listed as a medical or rehab
provider.

NPI

The
National Provider Identifier assigned to medical care providers.

Biller ID

A
code or number assigned to the vendor by the accounting department.

DBA Name

The
“doing business as” name should be entered for vendors classified as
individuals for 1099 reporting purposes.

Print Name

The
name to be printed on payments made to this vendor. If this field is
empty, the Search Name will be used.

State/Federal
Levy

Check
the box if the Payment program should display a message indicating that the
vendor has a state or federal lien.

Specialty

Press
the Ellipsis button to select from a list of available codes.

Examiner #

The
medical examiner number required in certain states such as Florida.

Work Status

A
special field used in the PERI Interface. If this data is required by the
PERI Data Exchange, press the Ellipsis button to select from a list of
available codes.

Direct Deposit

Check
this box if the vendor is to receive payments electronically.

Routing Number

The
routing number for the vendor’s bank.

Bank Account

The
vendor’s bank account
number.

The second screen contains the information needed to produce
the 1099-MISC
returns. The rest of the fields are used in the optional Medical Fee - Bill Review module.

Figure 3‑2: Vendor Page - Finance Section

The fields in the Finance section
of the page are described as follows:

Field Name

Description

W-9 on File

Check
this box if the W-9 is on file.

W-9 Expiration

The
date the current W-9 expires.

Class

Exempt
indicates that the vendor should not receive a 1099. If you file your
1099s electronically, enter Individual if the vendor's tax ID is a social
security number, otherwise it will be reported as a federal ID. In either
case, the program will strip out all dashes and report a nine digit number.

Primary
Vendor

If
there is more than one vendor with the same tax ID but different location
codes, use this field to indicate the Primary Vendor that should get the 1099.

Name
Control

Filing
Electronically: The name control should be the first four significant letters
of the name excluding spaces and titles such as Mr. and Dr.

2nd
TIN Notice

A
check indicates that you have received two notices within three years stating
that the vendor's tax ID is
incorrect. The 1099 program will also check this box on the form
so the IRS will not send any further notices regarding this vendor.

Special
Data

Filing
Electronically: This field may be used to enter special data to be included
when using the 1099 Combined Federal/State Filing program.

1099 Year

The
1099 Accumulation program will enter the year to
be reported.

1099 Other

1099 Legal

1099 Med

1099 Misc

The 1099 Accumulation program will update the 1099
Other (Income), Legal, Medical and Misc (Non-employee Comp) fields with the payments for pay codes
that have 3, C, 6, or 7 as the 1099 Type value.

Refer
to the 1099 Reporting Information below to find out
which record gets updated when there is more than one vendor with the same tax ID.

Service
Zip

The
zip code where the vendor provides service.

HMO/PPO Info

Press
the Ellipsis button for a list of valid HMO/PPO providers. Selecting a code will
automatically display the description and the range of dates when valid. Up
to four may be used when making payments to the vendor with the Medical Fee module. The program will check to see if
there is an HMO/PPO that covers the From Date in the payment record. If so, the program will use the
alternate rate table for the HMO/PPO when reviewing the billed items.

Facility

The
type of facility when it affects the repricing of medical bills.

Vendor Type

The
type of vendor to use for DOH filing purposes.

PPS Exempt

Check
this box if the vendor is exempt from PPS.

Paid
as Billed

Check
this box if medical bills should NOT be reduced for some reason (e.g. the
vendor is under the Maryland Health Services Cost
Review Commission).

Notes

Any
notes regarding the vendor.

1099 Reporting

A medical clinic with several
offices may use one tax ID and a unique location code for each office. When the
1099 Accumulation program is launched with the
Combine Vendor option, the first record for the vendor is normally used by default. In this example,
the one with the blank Location would be considered the primary vendor to
receive the 1099. (When sorted, numbers come before letters.)

Tax ID

Location

1099

94-1234567

YES

94-1234567

110A

NO

94-1234567

ABC

NO

If the primary vendor is not the first record, check the Primary
Vendor box so it
will be updated by the 1099 Accumulation program.

Editing an Existing Record

The Vendor menu provides a
number of standard options that will return pre-defined results lists based on
the value of the Filter field on the Vendor record or some other criteria.

·
Medical Providers (Vendors with a Filter = “P”)

·
Attorneys (Vendors with a Filter = “A”)

·
Pharmacies (Vendors with a Filter = “R”)

·
Other Vendors (Vendors with a Filter = “O”)

·
All Vendors (Vendors on claims where the current
user is the adjuster)

Optionally, Selected Vendors
can be used to locate the record you want to view and/or modify.  The Selected Vendors page displays a number of
fields for input of search criteria that will be used to find matching records.
By default the system looks for active
vendors.  If you need inactive vendors,
change the active filter in the list to “NO”.

Note that the following example
uses the standard result list. The one on your system may be different.  The search and filter features on the results
list page can be used to further narrow down the results.

Figure 3‑3: Vendor Result List

If the Tax ID or Location is changed, every payment made to the vendor will be updated for (1099) reporting purposes, even
those that are still in batch.  Any
batched payment will also be updated when the address is modified. In that
case, the historical payments will not be changed.

4.
Employer’s Report of Injury

The Employer’s Report of Injury module is an optional, add-on module
designed to assist you in filing a First Report of Injury (FROI) with the State. The module
allows you to:

·
Create a new report according to the state’s
current specifications and format.

·
Print the report and/or write selected fields to
an export file to be sent electronically to the state.

·
Determine whether adequate safeguards and
equipment were provided and if the employees used the safety measures.

·
Promote the report when a claim has been filed
to eliminate having to retype the relevant information.

Entering a New Employer’s Report

Creating a report is a simple
process. To begin, select New
FROI from a menu or click the New
button on the Employer’s Report result list.
When the Select Employee screen appears, use any of the lookup options
to find the desired record.

A record for the employee must
exist before a report of injury can be entered. If a record is not found, the
Employee must be
added.

The next step is to indicate
the state of jurisdiction. The employee’s state is
selected by default, but you may change it to that of the employer or choose
another state from the list.

Click Select to display the
screens for the specified state. Although every state has its own form for
filing purposes, much of the information is the same. To simplify the input
process for those companies that deal with multiple states, ATS has used the
same general layout for the screens regardless of the state.

For documentation purposes, we
have selected the screens for Illinois since that state uses the IAIABC form which is considered the standard. The General
section is shown below with the personal information such as the address, phone
number, date of birth and hire date read from the employee’s record.  The employee’s name is displayed in the title
bar for your convenience.

Figure 4‑1: Employer’s Report Page -
General Section

Typically, you will be asked to
enter the additional information described below. Other fields may be provided
depending on the state of jurisdiction.

Field Name

Description

State
of Hire

The
state in which the employee was hired.

Days per Week

The
average number of work days/week.

Hours
per Day

The
average number of hours worked/day.

Day
of Injury Paid

A
check indicates that the employee was paid for the day on which the
injury/illness occurred.

Salary
Continued

A
check indicates that the employee is receiving his/her regular salary in lieu
of worker’s compensation benefits.

Wage

The
program calculates and displays the employee’s weekly salary.

Period

The
pay period is always “Weekly”since the State wants to know the AWW.

NCCI Class Code

The
NCCI classification code may be required if it’s
on the state’s FROI.

Press <Alt>+2 or scroll down to
position to the Employer section that contains the employer and level
information. Note the Dept,
Division,
and Sub in the following example. The labels used to
identify the levels will vary depending on how your system has been set up with
the Administration- Configuration-Application Parameters menu.

Any information that is not
required by the IAIABC will have to be entered manually, but the standard
information in the following example will be displayed automatically if it
exists.

Figure 4‑2: Employer’s Report Page -
Employer Section

It is important to understand how the program
searches for the person’s employer in case some information is missing.
First, it looks at the levels specified for the employee to find a record
where the Employer box is checked. If one is not found, the program will see
if the employee’s region or state is marked as the employer. The client is
assumed to be the employer if no other one is found.

·
Level
3 (starting with Sub 3 and Sub 2 if used)

·
Level
2

·
Level
1

·
Region

·
State

·
Client

Information about the injury or illness should be entered
in the Detail section. Since each State form is different, the fields will
vary. The ones on the IAIABC form are shown below.

Figure 4‑3: Employer’s Report Page -
Detail Section

The following fields are on the
IAIABC form.
Depending on the state, the program may prompt you to enter additional
information.

Field Name

Description

Injury
Date

The
date of injury is required. A dialog will appear if there is an existing
report for the person on the same date.
Depending on what you see, continue entering the new report or exit
the program.

Time Began Work

The
(military) time the employee started to work (e.g. 1430) on the day of the
injury. The colon will be inserted for you.

Time
of Injury

The
time of injury in a military format.

Last
Work Date

The
last day the employee was at work.

Knowledge
Date

The
date the employer learned of the injury.

Disability
Start Date

The
date disability payments began (i.e. the first day lost due to the injury or
illness).

Report
Purpose Code

The
state’s code that describes the reason for submitting the report.

Location/Dept.

The
location where the injury or illness occurred.

County

The
county where the injury occurred.

Employer’s
Premises

A
check indicates that the injury/illness occurred at the work place.

Safeguards/safety
equipment provided

A
check indicates that the employer provided safety measures.

Safety Measures Used

A
check indicates that the employee used the safety measures that were
provided.

Returned
to Work

Check
the box and enter the date if the employee is back at work.

Fatal
Injury

A
check indicates that the employee died as a result of the injury/illness. If
so, enter the date of death.

The
fields in the Details section that indicate whether safety measures were
provided and/or used may not be required by the State, but ATS considers
these standard fields since they can provide valuable information for
reporting purposes.

All States require you to describe the incident in
detail. The fields in the Loss Description section indicate where the information
should be entered so the Report of Injury will be filled out correctly.

Figure 4‑4: Employer’s Report Page –
Loss Description Section

The Loss Codes section allows you to enter more details about
the injury. The screen shown below will appear regardless of which state was
specified.

Although a state may not
request this information on the report, the loss codes you enter will be transferred along with other
pertinent data if the report is promoted to a claim. These fields may also
provide valuable information for reporting purposes.

Figure 4‑5: Employer’s Report Page –
Loss Codes Section

The Medical section is provided
so you may enter information on the initial treatment that was provided along
with the physician, hospital, or off-site facility that was involved.

The information on the screen
shown below is requested on the IAIABC form. Since more and more states are adopting
this form, the Medical tab will display this screen regardless of which state
you have specified.

Also note the Initial Treatment
code.  If this is required, someone with
the authority to maintain the Loss Codes must enter these codes before they can be used
in a report of injury.

Figure 4‑6: Employer’s Report Page –
Medical Section

The Admin section is shown
below. Many states request information on the company which will be handling
the injury report. This is your company if you are adjudicating your own claims
or doing business as a third-party administrator (TPA). In either case, the program
will automatically fill in the information if it has been entered in the Agent record. A sample screen is shown below.

If required, the Date Notified
may be interpreted differently on your state form. Although this is usually the
date the claim administrator or insurance carrier received the First Report of
Injury, in Massachusetts it is the
date the injury or illness was reported as work related. Please refer to the
help message when in doubt as to what to enter.

Figure 4‑7: Employer’s Report Page –
Administrator Section

All of the insurance carrier
information on the IAIABC form may be entered in the Carrier section. If your company is self-insured in
the state or has only one carrier, a system administrator may use the Field
Properties feature to enter the pertinent information as default values so it
does not have to be typed into each new report.

If the Policy module is in use, one may be attached after
the report of injury has been saved.

Figure 4‑8: Employer’s Report Page –
Carrier Section

The special fields on this
screen are described as follows:

Field Name

Description

Self-Insured

A
check will indicate that carrier is the self-insured employer.

Policy

The
carrier's policy that will used, if the report becomes a claim, plus the
dates it is valid.

Agent

The
agent’s code and name.

Insured’s
Number

The
insured’s report number to display on the FROI if necessary.

OSHA Case Number

The
OSHA case number, if it is different than the ATS
claim number.

State
Claim Number

The
claim number assigned by the state of jurisdiction.

The last section, Summary, contains the information
shown in the example below.

Figure 4‑9: Employer’s Report Page –
Summary Section

The fields on the screen are
described as follows:

Field Name

Description

Promoted
to Claim

The
program will check this box if the report is promoted. (See a later section.)

Claim Number(s)

The
claim number assigned when the report is promoted. Depending
on how your system has been set up, an alternate claim number may be assigned
at the same time.

EDI Date

The
date the record was batched for transmission to the State.  This may not be the date it was actually
transmitted.

Completed
By

The
name of the person submitting the Employer’s Report to the State. (Required)

Title

The
title of the person submitting the Employer’s Report.

Phone

The
phone number of the person submitting the Employer’s Report.

Date

The
date the Employer’s Report was completed.

Saving an Employer’s Report

After entering the relevant
information, click the Save button. If the “Required Fields
Missing” message appears in the title bar, enter the data and click Save
again.

Although
a State may require certain information on the reports, there are very few
required fields on the ATS screens because we realize that an operator may
not have all the information at the time the report is created. We don’t want
to create a situation where contrived information might have to be entered in
order to save the record.

After the report has been saved, the employee’s masked SSN
(with the last four digits), an asterisk, and a counter
to indicate the number of injuries the person has reported will be displayed in
the window’s title bar. For example, “XXX-XX-8987*0004” is the employee’s
fourth report of injury.

At this time, the Print
buttons have been activated. The EDI Export feature is also available. These topics are
covered separately.

The Print Options

Before printing the State’s First Report of Injury, we recommend that you use
the blue Print button to view the information that you have
entered on the form.  If you find
anything that is missing or incorrect, we suggest that you return to the ATS
program, make the necessary corrections, and select the blue Print
button again.

The File-Print Page menu or the corresponding gray Print
button is available if you want to print the contents of the screens.

The Notes and
Diary Options

The ATS Diary and Notes features may be accessed using the associated
toolbar buttons. Please refer to the Claims chapter for details on using the Notes
feature. The Diary is covered in a separate chapter in this manual.

New First Report Option

The New button on the toolbar or <Alt>+N
will display the Select Employee screen so you can create a new report without
returning to the Console or Result List.

Open First Report Option

The Open button on the toolbar or <Alt>+O
will display the Select FROI criteria so you can look up an existing Report
of Injury without returning to the Console or Result List. The search criteria screen is
the same as in the snapshot shown below.

Editing an Existing Report

Authorized users may view
and/or edit Reports of Injury.  The Selected FROIs
menu item opens the Employer’s Report Search Criteria page that provides you
with a wide variety of search options.

Figure 4‑10: Employer’s Report Search Criteria

The following list shows
employees whose last names start with the letter “S” and have filed a report
for an injury that occurred between January 1, 2015 and December 31, 2015.

Figure 4‑11: Employer’s Report Result
List

Note that if the Region feature has been implemented and Region View has been set in your user record, you will
only be able to see a list of employees who have filed a Report of Injury in
your assigned region(s).

Other menu options provide you
with additional ways of looking for First Reports you have created.

They are:

Menu Option

Function

Recent

Lists
the First Reports completed in the last seven days.

Unpromoted

Lists
the First Reports that have not been promoted to a claim.  All but three have not been promoted on the
above list,

Promoted

Lists
the First Reports that have been promoted.  Note the blue arrow is used to identify the
promoted claim.

All

Lists
all the First Reports with the most recent at the top of the list.

Once you have selected the desired report, the program
will display the record so the required changes may be made.

All the operations covered in
the next sections can be performed as the report is created.  With the exception of changing the State of Jurisdiction, which can be done at any
time, the features will become available after the Employer Report is saved.

Batching the Employer’s Report Data

After saving the Employer’s Report, the EDI Batch menu option may be used to write selected data
to a text file for export purposes. This dialog will appear so you can indicate
the type of report you wish to send. The data will vary depending on which
report (MTC) code is chosen.

Figure 4‑12: Employer’s Report EDI Batch Dialog

The EDI process varies by state. Please refer to the
separate EDI Export Utility document for details.

Promoting a Report of Injury

Many of the incidents that are
reported never result in a claim action. If the employee does file a claim, the
report may be promoted to claim status so the pertinent data does not have to
be retyped.

To
promote an Employer’s Report of Injury to a claim use the Promote
button after the report has been saved.

The program will:

1.
Attach a policy (optional) and assign a claim
number.

If the Policy module is in use, there must be a policy that
covers the Injury Date. The program will check the From/Thru Dates for
the policies and display a message if one does not exist. Otherwise, select a
policy from the list of those that are available.

The program will automatically assign a claim number based on the value of the Next Claim Number, set using the Application
Parameters page. If the Next Claim Number field contains
a number (not all zeroes), the program will assign it to the claim. Otherwise,
the program will use the Fiscal Year from the client’s record and the Injury
Date in the
employer’s report to determine which year code to use at the beginning of the
claim number. For example, if the Fiscal Year is “0701” and the Injury Date is
“09/01/2010”, the claim number will start with “11”.

Retired people can develop an illness such as hearing loss and asbestosis
related to the work they did. If that situation exists in your company, you may
choose to base the first two digits of the claim number on the Open Date instead of the Injury Date by entering “OPEN” in the Next Claim Number field.

If policies are used, the first two digits of the number may be overwritten by
the policy’s Claim Number Prefix, if
one exists.

2.
Create a claim with the pertinent information
from the Employer’s Report. The program will transfer
any relevant information to the new claim.

3.
Write the claim number(s) on the Summary section of
the report along with a check in the Promote to Claim field. Also display the
new claim number in the title bar.

4.
A warning message will appear if there is
already a claim for the employee with the same date of injury.

All
reports are promoted with a Claim Type of “N” for notation. The claims adjuster
will need to decide whether the claim is a medical or indemnity case and
update the Claim Type accordingly.

5.
Claims

This chapter describes the ATS features that are
provided to help you manage claims as easily and efficiently as possible. Since
keeping notes is an integral part of the job, this feature is also covered in
this chapter.

Entering a New Claim

Users with the appropriate access rights may use the New Claim
item from a menu or click the New button on a Claim
Result List to begin entry.

The system will first ask you to select an employee.
Entering a last name that starts with “smith” will generate a list of employees
with names like Smith, Smithy, Smithies, and Smithers. A first name or any of
the other options may be entered to limit the choice list.

Figure 5‑1: Claim Search Criteria

A record for the employee must exist before you can
enter a claim. If one cannot be found, click New. When you Save
and Close the Employee data entry page, you will be automatically
returned to the Claims page and asked for the State of Jurisdiction for the claim.

Figure 5‑2: State of Jurisdiction Dialog

Click the Select button
and the Claim data input page will appear. The screen shown below is the
standard one provided by ATS. It contains all of the fields necessary to submit
subsequent Reports of Injury to the State of Jurisdiction for both IAIABC Release 1 and 3.

The required fields appear in yellow by default.  A system administrator may have set others as
required. The default labels for the levels in your company’s hierarchy are
Division,
Dept and Sub. Those on your screen have
probably been changed using the Application Parameters page.

Figure 5‑3: Claim Page – General Section (New)

All
of the information displayed above was taken from the employee’s record. The
personal information may not be edited from within the claim. If you need to
make a change, click the Ellipsis … button next to the Last
Name.

It is important to note that the name the employee is
known as in the ATS system may not be the person’s legal name.  If that is the case, be sure to enter the
name as known by the Social Security Administration in the employee record when
the claim will be submitted to the CMS.

The fields in the General section that are not
read from the employee’s record are described as follows.

Field Name

Description

Adjuster

The
user entering the claim is assigned as the adjuster by default.

Claim Type

Valid claim types are indemnity, medical, first
aid which is treated as a medical claim on most reports, and notation which
may be used to track an incident that has not become a claim. (Notations are
not included in the standard ATS reports.)

If
there  are  indemnity
reserves,  the
claim  type  will
be  changed  to “INDEMNITY” when the claim is saved.

Injury
Date

The
date the injury or illness occurred is required.  A warning is displayed if the date is over
six months ago.  When there is an
existing claim for that date, review the pertinent information on the other
claim to determine whether you are entering a duplicate claim.

If
the Policy module is in use, the program will search
for one that covers the fiscal year in which the injury occurred. When the
Administer-Configuration- Module Parameters menu has been used to enter a
Policy Form, but the Policy Format field is empty, the program will search
for a policy for a specific level, starting with the employee’s level 3
through 1, that covers the date the injury occurred (e.g. L101-2010).

If
a policy is not found for a level, the program will attach the first one it
finds that covers the date. The Tools-Policy menu may be used to select a different one
if necessary.

The
following Policy Formats may also have been used to specify
which policy should be assigned to the claim:

1.    @YR-L1 or @L1-YR: Searches for a policy
for the specified year and level 1 (e.g. 2010-L101).

2.    @ST-YR<L#: Uses the state code from the
specified level (1 thru 3) and the year to search for a policy (e.g.
FL-2010).

3.    @ST-YR: Uses the code for the state of
jurisdiction and the year to search for a policy.

When
a policy is found, the program will display the code in the window’s title
bar and write the Deductible on the Financial page.

If
a policy is not found, a message will appear to indicate that the claim
cannot be saved.

Injury
Time

The
(military) time the injury occurred in an HHMM format. This data is not
required, but if it is entered a special claim analysis may be run from the
Reports-Statistical menu.

CMS Date of Injury

The
CMS expects the date of accident or the first
exposure, ingestion, or implant. This may not be the date after which you are
legally responsible. The CMS needs the actual date for any recovery claims.
An approximate date is OK as long as it’s before the person’s date of
entitlement to Medicare. If this field is
empty, the program will automatically export the Injury Date.

First
Report

The
date the employer submitted the First Report of Injury.

Report
Date

The
date the employer was notified of the injury. This is usually referred to as
the knowledge date.

Death
Date

The
date of death should be entered when relevant. Note that in fatality cases,
we recommend that the employee’s beneficiary be set up as a dependent to facilitate the payment process.

Cause of Death

Indicate
if the death was due to the injury, not related to the injury or unknown.

Full
Denial Date

The
date the claim was denied.  This date
is required when submitting a SROI for a full denial to the state.

Denial
Rescinded

The
date the denial was rescinded.

Open
Date

The
date the claim was opened is a required field.  By default, the program will enter the
current date.

Closed
Date

The
date the claim is closed.  Refer to the
Closing a Claim section for details on using this feature and how the
reserves are affected.

Reopen
Date

A
closed claim may be reopened by deleting the Closed Date and saving the record. The current date will
automatically be displayed as the Reopened Date.

Start
TD

The
program will determine the date of compensation from the first indemnity or
rehab payment where the Grouper contains TD.  The date will be adjusted if the payment is
voided later.

This
date cannot be edited as it may be used in determining the number of lost
days to report on the OSHA log.

If
you plan on entering TD payments manually instead of using the
AutoPay module, the Administer-Configuration-Diary/Scan menu may be
used to set up diaries to let the adjuster know when the payments are due.

Stop
TD

The
date temporary disability benefits end.

Start
PD

The date of the first indemnity payment where the Grouper contains “PD”.

The
date will be adjusted if the payment is voided later.

If
PD payments are issued manually, the Diary Scan utility may be used to set up diaries
to notify the adjuster when they are due.

Stop
PD

The
date permanent disability benefits end.

Dependents

The
number of dependents added to the claim with the Tools-Dependents menu is displayed for informational
purposes.  Since this feature is used
in states where dependents affect the benefit rate, the Benefits dialog will
appear whenever this number changes so the rate may be adjusted accordingly.

Basic
Pay

The
employee’s salary without any fringe benefits.

Average Weekly Wage

The program will calculate and display the
average weekly wage based on the information in the employee's record.

The
Wage View flag may have been set with the
Administer-Configuration- Module Parameters menu to hide either the wage for
all claims or all except for indemnity.

Wage Effective

The
date the specified wage became effective.
This may be a required field when submitting a SROI in IAIABC Release 3.

Benefit Type

This value determines which rate table is
used to calculate the benefit.

Typically,
the choices are TD (temporary disability), PD (permanent disability) or VR (vocational
rehabilitation), but others may be available depending on the state of
jurisdiction.  If blank, TD benefits are calculated by
default.

Note
that this field is required in order to use the auto feature when making a
new payment.

Benefit

The weekly comp benefit rate for the state
of jurisdiction may be entered manually or calculated by
clicking the button to display the Benefit Calculator. Items such as the number of
dependents entered with the Tools- Dependents menu, Other Income, the COLA amount, and the
Benefit Adjustment are taken into consideration depending on the state’s
guidelines. (See the Benefit Type description for more information.)

In some states such as Virginia, a COLA
Requested box will appear in the top, right-hand corner. If the box is
checked to indicate that the employee wants COLA to be included in the
benefit payments, you may redisplay the dialog to see the date it was
requested by clicking the Ellipsis button.

The
following illustrates how the calculations are made:

Original
Weekly Amt  = Weekly Wage x Benefit rate

587.48
= 766.28 x 76.667

Final
Weekly Amt = Original Weekly Amt x Increase Multiple

613.92=
587.48 x 1.048

Weekly
Increase = Final Weekly Amt - Original Weekly Amt

26.44 = 625.68 - 587.48

Alternate Claim Number

When you save a claim for which auto
payments have been scheduled and the benefit rate has been adjusted, you will
be asked if those payments should be changed. If so, use the Tools-AutoPay option and adjust the amount. When the
state’s benefit rates change, you may run the BENFITUP program to update the
claim and payments scheduled with AutoPay accordingly.

This
field may contain a claim number that was used in a prior workers'
compensation package. ATS refers to it as the alternate claim number which is
available for lookup purposes.

Medicare Beneficary

A
check will indicate that the employee is a Medicare beneficiary. Note that this box may be
checked while processing a Query Response from the CMS.

HICN

Medicare’s health insurance
claim number.

ORM Assumed

A check indicates that the Responsible
Reporting Entity (RRE) has assumed
ongoing responsibility for medicals (ORM).  It’s important to understand the reference
to "ongoing" is not related to "ongoing reporting" but
rather the RRE’s responsibility to pay on an ongoing basis for the injured
party’s medicals associated with the claim. This typically only applies to
no-fault and workers’ compensation claims.

You
will not have this box on your screen if all your claims are adjudicated in a
state such as New York that mandates that employers assume ORM for the claimant’s lifetime. (The CMS Export program will check the state record
to determine if ORM applies to all claims in that jurisdiction.)

Note:
Once a claim with ORM has been submitted, the box must remain
checked when sending subsequent reports.

ORM Terminated

The date when ALL responsibility for
medicals has ended and there is no possibility that the claimant will
submit/apply for payment of additional medicals related to the claim.
See Sections 11.8 and 11.9 of the CMS User Guide for information concerning
extensions/exceptions regarding reporting ORM.

Note
that future dates will be accepted, but the date must not be more than six
months from the date of injury. A claim with ORM may be closed in the ATS system, but CMS regards it as still open until an update
report is sent with the ORM Termination Date. Normally, you would need to
continue to monitor claims when the state of jurisdiction mandates ORM benefits for the claimant’s
lifetime, but the CMS will recognize a statement from the treating physician
stating that no further medicals are expected. In that case, the ORM claim
can be terminated.

CMS Batched

ATS
keeps a history of all reports that have been batched and/or sent for a
claim. This history can be viewed from the CMS Batch option on the Bridge menu. This check box is
only on the screen for your reference.

The standard Details section is shown below with a
sample record. Although your screen may have been tailored to meet your needs,
most of the fields will probably be the same.

Figure 5‑4: Claim Page – Details Section

Normally, the Cause, Nature and Body Site fields are the only ones that are required
since the information is needed on many state-mandated forms. (The labels for
the loss codes may have been changed on your screen using the
Application Parameters screen.)

If
the Employer’s Report module is in use, some of this information
such as the loss codes and the county/state where the injury or
illness occurred will have been transferred when the report of injury was
promoted to a claim.

The fields on this screen are described as follows. It
should be noted that a number of fields on the page pertain to the OSHA 300 log. A document that covers this feature
in detail is available from ATS support.

Field Name

Description

Agency

The
source of the injury or illness such as slippery floor. This data is not
required, but may be entered to break down the injury in more detail.

Cause

The
cause or reason for the injury such as slip and fall is normally required.

ICD-9 Cause

This is the ICD-9 classification code for the cause of injury.  There is a very detailed list with more
than 1,200 codes from which to choose.
Since we can’t make it shorter, we suggest that you contact ATS
support, request a copy of the list, find the codes you normally use, and
make a quick reference chart.

This
code is required when reporting to the CMS after January 1, 2011.

Nature

The
nature of the injury such as sprain or fracture.

Body
Site

The
FIRST part of the body that was injured.
Use the Multi Body Parts button to enter additional body parts.

ICD-9 Diagnosis

This is the ICD-9 diagnosis code for the first body part that
was injured.  Up to 19 codes may be
exported.  Use the Multi Body Parts feature to enter the other parts and the
associated ICD-9 diagnosis codes.  Note
that only the Site and ICD-9 codes will be exported.  The nature and impairment percentage is
optional.

<<GRAPHIC: Multiple Body Parts Dialog>>

To
modify an entry, highlight it, update the data, and click Save
to move the item back to the grid. To remove an entry, highlight it, and
click the red X.

PERI Cause Code

There
are up to four elements in a PERI cause code. If you are a public entity that
uses this feature, click the Ellipsis button to enter the codes in order:
level 1 through level 4.

Location

The
code for the location of the accident may be selected from a list of items
entered with the Maintain-Industry-Location menu. (This is the Location that
appears in one of the columns on the OSHA 300 log.)

County
/ State

The
county and state where the injury or illness occurred. Note that the State is
required when using the ISO Export utility.

Last
Worked

The
last day the employee worked before the current disability began.

Current Disability Started

The first day the employee was off work due
to the injury or illness. This date will be read when using the Auto
Compensation button to schedule payments with the AutoPay module.

This
date and the RTW date will also be used to determine the
number of lost OSHA days for medical only claims and time loss
cases where the employee returned to work before the waiting period ended
(and payments would have been issued).

RTW Date

The
date the employee returned to work. (See the OSHA note above.)

RTW Type

Valid
entries are actual or return to work to indicate whether the RTW Date is the actual date the employee
returned to work or was released to return to work.

RTW with Restrictions

A
check indicates that the employee returned to work with restrictions.

Restricted
Work Days

The number of restricted or light duty days
may be entered using the Tools- Restricted Work Days menu option. Save the details in the dialog
and the program will update this field automatically. (This feature is
covered in the Tools Menu section.)

Note that according to the OSHA 300 guidelines, all restricted work days are
recordable. Transfers to another job due to the injury or illness must be
added to the restricted days for reporting purposes. Although a first job
transfer may be recorded in the TW Start and TW End fields, the Tools-
Restricted Days menu should be used to enter any subsequent period(s) in the
From/Thru Dates with “Job Transfer” as the Restriction.

Suspension Effective Date

The
date the suspension became effective will be exported to the state when
reporting a suspension.

Suspension Reason

The
reason for the suspension.

MMI Date

The maximum medical improvement (MMI) date is required
when using some of the MTC codes in the EDI export file to be transmitted to the state.

The
MMI date is also a statutory requirement in some
states such as Florida. When this date is reached, a popup message will
appear when saving a new payment for the claim. If you click "Yes"
to continue, a $10 copayment should be applied to doctor's visits paid to the
employee on or after the MMI date. If "No" is selected, the
operator will be returned to the check payment form.

P.
I. Percent

The percentage the employee is permanently
disabled.

Some
screens may also allow you to enter the date the employee became permanent
and stationary.

P.
I. Minimum

A
check indicates that payments are made for a minimal amount if a final rating
is not available.

TW Start

The date the employee started transitional
work should be entered if the person was
transferred to another job due to the injury or illness. If the employee has
had multiple job transfers, use the Tools-Restricted Days menu to enter the
subsequent period(s) in the From/Thru Dates with a note such as “Job
Transfer” as the Restriction.

Note
that according to the OSHA 300 guidelines, the number of days doing
transitional work will be added to the restricted work days
for reporting purposes.

TW Review

The
date to review the transitional work.

TW End

The
date that the transitional work ended.

OSHA Days

Since the OSHA 300 was implemented, both OSHA Days
restricted days are based upon calendar days.

The
OSHA Days field will always be empty in medical
only claims or when the employee returned to work before the waiting period
expired. In those cases, the days lost are calculated using the employee’s
Current Disability Began (First Day Off) and Returned to Work dates. (A
technical note on producing the OSHA 300 is available from ATS support.)

The
number of lost OSHA days for an indemnity claim are normally
updated as payments are made against reserve categories 1 and 3 (indemnity
and rehab) for pay codes with “TD” in the Grouper
field.

If
the claim is in a state or federal jurisdiction that tracks loss of earning
power, temporary disability payments will need to be made with a pay code
that contains I08 (wage loss) so the days will be ignored when reporting lost
days to OSHA. For example,
someone working another job or the same job with a restriction that pays less
than their usual salary would get a comp payment to make up the difference. If this feature
is not used, the days would be counted as both restricted and lost time on
the report.

Note:
Auto payments will not update this value until the payments are batched.

OSHA Code

If
the claim is for an occupational illness or disease, enter the appropriate
OSHA code for reporting purposes.

Privacy
Case

A
check in this box indicates that the employee’s name should not be displayed
on the OSHA 300 Log.

Recordable

By
default, all claims must be reported to OSHA.  Remove the check from this box if the
employer has determined that this claim is not recordable and should not
appear on the log.

Injured
at Work

A
check in this box indicates that the accident or illness occurred on the
employer's premises. Although this information is not required, it may be
useful in custom management and/or safety reports.

Wage Continued

A
check in this box indicates that the employee is receiving his/her payroll in
lieu of worker’s compensation benefits.

Serious
& Willful

A
check will indicate that the accident is considered serious and willful.

Hospitalized

A
check will indicate that the employee is/was hospitalized due to the accident
or illness.

Rehabilitation

A
check will indicate that the employee is/was receiving vocational
rehabilitation services.

Broken Waiting Period

A check will indicate that the waiting
period was broken. An option on the Tools menu may be used to track the time
missed. Your screen may have been customized to display this value.

Please
refer to the Using the Tools Menu section for details on how to use this
feature.

NCCI Injury Code

The
type of injury code related to the injury or illness is required for some
state reports. Click the Ellipsis button to list the codes that have been
entered with the Maintain-Carrier Tables-NCCI Type of Loss menu.

Subrogation

A
check in this box indicates that the claim is in subrogation or that the
possibility for recoveries exists.

Litigation

A check in this box indicates that the
claim is or may be in litigation. This box will automatically be checked when
a legal firm has been entered for either the claimant or the defense.

These
claims will be identified as "LEGAL" on some of the standard
reports.

Longshoreman Act

A
check in this box indicates that this is a federal claim covered under the
Longshoreman Act.

Include
on SI-4

A
check indicates that this claim should be included on New York’s SI-4 report.

Became
Lost Time

This
box should be checked if the claim was initially medical only before becoming
a lost time case.

Second
Injury Fund Date

The
last day to apply for reimbursement from the state’s second injury fund if
applicable.

Injury
Description

The
description of the injury.  Note that
the first fifty (50) characters of the description will be exported to the
CMS for Medicare beneficiaries. It should describe the cause
of the incident and the body parts that were injured. The description is
required through December 31, 2010 if no ICD-9 cause and diagnosis codes are provided.

The Reserves section is used to track the amounts reserved,
paid, and outstanding.  In addition, the
fields in the lower portion of the screen may be used to enter the name and
address of the party involved in subrogation.  Later, this information can be retrieved when
making a recovery using Finance features.

The standard screen shows six categories, but the last
two are optional. The number of categories is set with the Application
Parameters menu. The names of the categories and the
default reserve values for new indemnity and/or medical claims are entered on
the Reserve Types maintenance page.

Normally,
reserves may either
be entered manually in the Incurred fields or by selecting the Reserve
Worksheet button to display a special worksheet that
calculates reserves based upon making specific payments.  Depending on how your system has been set up,
you may only be able to use the worksheet. (See the Reserve Worksheet section
later in this chapter for details.)

A worksheet is also available if you use the Stanford
Reserve Estimate which calculates the reserves based upon the Nature and Body Site codes in the claim. (Stanford Reserves are entered using the User Tables maintenance
page.)

When a payment is made, the amount Paid is updated and
subtracted from the Incurred. The Future Reserves and Totals are adjusted accordingly. Credits and voids will be subtracted from the amount
paid, but recoveries won’t be. Any Recoveries are recorded separately.

Figure 5‑5: Claim Page – Reserves Section

When you save a claim, the program will check for any
changes to the reserves.  If any have been made, a dialog will be
displayed so you can indicate the reason for making the change(s).  The sample change codes shown below were
entered with the Reserve Change option on the Reserve/Payment/Recovery maintenance
page.  After the record has been saved,
the amounts on the screen will be updated.  Later, these transactions may be viewed with
the Reserves History button.

Figure 5‑6: Reserves Change
Reason Dialog

Note
that the Claim Type will automatically be changed to “INDEMNITY”
if there are any indemnity reserves.
If any other type of reserves is entered and the Claim Type is “NOTATE ONLY”,
it will be changed to “MEDICAL.

The Medical section displays the following screen. Note
the grayed-out fields below.  You cannot
type in the information. After the claim has been saved, an unlimited number of
medical providers may be added to a claim using the procedure described
below.  The information on the primary
care provider (i.e. the first one on the list) will appear in the Medical section.
Other details may be supplied as needed.

Figure 5‑7: Claim Page – Medical Section

To select a specific medical care provider:

1.
Click the Ellipsis button next to the Medical
Provider’s Code to display the Case Management screen with menu options for Care Providers
and Diagnosis Codes.  Select the Care
Providers menu and click New. When this window appears, click the Ellipsis
button next to the Fed ID Number to display the Vendor Selection dialog. Note
that only vendors with “P” or nothing in the filter field will be displayed.

The ATS Case
Management system is an optional, add-on module that is
described in the Options chapter. The standard system uses two of these
features.

2.
The program will display the information found
in the selected vendor’s record. If there is no
contact name in the record, you may enter a name here or directly on the
Medical page. Note that the Physician and Contact’s Phone/Fax will not appear
on the Medical page unless your claim screens have been customized.

3.
Click Save to add the vendor to the list of care providers. Exit the Case
Management window.

4.
If there is more than one vendor on the list, the first one is considered the
primary provider whose information will appear on the Medical page.

To
make another provider primary, highlight the provider and click the Make
Primary button on the toolbar. The next time you view the list, it will appear
at the top.

When
there is more than one provider, we recommend that the vendor who will receive the majority of the medical
payments is made primary so that the Payment module will get the name and
address information from the claim record when a “P” is entered as the Payee.
As the medical treatment changes, the primary vendor may also be changed to
facilitate the payment process.

The Legal Firms section may be used when a claim has gone into
litigation.  Click the Ellipsis button to
search for a vendor.  Only those with a Filter containing an “A” or
nothing will be available.  The program
will fill in the name and contact information from the vendor’s record you
selected.  The date the case was assigned
to the firm and any additional attorneys or legal firms involved may be entered
when relevant.

When a legal firm has been specified, the program will
check the Litigation box in the Details section as it saves the
claim.

Figure 5‑8: Claim Page – Legal Firms Section

Most of the fields on the screen are self-explanatory.
Those that have been added or modified for CMS reporting are:

Field Name

Description

Type
of Representative

The
type of representative, either: Attorney, Guardian/Conservator, Power of
Attorney, or Other.

TIN
/ Vendor code

The
tax ID, either a FEIN or SSN.  If you click the ellipsis button to search
for a legal firm, the program will fill in the vendor’s code and
relevant data from the vendor’s table.

Firm
Name

The
name of the firm, if appropriate. This is required on reports submitted on or
after January 1, 2011 if the representative is associated with or is a member
of a firm.

Address
and Phone

The
representative’s address and phone number. Representative’s Name     The first and last name of the
representative.

When the claim has gone into litigation, the Litigation screen may be used to add information regarding
the case.

Figure 5‑9: Claim Page – Litigation Section

The Litigation section of the standard screen is shown above.
A description of the fields; including those for CMS reporting, are described as follows:

Field Name

Description

Date
Filed

The
date the case was filed with the state workers’ comp board.

Date
Assigned

The
date the workers’ comp board assigned a number to the case.

Case
Number

The
claim number assigned by the state.

Mediation

The
date set for mediation.

Trial

The
date set for the trial.

Claimant’s
Demand

The
amount the claimant wanted.

Initial
Offer

The
amount and date of the initial offer.

Final
Offer

The
amount and date of the final offer.

Settlement (TPOC)

For structured settlements or annuities,
enter the total amount of the obligation based on life expectancy, not the
amount of the individual payments. Include the amount an insurance carrier
reimburses the self- insured entity for a payment made to the injured individual. When an
entity is self-insured for a deductible but the payment of that deductible is
done through the insurer, then the insurer is responsible for reporting the
deductible, not the self-insurer.

Note: The CMS refers to the settlement as the "Total
Payment to the Claimant" or TPOC.  This field is for the first TPOC.  Use the Actions- Bridge menu to enter up to
four additional amounts.

Since
there are current thresholds for CMS reporting,
we suggest that the system administrator set the Settlement Date and Amount as transactional fields so
you will be able to provide proof as to why the claim was  not reported earlier (i.e. the amount was
less than the threshold on the date in question).

Settlement Amount

The
date is when the obligation was established; the date the obligation is
signed if there is a written agreement unless court approval is required. If
court approval is required, it is the later of the date the obligation is
signed or the date of court approval. If there is no written agreement it is
the date the payment is issued (or the first payment if there
will be multiple payments).

Funding
Delayed

The
actual or estimated date of the settlement (i.e. when the money was or will
be released).

Type
of Settlement

A
code for the type of settlement made.

Court

The
name of the court handling the case.

Judge

The
name of the presiding judge.

Status
Reports

The
status reports that were filed.

Litigation Plan

The
name of the litigation plan that was used.

Action
Over

Check
this box if the litigation is over.

Outcome

Indicate
the outcome of the case. Press the Ellipsis button for a list of choices
entered with the Maintain-Legal menu.

Defendant(s)

The
name of 1 to 4 defendants with last name first as in Johnson, Randy.

CMS Reporting Notes

1.
When you have a situation where you have assumed
responsibility for medical and there is no dispute, the Settlement Amount should be blank. For example, six
months after the claimant tripped and broke his leg, everyone agrees there will
be no future medical and the claim is closed. No settlement is involved.

2.
For settlements (TPOCs) involving a deductible,
be sure to include it if you are responsible for reporting both the deductible
and any amount above the deductible.

3.
The CMS recognizes four additional TPOCs so an option
was added to the Bridge menu which is covered later in this chapter.

The Rehab section may be used if the claimant is or was
receiving any vocational rehabilitation services.

Figure 5‑10: Claim Page – Rehab Section

The following fields appear on the standard screen in
addition to the vendor information.

Field Name

Description

Patient
Number

The
patient number assigned to the claimant.

Rehab
Number

The
vocational rehabilitation number.

Date
Assigned

The
date the claimant was assigned to a rehabilitation program.

Plan

The
plan used by the vendor providing the rehabilitation services.

Date
Rehab Started

The
date the claimant started rehabilitation.

Date
Rehab Ended

The
date the claimant ended rehabilitation.

Printing a Claim

The File-Print menu may be used to print all the fields
on the selected pages even those that have been created only for your use.
Depending on the particular screen, you may have to set the Preference for the
printer to landscape when the Print dialog appears so the fields on the right
will be displayed on the printout.

Saving a Claim

When the claim is saved, the program will:

1.    Check for
required fields. If any are blank, the message “Required Fields Missing” will
appear in the title bar and position you on that page so you can enter the
missing information.

Note that the Claim Type will automatically be changed to “INDEMNITY”
if there are any indemnity reserves.

2.    Assign a
claim number where the
first 2-digits are based on the Fiscal Year in the client’s record and the
Injury or Open Date. For example, if the Injury Date is “09/01/2010” and the Fiscal Year is “0701”,
the claim number will start with “11”.
To base the number on the Open Date, enter “OPEN” as the Next Claim
Number with the
Administer-Configuration-Application Parameters menu.

If policies are used, these 2-digits may be overwritten
by the Claim Number Prefix in
the policy.

Opening another Claim

The Open Claim button may be used to
select another claim. The Claim Selection screen shown below will appear to assist you
in finding the claim you wish to view and/or edit. The original claim screen
will stay open.

If you want to view another claim that the employee has
filed, click the Open Other Employee Claims button to display a list of all the other
claims. The original claim screen will still be open after you select another
one so you may refer back to it if necessary.

Editing a Claim

Users with the proper authority may edit a claim using
the Select Claim menu item. A variety of options are provided to assist you in
finding a claim. If you know the claim number, enter it on the Claim
Selection screen. For example, you could search for all
claims with injury dates between 1/1/2019 and 6/30/2019 where the adjuster is
DEMO.

Figure 5‑11: Claim Selection Screen

Click Search or press <Enter>
and a list of possible matches will appear. Select the one you want to view
and/or modify.

Figure 5‑12: Selected Claims List

Closing a Claim

Clicking the Exit button
will ask if it is OK to close the claim (with the current date), file the
record, and exit. If Auto Close has been set on the Application Parameters menu, the incurred reserves will be set to equal the paid-to-date so the futures
will be zero.

If a closed date is entered manually (and the value of
Auto Close is set to “Y”), you will be asked what to do
about the future reserves when saving the record.

However you close the claim, the program will search
for future diaries. If any are found, you will be asked if they should be deleted.

The claim cannot be closed if the user’s reserve limit
is not high enough to zero out the future reserves.

Using the Claim Tools

The Menu Bar provides you with a number of features
that make it easy to perform the typical operations that need to be completed
when processing a claim. Each of the items is covered in alphabetical order in
this section.

It is important to note that many of the tools are
available on the selection screen.
Simply highlight the desired claim and click the button on the toolbar.  You don’t have to actually open the claim.

AutoPay

This option displays the Auto Pay List so that you
can schedule recurring payments or edit an existing schedule. This feature is
covered in detail in the Financial chapter.

Figure 5‑13: Auto Pay Screen

Clicking the Auto Setup of Compensation button displays
the setup screen.

Figure 5‑14: Auto Pay Setup Screen

Set the Add Weeks field to the number of weeks to pay and
then click the OK button.

Dependents

This feature is provided to associate dependents with
a specific claim when:

1.    The state
of jurisdiction for the claim considers dependents when
calculating the employee’s benefit rate.

2.    The
employee has died. In this case, the individual who will receive the death
benefits may be entered as a dependent on the claim to facilitate the payment process.

3.    The
employee’s wages have been garnished and a lien has been entered in the employee’s
record.

Diary

The ATS Diary is a powerful tool that may be used to remind you
of things that need to be done. Depending on how the system has been set up,
claim specific diaries may also be generated automatically.

In this section, we will provide you with an overview
of the ATS Diary. All of the features are covered in detail in a
separate chapter of this manual.

Existing diaries may be viewed or new ones created
depending on the user’s access rights. When enabled, this feature may be used via
the Diary menu item. (The Diary module is also available
from the ATS Console.)

In the following example, the window is empty because
there are no diaries for the claim.

Figure 5‑15: Claim Diaries List

To create a new Diary, click the New
button. The Diary will automatically be related to the claim you are currently
working on.

A sample diary is shown below.

Figure 5‑16: Claim Diary

The Subject is the text to be displayed on the Diary List. Entering a Message is optional. After
you finish entering the message, click the Save button to
save the entry and then exit. The new diary will appear on the list.

Editing Diary Entries

Diaries may be edited by selecting the item and
clicking the Open button. The fields in the diary are edited in the
same dialog that is used to create a new entry.

Marking Diary Entries as Reviewed

A diary must be marked as reviewed before it can be
removed from the Active Diary List. To do this, edit the entry and check the
Reviewed box. After you exit, the item will no longer appear on the list.

We have just touched upon the features in the ATS
Diary. For complete information, please refer to the
Diary chapter in this manual.

Forms/Letters

This feature may be used any time you wish to create
a document using the currently displayed claim. Standard forms for the state of
jurisdiction specified in the claim will be listed along
with any custom or user documents that have been designed for your organization.

The ATS system allows you to save the documents that
have been sent for a claim so they may be viewed later with the History module. For information on how to set up this
feature, refer to the Forms/Letters section of this manual.

General Payments

Click the General Payment menu option to make a
payment on the
claim. See the Finance chapter for information on how to use this program.

ISO Claim
Search Export
Utility

The Insurance Services Offices (ISO) acquired the Central Index
Bureau (CIB), a national clearinghouse
for data on bodily injury claims that can be used to identify possibly
fraudulent claims.

ATS provides the ISO Export utility as an optional, add-on
interface with the ClaimSearch software from this third-party vendor. Once the utility has been
installed, you may use this feature to write selected fields to a text file for
export purposes. This dialog will appear so you can select the type of report
you wish to send.

Figure 5‑17: ISO Export
Utility

If you are planning on using this feature, it is
important to note that the items below are required in order for the utility to
operate successfully.

·
Social Security Number

·
Name (including any middle initial)

·
Street Address

·
City

·
State

·
Zip Code

·
Date of Birth

·
Date of Injury

·
Location State (where the injury occurred)

·
Cause

·
Body Site

·
Nature

If any of this information is missing, an error will
be detected when you attempt to use the Prepare to Export menu in the Process
module.

Medical Fee Payments

The Medical Fee or Bill Review module is an optional, add-on product designed
to lower your medical costs by paying the maximum reimbursable for each line
item on the bill. The Medical Fee Payments menu or the corresponding toolbar
button may be used to launch the program. See the Finance chapter for complete
information on how to use this product.

Notes

Existing notes may be viewed or new ones created
depending on the user’s access rights. When enabled, this feature is available via
a toolbar button. By default, the notes will come up in a grid.

Figure 5‑18: Claim Notes List

Click the Report View menu item to display each
note and the contents in a report format that can be printed.

Figure 5‑19: Claim Notes Report
Format

Editing Notes

Notes may be edited only on the day they were
created. Since claim notes have the potential of becoming legal documents, they
may not be changed afterwards.

Creating New Notes

To create a new note, use the New button.
You will be asked to pick the type of note you wish to create. By default, the
program assumes   that you want to create
a note for the current claim. To write a note for another one, click the Selected
Claim button. The LOB (and DataSource) box will become active so it
can be changed if necessary. For example, you may have a case where a bus
driver (an employee) has both a comp and a liability claim. Being able to write
a note for both claims from the same place is a very handy feature.

The dialog shown below is used to create notes.

Figure 5‑20: Note Entry Dialog

Inserting Attachments

Click the Attach Documents
button to display the dialog shown below.
Click the Browse button to find the file you
want. By default, the program will look in the user's My Pictures folder. After
selecting a file, click the Save button.

Figure 5‑21: Note Attachment Dialog

After selecting a file, an icon will appear in the
note. When the note is saved, a paper clip will appear in the first column for
the entry in the Notes window to indicate that there is an
attachment.

Changing the Filter

The Filter Results menu displays the following dialog
so you may control which notes will appear.
Before using any of the features covered in this section, it is very
important to note that the filters will be used regardless of what claim is
involved until they are turned off or you log out of the ATS system.

The default is to display all notes regardless of
category. In this example, only general notes will appear after clicking OK.
By default, the program does not check the date when selecting notes, but you
enter a specific range of dates or within a specific number of months as in the
example. You may also use the search feature to display only notes that contain
specific characters in the subject line.

History

Selecting History on the Menu bar of the Claim screen will open
the History dialog. This dialog provides access to information about actions
that have occurred during the life of the claim, including; payments, recoveries,
reserves, letters, transactions. It also includes an
Audit feature
that provides a chronological list of every action associated with the claim.  See the History chapter for complete
information on how to use this module.

Payment History

Payments may be used to view the payment, credit and void transactions for the claim.

Figure
5‑22: Claim Payment History

Recovery History

Recoveries may be used to view the recoveries that have
been received for the claim.

Figure
5‑23: Claim Recovery History

Reserve History

The Reserve History button may be used to view the reserves changes that have been made on the claim.   See the History chapter for complete
information on how to use this module.

Figure 5‑24: Claim Reserve History

Letter History

The Letter History menu option shows the forms and letters that have been produced for the claim.

Figure
5‑25: Claim Letter History

Audit

The Audit menu item provides access to a chronological
list of all actions that have taken place for the selected claim.

Figure
5‑26: Claim Audit

Reserve Worksheet

The reserve worksheet is designed to assist adjusters in calculating
the reserves for a claim. Depending on a system setting, it
may be the only way you can enter reserves.

The worksheet is not intended to be a financial tool
since there will never be a program that balances the amounts in the worksheet
against the reserves in the claim. Regardless, the information
should prove to be a valuable reference when the worksheet is used to track the
changes throughout the life of the claim.

Third-party administrators or companies providing similar services should
find the worksheet especially useful when reporting reserve changes to their
clients or members.

Figure 5‑27: Reserve Worksheet

Click the Calc button to
bring up a special payment calculator. Since indemnity reserves are being calculated, the Benefit Type and Rate from the claim are displayed in the
dialog. The total is calculated by multiplying the benefit by the estimated
number of weeks.

To calculate the claimant’s life expectancy based on
the person’s age, sex, and race, click the Ellipsis
button after the Number of Weeks box. The program will fill in the weeks and
the total amount of PD benefits.

Clicking Save will
close the calculator and enter the value and the equation in the Amount and
Note boxes on the worksheet. Click Add to move
the item to the Worksheet List box and add the amount.

Click the Apply button
to update the claim with the proposed amount. The next time you use the
worksheet the value will appear as the future reserves and the Worksheet Items box will be empty.
Click the Historical option to redisplay the previous
transaction(s).

A Close button is displayed if your
system has been set up to use the reserve worksheet as an optional feature. When Close
is clicked instead of Apply, the window will close.  The reserves in the claim will not be updated.

A Cancel button will appear instead of Close
when using the worksheet is mandatory (i.e. you can not edit the value on the Reserves page). In this case, the record for the
current change will be deleted from the worksheet items.

If either button is selected before clicking Add
to move a new entry into the Worksheets Item box, the program will exit and
leave everything the way it was before you started adding the new item.

Decreasing the Reserves

There will be times when you need to decrease the
reserves. To do this select the desired reserve category,
enter a negative value in the Selected Items-Amount box, add an optional Note,
and click Add to move it to the worksheet items. Then select Apply to update
the reserves.

Replacing the Reserves

The Replace feature may also be used to change the
value of the future reserves if there is only one transaction for the
category. For example, suppose that the estimated number of TD weeks was incorrect. A new item for the
correct amount may be entered using Replace instead of the Add button. The
future reserves will be set to that value.

Special Considerations

1.    The menu
item will be disabled if the operator does not have permission to change
reserves. (The program will check the operator’s reserve
change limit when the claim is saved, and conditionally allow the changes to be
made.)

2.    Contact
ATS support if you would like to use the reserve worksheet exclusively.

Close Claim

Selecting Close Claim will ask if it is OK to close the claim (with
the current date), file the record, and exit. If Auto Close has been set using the Application Parameters screen, the incurred reserves will be set to equal the paid-to-date so the
futures will be zero. If a closed date is entered manually (and the value of
Auto Close is set to “Y”), you will be asked what to do about the future
reserves when saving the record.

However you close the claim, the program will search
for future diaries. If any are found, you will be asked if they should be
deleted.

The claim cannot be closed if the user’s reserve
limit is not high enough to zero out the future reserves.

EDI Export Utility

This utility may be used to write selected fields
into an ASCII text file for export purposes. The EDI Batch dialog lists the reports that have been
batched/sent Since the EDI Export process varies by state, it is documented
separately.

Figure 5‑28: EDI Batch Screen

Jurisdiction State

When a new claim is saved, the program automatically
assumes that the employer’s state is the state of jurisdiction to be used to calculate the claimant's benefit
rate. The State of Jurisdiction field must be changed in the Detail section,
when necessary.

Policy

If the Policy module is in use, the program will read the
injury date and search for a policy for that year and level (the default) or
for one using the special policy format entered in the Option/Module screen. If
a policy is not found, a warning will be displayed and the claim cannot be
saved.

Unless a special format has been specified, this
option may be used to display a list of policies that have been entered with
the Policy menu. Making a selection will enable the Save
button.  After a policy has been attached
to the claim, the program will display the Policy Number in the window title
bar and write the Deductible amount in the claim record.

Restricted Days

This menu option or toolbar button displays the form
for tracking the details about any restricted work days. Each time you save
specific from/thru dates and a restriction, the information will be displayed
in the box at the top of the dialog. The program will update the Restricted
Work Days field on the Detail page when you exit the
dialog.

Restrictions may be entered manually or by selecting
the Restricted Days menu and selecting a code entered with the Restricted Duty
menu.

According to the OSHA 300 guidelines, all restricted work days are
recordable. Transfers to another job due to the injury or illness must be added
to the restricted days for reporting purposes. Although a first job transfer
may be recorded in the TW Start and TW End fields, use the Restricted
Days menu to enter any subsequent period(s) in the From/Thru  Dates with “Job Transfer” as the Restriction.

In cases where the employee receives indemnity
payments to compensate for the loss of earning power due to a restriction,
enter “I08” (wage loss) in the Report Category field for the pay code so the
days are not counted as both time lost and restricted days on the OSHA log.

Multiple Body Parts

You may report up to 19 different body parts that were injured and their corresponding
IDC-9 diagnosis codes. Use this menu or the Ellipsis button next to the Body
Site field to enter this information. Note that
entering the nature and impairment percentage is optional.

To modify an entry, highlight it, update the data,
and click Save to move the item back to the grid. If you need to remove an
entry, highlight it, and click the red X.

TPOC

The CMS recognizes up to a total of five settlements
or TPOC (Total
Payment to the Claimant) amounts so an option was added to the Bridge menu to
display this window.

Please note that the grid will be blank until you
enter an amount and date(s). All the amounts will be totaled including the
Settlement (TPOC) Amount on the Litigation page to make it easy to determine whether or
not the amount is over the threshold and must be reported.

CMS Batch

A CMS Batch option has been added to the Bridge menu.
Selecting the option will display this window so you can batch different types
of records or transactions. The CMS refers to these as Action Types. For your
convenience, a history of what was batched and sent (by whom) will appear in
the window.

The Action Types

Add

An "add" record or transaction should be
submitted for a new claim that was never submitted, was submitted but not
accepted due to errors, or a claim where the RRE assumed ongoing responsibility for medicals
previously, but the injured party has just become entitled to Medicare. The CMS stores claims by the following key
information:

·     Injured
Party SSN, HICN, Last Name, First Name, Date
of Birth and Gender

·    CMS Date of Injury/Loss

·    ORM Indicator

Delete

A "delete" record or transaction should be sent
to remove information from the CMS database if the original record should never
have sent in the first place or when you need to change key data submitted
previously. In the latter case, the RRE must send a delete record with the key
information that matches the previously accepted (add) record followed by
another add record with the changed information.

Because Medicare stores claims submitted previously by the key
information listed above, it is important that the data not be changed in the
claim. We strongly recommend that someone with system administration rights set
these fields as transactional so the program will track what changes were made
to the data, when the changes were made and by whom. This way you can confirm
that the data is the same.

Update

An "Update" should be sent when you need to
change information previously submitted and accepted. The key information
(listed above) in an update record must also match that in the add record in
order for the transaction to be accepted.

Update records should be submitted under these three
circumstances:

1.    An RRE needs to send the ORM Termination Date to indicate that the
responsibility for ongoing medicals has ended. This may be a simple termination
or it might be associated with the reporting of a settlement, judgment, award,
or other payment TPOC amount/date.

2.  A report of
ongoing responsibility for medicals has already been submitted and accepted and
there is a separate settlement, judgment, award, or other payment TPOC amount/date. The RRE continues to retain ongoing responsibility for
medicals.

3.
Information critical for use by Medicare in its claim payment and recovery processes has changed.

If you need to update one of the key fields listed
above, follow the process described in the previous section where a delete and
add record are required.

If you need to update one of these other fields, send
an update transaction:

·     ICD-9 Diagnosis Codes

·
Description of Illness/Injury

·    Carrier’s TIN (FEIN)

·    TPOC (Settlement) Date

·    TPOC (Settlement) Amount

·    Claimant’s
Representative Information

EFC

The Electronic Filing Cabinet (EFC) module is also called the
Document Manager.  This is the ATS solution to the paperless
document flow many entities require.  For
instructions on using the EFC and help videos, please go to the following
website and create a login:  www.grocefc.com.

Figure 5‑29: EFC –
Document Manager

6.
Finance

Operators with the appropriate authority can handle any
financial operation regarding a claim. The transactions will be covered in the
following order:

·
Making General Payments

·
Entering Recoveries

·
Scheduling Auto Payments

·
Voiding Payments

·
Changing Reserves

·
Editing Batched Payments

·
Issuing Credits

·
Using the Bill Review Module

Making General Payments

If you are in Explore, you can make payments without
actually opening the claim. Simply select the desired claim and click the
General Payments button. The button is also available if you
are already editing a claim and want to make a payment.

Knowing that some bills arrive after a claim has been
closed, the ATS System has a special Stair Step Reserves feature that may be set so you can make a payment without having to reopen the claim.

The future reserves are always displayed for your convenience, but
the bank account number and the balance in the trust will not appear if you are
creating vouchers. (The number of reserve categories and their names will
depend on how your ATS System has been set up.)

On the upper right side of the screen, you’ll see a
special field that displays the claim number with an ellipsis button to the right.  This field allows you to enter multiple
payments rapidly by saving the payment, typing the next claim number
in this field, entering the next payment and saving.  The ellipsis button provides a claim search
function if you don’t have the claim number available.

The example above shows an indemnity payment that was set up by simply clicking the
Ellipsis button next to the amount. Refer to the fields below for information
on this feature. The fields are described as follows:

Field Name

Description

Pay
Type

The payment type is either voucher or check. Note that
checks debit the trust fund (bank account) balance, but vouchers do not.

The
record shown above will produce a voucher so the number of the trust fund
account and the balance in the account are not displayed at the bottom of the
screen. This information will appear if you produce checks.

Amount

The amount to be paid. A special feature
allows you to make an auto indemnity payment by pressing the Ellipsis button. The program
will automatically display the amount, the employee’s name and address, the
default From/Thru dates and “1” in the reserve category field. A default pay
code may also appear. (The defaults are set with the Administer-Configuration-Application
Parameters menu.)

If there is a negative account balance, you
may get a "Bank Balance Insufficient" message depending on a
setting entered with the Administer-Configuration- Module Parameters menu.
When this message appears, the amount will be reset to zero.

Another
setting may allow you to enter a batched payment with a negative balance. Attempting to print
a payment or enter a notation will display the message "You may only
batch this payment due to low funds".

If you are using the Stair Step Reserves feature set with the Administer-
Configuration-Application Parameters menu, the reserves will automatically be increased to cover the
payment.

Vendor
Code

If the payee is any of the following, enter
the code and the program will fill in the information from the claim.

C         claimant

D         dependent (a choice list will appear)

CA       claimant’s attorney

DA       defense attorney

P          medical provider

Otherwise, enter the vendor code including the asterisk and location or
press the Ellipsis button to select a vendor from the table.

From/Thru
Periods

The dates for up to three billing/payment periods may be entered. Pressing the
Ellipsis button next to the amount will display a period based on the Thru
date for the last indemnity payment and whether the Benefit type for the claim is “TD” or “PD”. By default,
these are two week periods, but the values may be changed with the
Administer-Configuration-Application Parameters menu.
If the From/Thru period is changed for an auto calculated indemnity
payment, the program will display a message explaining how the benefit amount
was recalculated and ask if the amount should be adjusted.

When
a future date has been entered, the program will display “Warning: Date entered
is greater than today’s date” on the title bar. Depending on your check
printing schedule, you may need to enter future dates. In that case, ignore
the warning message when it appears.

Back
and post-dating payments may be allowed depending on the settings entered
with the Administer-Configuration-Module Parameters menu. Note that it is
very important to be able to back-date a notated payment that was printed on a prior date. The
post-dating feature is also useful since it allows payments to be entered for
printing sometime in the future when you may or may not be in the office
(e.g, on vacation).

Reserve
Cat

The
code for the reserve category that the payment will be drawn against. If the payee is a
vendor with a default reserve category and pay
code, these values will be displayed on the screen automatically, but they
can be modified.

Wage Continued

If the Wage Continued flag is set in the claim, the
message “Warning - Wage Continued” will appear to remind you that an
indemnity payment is being made to an employee who is
receiving his or her salary in lieu of worker’s comp benefits.

A message will also be displayed when auto
payments have been scheduled for that period.

Unless
the Negative Reserves value has been set to “Y” with the
Administer- Configuration-Module Parameters menu, the amount to be paid may
not be more than the future reserves for the specified category. If the amount is
higher, the program will read the Stair Step Reserves value set with the Administer-
Configuration-Application Parameters menu. If the value is “N”, you will be given
an opportunity to edit the reserves and increase the amount so the payment may be issued. For example, “Futures
insufficient by 286.00. (Use the Change Reserves icon on the tool bar.”

If
Stair Step Reserves contains an “A”, the incurred amount will be
automatically increased by the amount of the payment. A value of “C”
will increase the reserves for closed claims only. In both cases, the
future reserves will still be zero after making the payment.

Refer
to the Editing Reserves section in this chapter for more information
on this process.

Payment
Code

The
payment or cost center code for the specified
reserve category. Default codes for auto TD or PD indemnity payments may be set with the
Administer- Configuration-Application Parameters menu.

OSHA Days

When
making a payment to the employee from reserve category 1 or 3
(indemnity or rehab), the program will check the contents of the Grouper
field in the specified Payment Code. If this value
contains “TD”, then the
From/Thru days are used to calculate the OSHA Days based on a calendar week. This value
will be displayed on the screen and added to the existing values in the claim
record.

There
will be times when an employee performs another job or the same job with
restrictions due to an injury or illness. If the job pays less than the
usual, the employee should get a comp payment to make up the difference. In that case, it
is very important that the temporary disability payment is made with a pay
code that contains I08 (wage loss) in the report category so the days in the
From/Thru period will be ignored when reporting to OSHA. If this feature
is not used, the days would be counted as lost time when the employee is
really at work.

Note

An
optional note or memo to be displayed on the check/voucher.

Status

There are three choices:

1.
Batch the payment record so that it can be printed later or
exported with the Accounting Interface module.

2.
Notate payments that were issued without using the ATS
System. For example, suppose a check is lost. After voiding the original
payment, enter a notated
payment with the same date.

3.
Click the Print button if you want to print the payment immediately.

Form Number

Process
Date

When the Status is Print or Notate, the
program will make these fields available and fill in the form number and
current date which can be changed if necessary.

This
is a handy feature when the original payment was incorrect (e.g. has the wrong reserve
category) and has to be voided. You can’t batch another payment because the
check has already been cashed. In this case, you will need to enter a notated
payment

Note
that the next check number is stored in the bank information entered with the
Trust Fund menu while the voucher number is in the client’s record.

Due
Date

The Due Date field is available when the
payment is to be batched. If there is no specific
date, leave the field empty so the payment will be included the next time a
batch is printed.

Back
and post-dating payments may be allowed depending on the settings entered
with the Administer-Configuration-Module Parameters menu. Since the Print
Batch program asks for a due date, the post-dating
feature allows you to enter payments to be printed in the future. It is also
important to be able to back- date a notated payment that was printed on a prior date.

Separate
Handling

If
the Separate Handling box is checked, the payment will not be combined with other payments to
the same vendor. Checking this box
also allows you to inform the accounting department (when the Handle Return
File option in the Accounting Interface is used) that the check should be
sent back to claims for special handling before it is mailed.

EDI Late Reason

Each
state requires that the initial indemnity payment is issued a specific number of days after
the date of injury. If this payment will be transmitted to the state via EDI, then select a
code to indicate why the payment is late. Omitting the code may cause the
state to reject the transaction.

Invoice
Number

The
invoice or reference number being paid, if any.

Saving a Payment

At this point, the program will search for possible
duplicate payments for the same payee, reserve category, pay code and from
date. If one is found, the program will display all the details on the other
payment(s) so you can decide whether you should click
Continue and save the payment. Clicking Cancel will leave you in the payment
screen without saving the record the payment is over this amount, the program
will display “Over check limit. Record will be pended.” The payment will be
pended until someone with a higher limit releases it (to batch) with the
Process- Edit Batch menu.

In states such as Florida and South Carolina, the MMI Date in the claim determines whether a $10
copayment can be applied to a medical payment. A message will appear if the
date has been reached. Click Yes to apply the $10. The No
button will return to the payment program. When you Save the record, the
program will clear the screen except for the payee. At this point, you can
enter another payment to the same or a different payee or exit the program.

Scheduling Auto Payments

The AutoPay module is included with the standard ATS
System so you may schedule payments to be made on a regular, ongoing basis.
This feature is available from the menu from within a claim or from the
Selected Claims list screen after selecting a claim.

The program displays the following screen. .

Figure 6‑1: AutoPay Screen

Depending on how the claim has been set up, the
following buttons may be used.

Button

Function

Edit

Displays
the selected payment record for viewing and/or editing purposes.
If the list is empty, this button will be disabled.

New

Displays
a blank form so a new record may be entered.

Auto
Setup

Sets
up a new payment schedule automatically. This button will be
disabled if there is a Start TD or Start PD Date in the claim.

Close

Exits
to wherever you started, either the claim or the Selected Claim menu.

There are two ways of scheduling new payments. Each
method will be covered in this section.

Using the Auto Setup of
Compensation Button

The Auto Setup button is available for setting up the benefit
period. It will be enabled for indemnity claims that have a specific Benefit Rate, but no benefit payments (i.e. the Start
TD and Start PD Date fields are both empty).

Figure 6‑2: AutoPay Setup

Selecting the button will prompt for the compensation
period. The First Day Lost will be displayed if the date exists in the
claim record. Enter the date when the period will end. It can always be changed
later. If you don’t know the exact date, add the number of weeks to be paid and
click the Pay Comp Thru field to update the ending date.

Click OK and the program will set up the payment schedule as shown in the following example.

In addition to the information found in the claim
record, the program will search the various tables to find the default values
for the Pay Code, State Days, and Waiting Period when the Auto Setup of Compensation feature is used. (All of the
fields will be covered next.)

If the program finds all the required information and
the Pay Day value for the employer is set to something besides any day, then
the only thing left to do is save the record. Otherwise, the date for the Next
Check must be entered before the record can be
saved.

Using the New Button to Schedule Payments

If you use the New button,
normally the information on the form will have to be entered manually. The
fields are described as follows:

Field Name

Description

Record
#

The default is “1” for the first payment schedule. Enter “2” to indicate a 2nd one.

A
total of nine records may exist at any one time. Records no longer appear on
the list after the last payment has been made.

PMT
Type

The  payment  type
is  either  checks
or  vouchers.  If
necessary,  a  system administrator may change the default
value.

Payee ID

The payee’s social security or federal ID
number. Enter "C" if the payee is the claimant, "D" for a
dependent receiving alimony or child support, or press
the Ellipsis button for a list of vendors.

If
this is a fatality case, we recommend that you enter the individual who will
receive the death benefits as a dependent to make it easier to schedule payments.

Payee

The
name of the payee will be filled in automatically after reading the social
security number or vendor code in the previous field.

2nd
Payee

The
name of a second payee if any. For example, if the employee's check needs to
go to a legal firm for disbursement, the c/o name should be entered here.

Address, City, State, Zip, Phone

The
address and phone information will be filled in automatically after reading
the record with the specified social security or federal ID number.

RSV
Cat

The
reserve category to be used. The Auto Setup feature will enter “Indemnity” by default. Press
the Ellipsis button for a list of other categories that are available on your
system.

Pay
Code

The payment or cost center code. Press the Ellipsis
Button for a list of codes that are available for the specified reserve
category.

If
the Auto Setup button is used, the program will use the
Benefit Type code specified in the claim record to look
for the default code set up with the Administer-Configure-Application Parameters menu.

Rate

The
employee’s benefit rate. If an amount has been entered in the claim record,
it will be displayed here automatically. (A benefit rate must have been
entered in the claim in order to use the Auto Setup feature.)

Work
Comp From

When
the Auto Setup of Compensation button is used, the program
will calculate the starting date based on the First Day Lost and the days in the state's waiting period, otherwise
it must be entered manually. In either case, the From Date will be adjusted
as payments are made.

Work
Comp Thru

The
day benefits should end. The program that batches the payments will generate
"Next to Last Payment" and "Last Payment" diaries to warn
the adjuster that the claim should be reviewed.  This date may be modified if the payment period needs to be shortened or extended.

Wait
Period From/Thru

When the Auto Setup of Compensation button is used, the program
automatically calculates the From and Thru dates based on the Waiting Period and Before Paid values in the record for the
claim's state of jurisdiction.

This
feature will not work correctly if the values in the state's record are
incorrect. If for some reason, you do not want the program to calculate the
waiting period payment, zero out the
values for the state.

Pay
Period

The Auto Setup feature will automatically enter “B”
(bi-weekly) as the Pay Period.

Other
valid entries are “W” (weekly) and “M” (monthly).

Benefit Type

The
benefit type from the claim record, either “TD” (temporary
disability), “PD” (permanent
disability), or “VR” (vocational rehabilitation).

PMT
Periods

The
total number of payments to be made will be calculated after you have entered
the pay period and from/thru dates. This value can not be modified. It will
be updated automatically as payments are made.

Original
From

The
Comp Period From Date will be updated as payments are made, but the original
date is displayed here for your information.

Next
Check

The
date of the next payment. This date will
appear as the first Batch On date on the list of future payments. (See
below for details.)

Prior
Check

The
date of the last payment that was batched.

Saving a Payment Schedule

When the record is saved, the program will check the
claim to verify that there are sufficient reserves to make the payments. If there aren’t, you
will be prompted to increase the reserves accordingly.

AutoPay creates the payment schedule and displays it on the screen as it
saves the record. This particular example was created to batch the payments
after the pay period (AutoPay Mode set to A) and the employer’s Pay Day set to
any day. (Refer to the Setup Procedure in a later section.) The Next Check date is used as the first Batch On date. This is the most typical
configuration.

Note the first payment on the list is for the waiting period. In the
state of jurisdiction for the claim, there is a 14 day period before
those days can be paid.

Calculating the Last Payment

Typically, the Comp Thru Date does not fall at the
end of a pay period so the last payment is only for a few days. When that happens, the
program will check the Scheduled Hours in the claim record.

If there are no Scheduled Hours, AutoPay assumes that the individual works a regular
week and calculates the payment accordingly. But, suppose the employee works
Monday and Wednesday through Saturday. (Work days are those which contain a
value in the Total field on the Scheduled Hours dialog.) If the Thru Date falls
on a Wednesday, the program will know that the employee does not work on
Tuesday and only pay for two lost days.

The program that batches the auto payments will generate
a diary to the adjuster when the next to the last and the last payments are
batched.

Batching Auto Payments

The Autobat program must be run to batch payments
according to their Batch On date.
AUTO will be stored as the user who processed the transaction. Although the
reserves must be
sufficient to schedule the payments, the reserves may have been used up since
then.

Auto payments will always be batched because of a
possible late penalty. When the reserves are insufficient, the program checks the Stair
Step Reserves value entered with the Application Parameters.  If it is either "Closed" or
"All", the reserves will be automatically increased to cover the
payment. Unless Negative Reserves has been set to “N”,
the futures will become negative. In any case, a diary will be sent to the
adjuster.

Auto Batch logs may be viewed with the Image Files menu.
When appropriate, "Next to Last Payment" and "Last Payment"
entries will appear along with a diary telling the adjuster to review the
claim.

The number of OSHA Days in the claim is updated as payments are
batched against reserve categories 1 and 3 (indemnity and rehab) for pay codes
with “TD”
in the Grouper field. This number is based on a calendar week.

Setup Procedure

The system administrator must set up AutoPay so payment schedules are created to meet your particular
needs. When the record is saved, the program will check the Pay Day and AutoPay
Mode values as defined below.

Item

Set In

Value

Pay
Day

Employer’s
record

Sunday
thru Saturday or Any Day

AutoPay Mode

Application
Parameters

Standard (sets the first Print Date to the
first Pay Day at the end of the pay period)

After (sets the first Print Date to the
first pay day after the pay period ends)

When the Auto Setup of Compensation feature is used and Pay Day is
set to a specific day of the week, the program will ignore the Next Check date, if one exists, and use the AutoPay Mode to calculate it and the subsequent Print
Dates (displayed with the List option). Changing the Next Check date will have
no effect.

Changing the Reserves

The Reserve Change button will display the following dialog so
the reserves for an open claim may be changed depending on
the permissions granted in your user’s profile. This dialog also appears when
the reserves must be increased in order to enter a payment.

Before the modified reserves can be saved, a Reserve Change reason must be selected using the drop-downs
on the right. These changes may be viewed later with the History module.

Reserve Change Limits

There are two types of reserve limits that may be set
in the ATS Security System: a Cumulative Limit which is the total incurred entered per user
that cannot be exceeded and a One Time Limit which is the amount that may be entered during
a session. (A session ends after exiting the program.)

These limits may apply to the total reserves or to individual reserve categories. For
example, suppose the One Time Limit is set to 25,000 and the Cumulative Limit is 50,000. Depending on the current amount in
the specified category, the change may or may not be allowed. Note that the
Cumulative Limit examples assume that prior changes to the incurred were made
by the same user.

One Time Limit=25,000         Cumulative Limit=50,000

Incurred in Claim        Reserve Change          Allowed?

Example 1       15,000                         25,000                         YES

Example 2       35,000                         25,000                         NO

Example 3       45,000                         10,000                         NO

It is important to note that when both the limits are
zero or null, there is no limitation on the changes that may be made. If the
One Time Limit is set to 25,000 and the Cumulative Limit is zero, the user may increase the reserves up to $25,000 a session regardless of the
current amount in the claim.

One Time Limit=25,000         Cumulative Limit=0

Incurred in Claim        Reserve Change          Allowed?

Example 1       15,000                         25,000                         YES

Example 2       35,000                         25,000                         YES

Example 3       35,000                         35,000                         NO

Conversely, if
the One Time Limit is set to zero and the Cumulative Limit is 50,000, the reserves may be increased by any amount until a total
of $50,000.

One Time Limit=0                  Cumulative Limit=50,000

Incurred in Claim        Reserve Change          Allowed?

Example 1       15,000                         25,000                         YES

Example 2       35,000                         15,000                         YES

Example 3       5,000                           50,000                         NO

The program will automatically update the future
reserves and
display the new totals as the incurred values are modified.

Issuing Credits

There may be times when you need to issue a credit
against a specific claim. The credit might be for a particular payment when there was an overpayment. A credit may
also be issued when there has been money recovered and the amount should be
subtracted from the amount paid. In that case, there would be no prior payment
involved. Regardless, if the claim is closed and the futures are zero, they
will remain zero after the transaction has been made. Each of these type of
credits will be covered in this section.

A Standard Credit

Select the Payment History button if you need to issue a credit for all
or a part of a specific payment. The following screen will
appear with a list of the payments that have been made. The list may include some
existing credits where the form number ends with *R and a number.

Scroll through the list until you find the payment you want.
Then, select the payment and click the Credit button.
The program will display the Credit screen along with the data from the
original payment. Note the Status field. A warning message will appear if you
attempt to credit a payment that has been voided.

The cursor will be positioned in the Credit Date field
so that you can modify the following items. Save the record to complete the
transaction.

Field Name

Description

Credit
Date - Time

The
current date and time appear by default.

Amount

The
amount to credit may not exceed the amount of the original payment. If a credit has
already been applied, it will be subtracted from this value.

Note

The  note
or  memo  that
appeared  on  the
original  payment  is displayed. It may be modified to
indicate the reason for the credit.

Credit No Check

This option allows you to issue a credit for a claim
when there is no particular payment involved (e.g. the credit applies to a group
of payments). This feature should also be used when the money recovered on a
claim must be deducted from the amount paid. In this case, the amount could not
be entered as a recovery since these are tracked separately in the ATS System.

After selecting the desired claim, pick the Credit
(no check) button. The program will display the same form used to issue
standard credits, but the information has to be entered manually since there is
no payment record..

The fields on the form are described as follows:

Field Name

Description

Vendor
Code

If
the payee is any of the following, enter the code and the vendor code, name, and address will be filled in
with the information in the claim record.

·
C          claimant

·
P
medical provider

·
CA        claimant’s
attorney

·
DA       defense
attorney

If
the payee is someone else, press the Ellipsis button to search for the vendor.

Reserve
Cat

The
code for the reserve category to be credited.

Amount
PTD

As
soon as the reserve category has been specified, the total amount paid for
that category will be displayed.

Payment
Type

The
type is either check or voucher.

Credit
Date/Time

Normally,
this data is not changed.

Reason

A
note explaining why the credit was issued.

Credit
Amount

The
amount to be credited may not exceed the amount paid.

Entering a Recovery

In the ATS System, recoveries are tracked separately
from payments, credits, and voids. The amount paid will not be adjusted. Use
the Credit menu when the money received must be deducted from the amount paid
against the claim.

The fields to be entered on the form are described as
follows:

Field Name

Description

Recovery
Amount

The
amount recovered. A warning will be displayed if this amount is greater than
the amount paid.

Vendor
Code

The
code for the vendor making the payment. Press the
Ellipsis button to search the vendor records or enter “C” to display the
Claimant’s information or "S" to display the Recovery (Subro) Party
from the claim. In the latter case, no vendor code will appear because there
is none in the claim.

Invoice
No./Date

The
invoice or reference number and date. (optional) From/Thru                       The range of dates in
the period. (optional)

Reserve
Category

The
code for the category from which the recovery will be made.

Recovery
Type

The
code indicating the type of recovery is normally a required field.

Note

An
optional note regarding the recovery.

Recovery
Date - Time

The
current date and time may be modified if necessary.

Update
Bank

A
check will update the bank balance (i.e. the client’s trust fund). This value
has no effect if you use the ATS System to issue vouchers, not checks.

Voiding Transactions

Menu options are available so that you may void a payment or recovery. Typically, that is necessary when
a transaction was entered incorrectly.

Checks and
Vouchers

Whether the payment was entered for the wrong reserve category and
pay code or it was lost in the mail, the original transaction should be voided
and re-entered.. This is done by selecting the History button . The following screen will appear with
a list of the payments that have been made.

Scroll through the list until you find the payment you want.
Then, select the payment and click the Void button. The program will display the Void
screen along with the data from the original payment.

The following screen is used to void payments. The only fields that may be edited
are the Void Date,
Reason, and the Type. Simply save the record to void the payment.  If the claim is closed and the futures are
zero, they will remain zero after the transaction has been voided.

Note:

1.
Voiding a benefit payment may affect the Start TD or Start PD dates in the claim. If the first payment is
voided, the new starting date will be the From Date in the second payment.

2.
If the claim is closed and the futures are zero,
they will remain zero after the transaction has been voided.

Recoveries

Suppose you receive money on a claim and enter it as a
recovery before realizing it should have been a credit so the amount would have
been deducted from the paid. In that case, you will need to void the original transaction by selecting the Recovery
History button.

The following screen will appear with a list of the
recoveries that have been made.

Highlight the record to be voided click the Void button. The date, the reason for voiding the
transaction, and a code indicating the type of void are the only items that can be entered. To
void the recovery, simply save the record. If the bank (trust fund) was updated
when the original recovery was made, a message will appear to let you that the
balance has been adjusted.

Editing Batched Payments

All payments that are entered with a status of “B” are
batched for future processing. At any time, these batched payments may be
reviewed, approved, posted, deleted and/or released (when pended) by anyone
with the proper access level.

Use the Process-Batched Payments menu and click Process to view all the
payments.

Use the Previous and Next buttons to page through the
list. The columns contain the following information.

Column

Contents

Type

The
type of payment where C = check and V = voucher

Status

“A”
if the Approve feature is used, otherwise empty.

Entry

The
code for the user who entered the payment or AUTO if the system batched the
reoccurring payment.

Amount

The
amount of the payment

Payee

The
name of the payee

From/Thru

The
dates in the billing period

Due

The
date the payment is to be issued

Desc

The
pay code

Transaction

The
claim number followed by an asterisk and the number of
the payment issued for the claim

Voucher

The  number
assigned  when  the
item  has  been
exported  with  the Accounting Interface module

Entry
Date

The
date the payment was batched

Mode Filters

The Edit Batch utility has a wide variety of features as
evidenced by the number of buttons and check/edit boxes that appear on the
form. Each of the features, including those available from the menu, will be
covered in the following sections.

There are two buttons that may be used to process
batched (the default) or pended payments which were entered for more than the
operator’s check writing limit.

The following filters are available to select a
specific group of batched payments.

(Not) Approved

The ATS System has a Pre-Approve feature that may be
used to require the approval of payments before they can be printed.

If the Pre-Approve flag has been set using the Module
Parameters screen, these filters will be enabled so that all payments that are
not approved will be listed when the Process button is clicked. Remove the
check in the Not box to get a list of approved payments. (Approved payments
will have an "A" in the Status column.)

(Not) Exported

By default, all the payments that have not been
exported using the Accounting Interface will be listed. Remove the check in the
Not box to get a list of exported payments that have a number in the Voucher column.

Region

When the Region feature has been implemented, this filter may
be used to display a list of payments for claims in a specific region. An operator
may only view payments for a particular region if one is specified in the
operator's record and the Region View is turned on.

Selected Claims

By default, the payments for all the claims that meet
the other criteria (filters) will be listed. When this is a long list, it may
be difficult to find a payment for a specific claim. In that case, click the
Claims ellipsis
button to display the Select Claim screen. Pick a claim and only those payments
will appear on the list.

Due Date

The Payment program allows you to specify a Due Date
for each batched payment. By default, this field is
empty so this filter will have no effect.

Depending on the settings entered using the Module
Parameters screen, post-dating payments may be allowed. In that case, the Due
Date filter may be used to display payments with dates either on or before the
date specified (in the filter) or blank.

Operations

A variety of buttons are available so you can perform
the following functions.

Approve

If the Pre-Approve flag has been set to "Y" using
the Module Parameters screen, the Approve button
will be enabled so batched payments can be approved by an operator with the
authority to print checks. Otherwise, this button will be disabled (grayed out)
since this step is not required. When this feature is used, approved payments
will have an "A" in the Status column.

Delete

Any payment may be deleted from batch by an operator with
Delete permission. Simply highlight the desired item and click the Delete
button. The program will ask if you want to perform the operation. To continue,
click the Yes button. The program will remove all references to the
batched payment from the system and adjust the reserves/paid amounts for the claim.

Post

When a check has been made out by hand or printed with
a foreign system, an operator with Print Payments permission should use the Post
button to post the payment to the check history table. The date and form
number may be changed if necessary.

The next voucher number is found in the client’s
record, whereas check numbers are stored in the information for the bank
account.

Release

Use Pend mode to view any payments that were entered
for an amount over the operator’s check writing limit. Select one of the
payments. If your check writing limit is higher than the amount of the payment, the Release button
will be available to place it in Batch mode.

View

Use the View button to view all of the
information on a specific payment. Notice the Browse
button in the Payee group. Suppose that a payment had issued to
the wrong vendor. This button may be used to
display the Select Vendor dialog and pick the correct vendor without having to
void the
payment and enter a new one. After making a change, click the Process
button again to update the Payee name on the list.

Reports

The Edit Batch Report button may be used to
produce a wide variety of reports with the currently listed payments. Clicking
the button will display the specification screen with all of the default values
as shown below. Check the Page Eject box if you want a new page to be used when
the value being sorted by changes.

The report specifications are as follows:

Field

Contents

Sort
By

Payments
may be sorted by Adjuster (the default), Claimant, Reserve Category/ Pay Code, ATS Claim Number, Alternate Claim
Number, or Region/Level 1.

Mode

Batched
or Pending payments.

Checks

A
check will display only checks on the report.

Vouchers

A
check will display only vouchers on the report.

(Un)
Approves

If
the Pre-Approve feature is used, a check will indicate which payments should
be included.

(Not)
Exported

A
check will either include the payments that have been exported (for printing)
or not.

Claim
Number

By
default, the wildcard % is used to include all claims. Click the ellipsis
button to select a particular one.

Region

By
default, payments for all regions will be included.

Level
1

By
default, payments for all levels will be included.

Page
Eject

A
check will cause a page eject each time the Sort By value changes.

When you have finished entering the specifications,
click the Print Preview button to load the report into the ATS
Print Previewer where it may be reviewed and/or printed.

Medical Fee Module

Each year, medical costs continue to skyrocket. Instead
of simply paying the full amount on every invoice, use the Medical Fee module, an optional, add-on product designed
to lower your medical costs. Each line item on the invoice is calculated and
either accepted or overridden based on the state’s fee schedule, the DOL’s OWCP
schedule, and/or the Usual and Customary Reimbursement (UCR) value. A vendor’s custom fee schedule may
also be used.

This module has also automated the printing of
Explanation of Benefits to the medical providers. The UCR module is an optional feature and not part of
the standard ATS/Comp Medical Fee product.

Bundling and unbundling is another optional feature
that is available. The data to implement any of these features is available
from a third party.

Setup Considerations

1.    By
default, the program will check to see if the specified vendor has an HMO/PPO with Valid From/Thru dates that cover the From
date in the payment record. If so, it will look in the HMO/ PPO’s
record for the rate table to be used.

When a rate table is not specified (or found), the
program will use the vendor’s State to see if the
Schedule flag for that state has been set with the Maintain-State Codes menu.

If the vendor’s State field is empty or the
state has no fee schedule, a message will appear indicating that it will use
the Fee State Code set with the Administer-Configuration-Module Parameters menu
to calculate the amount for the line items to be paid on the invoice.

2.    If UCR percentiles are to be used, they should be
stored by state with the Medical Fee- UCR Percentile menu. By
default, the program will detect that a percentile exists for the vendor’s state and use the UCR value
to calculate the amounts, based on the zip code,  for the line items ignoring the $ per Unit
value in the fee schedule.

3.   If the
Override State flag has been set with the Module Parameters menu, the program
will calculate the amount of the line item using both of the above methods and
display whichever amount is lower.

Making a Payment

The bill review process is quick and easy. The Bill
Review button will display a data entry screen with
two pages, the first of which is used to enter general information on the
payment as shown
below.

Field Name

Description

Payment
Type

The
type of payment, either check or
voucher.

Invoice

The
number of the invoice that is being paid.

Invoice
Date

The
date of the invoice.

Received

The
date the department received the invoice may be entered for accounting
purposes

Status

The
status of the payment; either batch to
be printed later, print when the record is saved or notation only, which
writes the payment record to the check history file with a specified form
number and processed date without printing it first.

Payment
Code

The
code for the type of payment.

Payment
Note

A
note to be displayed on the check or voucher.

Vendor
Code

Enter
“C” if the payee is the claimant or press the Ellipsis button to select an
active vendor.

Payee

Making
a selection will display the name and address from the vendor’s record.

Clicking the Line Items
button will display the page shown below.

The fields on this form are described as follows:

Field Name

Description

Amount

The
amount on the invoice. The total amount that will be paid for the line
item(s) is displayed in the Payable field. The program will display a message
and adjust the amount for the line item or the amount payable if either is
greater than the invoiced amount.

Service
Zip

By
default, the vendor’s zip will be
displayed as the zip code where the service was performed. This zip code will
not only determine which fee schedule is used, but also the tax rate if tax
is to be applied as in New Mexico.

ICD-9

The
ICD-9 code(s) from the invoice. Up to four codes
may be entered.

Inpatient

A
check indicates that the employee has been admitted in a facility and treated
as an inpatient.

Item

The
number of the line item. Use the arrow keys to enter another item or review a
previous one listed in the grid below.

From/Thru

The starting and ending date of the billing
period. (The default ending date is the same as the From Date.) These dates
will determine which particular fee schedule to use. (It must be after the
open date on the claim.)

For
your convenience, the previous From/Thru dates will be displayed as you enter
new line items.

ICD-9

A
number to specify which ICD-9 code applies to the specified CPT code for the line item.

Invoiced
CPT Code

The CPT code for the item. Normally, this must be a
valid code (in the fee schedule) in order to continue. The exception is
“00000”, which may be used to enter a miscellaneous item that is not found in
any fee schedule.

Note
that the professional component or technical unit value may be used instead
of the maximum reimbursable by entering the CPT code followed by either "-26" or
“-27” respectively (e.g. 00100-26).

CPT Code

If
the UCR module is in use, the vendor’s zip code will be
used to determine the appropriate region.

Description

The
description of the procedure.

Modifiers

Up
to three modifiers may be applied to the CPT code. For example, the following modifiers
may be applied to CPT 00100.

Specialty

When
there is a specialty associated with the CPT code, it may be selected from a list of
choices by clicking the Ellipsis button.

Qty

The
number of units billed for this line item. Unit Amount     The amount billed per unit is optional.

Amount

The amount billed for the procedure. If the
amount per unit has been specified, the program will multiply it by the
quantity when the Qty is greater than one and the CPT code begins with 1 or higher (anesthesia
units are billed differently).

When
the following situation occurs, the invoiced amount will be set to zero.

The values from the preceding Invoiced
fields will appear as soon as the Amount is entered.

Accepted
Amount

The Maximum Reimburseable Amount (MRA) is
displayed if it is less than the amount invoiced, otherwise the MRA will
appear. As the amount of each line item is accepted, the total value in the
Payable field will be incremented.

Note
that if the Bundling/Unbundling feature is in use, the program will check
for major or comprehensive procedures that consist of a number of individual
procedures. For example, the CPT code 31505 (larynoscopy diagnostic) consists
of many other procedures, one of which is 36000 (microsurgery add-on). If
both are on the same bill, the program will detect that the "code 36000
is part of the comprehensive procedure code 31505" and enter ZERO in the
accepted amount for line 36000. The program will also look for mutually
exclusive procedures (e.g. 27177 and 11010) that are not allowed on the same
bill.

Override

An
override code to explain why the amount to be paid is different than the
amount billed. Press the Ellipsis button for the user-defined choices entered
with the Tables-Medical Fee menu.

Futures

The
amount available in the claim’s (future) medical reserves. See below for
details when the amount is insufficient to cover the payment.

Payable

As  line
items  are  entered
and  accepted,  the
program  will  adjust
this  value accordingly. When
the record is saved, this amount will be used to update the paid to date and
future reserves in the claim.

Rate
Table

The
program will display the name of the fee schedule table in use.

If you are in the Override field and want to enter
another line item, press <Page Down> to
increment the Line Number by one and move the cursor to the next From field. By
default, the previous From/ Thru dates will be displayed for your convenience.

Saving the Record

After all the line items have been entered, save the
record. The program will verify that the future medical reserves will cover the payment. If the futures are not
enough, the program will check the Negative Reserves value set with the Module Parameters menu.

If the Negative Reserves value is "Y", the entry is allowed
and the future reserves in the claim will become negative. If the
value is "N", the program will check the Stair Step Reserves value that was set using the Application
Parameters screen.

If the Stair Step Reserves value is “A”, the incurred amount in the claim
will automatically be increased to cover the payment. Otherwise, the Edit Reserves
dialog may be used to increase the reserves. (All changes depend on the
operator's reserve limit.) Clicking Close without
making a change will decrease the amount to equal the future reserves.

At this point, the payment will be batched, printed, or manually posted
to history depending on how the Status field is set.

Note that the payment will be pended if it is over the operator’s
check writing limit. (Pended payments must be released using the File menu in
the Batched Payments section of the Process module.)

After the record is saved, you will be asked if you
want to input another payment for this claim. If you click Yes,
the form will be cleared so you can start again. Otherwise, you will be
returned to the main menu.

The Bundling and
Unbundling Feature

When this optional feature is in use, the program
will check for mutually exclusive procedures (e.g. 27177 and 11010) that are
not allowed on the same bill. It will also look for major or comprehensive
procedures that consist of a number of individual components or procedures. For
example, the CPT code 31505 (larynoscopy diagnostic) consists
of many other procedures, one of which is 36000 (microsurgery add-on). If both
are on the same bill, the program will detect that the "code 36000 is part
of the comprehensive procedure code 31505" and enter ZERO in the accepted
amount for line 36000.

Using Custom Fee Schedules

The ATS system supports multiple fee schedules; federal (DOL), state, and
the usual and customary reimbursement (UCR) schedule. In that case, the
program will display the amounts in the different schedules so the user can
make a selection.

Discounts and/or custom fee
schedules can also be setup for specific vendors.
(Without this ability to use custom schedules, invoices for vendors that use
their own service codes could not be reviewed.) After custom schedules have
been setup, their use is transparent during data entry unless the code on the
invoice is found in multiple schedules.

If you would like to use this feature, please contact
ATS support as the procedure is beyond the scope of this manual.

Printing the Explanation of Benefits

The Explanation of Benefits (EOB) is normally printed at the
same time as the payment. A special menu option is
provided for those clients who export their payments to be printed by a foreign
system and/or want to print them again later.

An option on the Financial menu may be used to print
the EOBs any time after the check or voucher payments have been printed (not
while they are still batched). When the report screen appears, enter the
specifications to meet your requirements.

Field Name

Description

Provider
Code

A
specific provider (vendor) code. Leave this
field empty to include every provider that received a payment within the specified range of dates.

Display
By

The
EOBs will be sorted by provider code and then by either the claimant’s name
(the default) or the claim number.

Starting
Date

The
first payment date to be selected. By default, this is the
date that was used the last time the forms were produced.

Ending
Date

The
date of the last payments to be selected.

An example of the standard EOB has been included below.

Figure
6‑3: Sample Explanation of Benefits

The process home page

Figure
6‑4: Process Home Page

Batch

All payments that are entered with a status of “B”
are batched for future processing. At any time, these batched payments may be
reviewed, approved, posted, deleted and/or released (when pended) by anyone
with the proper access level.

Use the Batched Payments menu and click the Process button
to view all the payments.

Use the Previous and Next
buttons to page through the list. The columns contain the following
information.

Column

Contents

Type

The
type of payment where C = check and V = voucher

Status

“A”
if the Approve feature is used, otherwise empty.

Entry

The
code for the user who entered the payment or AUTO if the system batched the reoccurring
payment.

Amount

The
amount of the payment

Payee

The
name of the payee

From/Thru

The
dates in the billing period

Due

The
date the payment is to be issued

Desc

The
pay code

Transaction

The
claim number followed by an asterisk and the number of
the payment issued for the claim

Voucher

The  number
assigned  when  the
item  has  been
exported  with  the Accounting Interface module

Entry
Date

The
date the payment was batched

Mode Filters

The Edit Batch utility has a wide variety of features as
evidenced by the number of buttons and check/edit boxes that appear on the
form. Each of the features, including those available from the menu, will be
covered in the following sections.

There are two buttons that may be used to process
batched (the default) or pended payments which were entered for more than the
operator’s check writing limit.

The following filters are available to select a
specific group of batched payments.

Figure
6‑5: Batch Mode
Filters

(Not) Approved

The ATS System has a Pre-Approve feature that may be
used to require the approval of payments before they can be printed.

If the Pre-Approve flag has been set in Module
Parameters, these filters will be enabled so that all payments that are not
approved will be listed when the Process button is clicked. Remove the check in
the Not box to get a list of approved payments. (Approved payments will have an
"A" in the Status column.)

(Not) Exported

By default, all the payments that have not been
exported using the Accounting Interface will be listed. Remove the check in the
Not box to get a list of exported payments that have a number in the Voucher column.

Criteria

When the Region feature has been implemented, this filter may
be used to display a list of payments for claims in a specific region. An
operator may only view payments for a particular region if one is specified in
the operator's record and the Region View is turned on.

Also available is the due-date filter.

Advanced Filter

By default, the payments for all the claims that meet
the other criteria (filters) will be listed. When this is a long list, it may
be difficult to find a payment for a specific claim. In that case, click the
Claims ellipsis
button to display the Select Claim screen. Pick a claim and only those payments
will appear on the list.

Figure
6‑6: Advanced Filter

Operations

Figure
6‑7: Operation Buttons

A variety of buttons are available so you can perform
the following functions.

Approve/Un-Approve

If the Pre-Approve flag has been set to "Y"
with Module Parameters, these buttons will be enabled so batched payments can
be approved by an operator with the authority to print checks. Otherwise, this
button will be disabled (grayed out) since this step is not required. When this
feature is used, approved payments will have an "A" in the Status
column.

Delete

Any payment may be deleted from batch by an operator with
Delete permission. Simply highlight the desired item and click the Delete
button. The program will ask if you want to perform the operation. To continue,
click Yes. The program will remove all references to the
batched payment from the system and adjust the reserves/paid amounts for the claim.

Post

When a check has been made out by hand or printed with
a foreign system, an operator with Print Payments permission should use the Post button to post the payment to the check history table. The date and form
number may be changed if necessary.

The next voucher number is found in the client’s
record, whereas check numbers are stored in the information for the bank
account.

Release

Use Pend mode to view any payments that were entered
for an amount over the operator’s check writing limit. Select one of the
payments. If your check writing limit is higher than the amount of the payment, the Release button
will be available to place it in Batch mode.

View Button(s)
on the grid

Figure
6‑8: Grid View Buttons

Use the View button to view all of the
information on a specific payment. With proper authority
information within the batched payment can be modified.

Report

The Report button may be used to
produce a wide variety of reports with the currently listed payments.

Export

The Export button will export the
grid to a Microsoft Excel type format.

Rebatch

This feature is used to search printed items that may need
to be reprinted due to a print job error or a mistake on a check or checks.

Figure
6‑9: Rebatch Payments Screen

Once
you enter the search criteria and have records in the grid you will then be
presented with the View option button as in edit batch as
well as a button to Rebatch the selected items. Use the check box to the
left of the item you wish to rebatch or use the checkbox in the header section
to select all of the records in the grid.

Figure
6‑10: Payments Grid

Export

This button will export the grid to a Microsoft Excel
type of format.

7.
History

The ATS History module is a powerful tool designed to let you
review the operations that have been performed on a claim. The types of
operations are divided into categories with a variety of search criteria to
help you find the information you want. The categories are:

·
Payments

·
Letters

·
Recoveries

·
Reserves

·
Transactions

·
Audit

The History view pages may be accessed from the Toolbar
buttons after you have selected a claim on a Claim List or from the Menu Bar within
the claim program.

Payment History

This option is covered first since it is the one used
most often. The payment history is queried with the following dialog.

Every payment will be listed when using the default
selection criteria: all payments from the date the claim was opened to the
current date regardless of reserve category. The total paid, batched, and the
grand totals appear at the bottom of the form.

You may search for a specific group of payments by
modifying any of the following criteria.

Criteria

Function

Date
Range

Lists
payments made from one date through another. The program will start selecting
from the date the claim was opened though the current date by default.

Reserve
Category

Selects
payments made to one, a group of accounts or all of the reserve accounts. The
default will select payments regardless of category.

Click the Process button
to list the payments that match the selection criteria. By default, the
payments are sorted in descending order by date with the most recent entry
first.

Figure 7‑1: Claim History -
Payments

Select Button

Any of the History options that display a dialog with an Open
button allow you to look at the details for a selected item. All the fields are
disabled so they can’t be edited.

Figure 7‑2: Claim History -
Payment Detail

Report Button

The Report button displays a report
with just the items that appear on the selection list. For example, suppose
someone requests a list of the payments made against the first reserve category.
In that case, remove the checks for all the other the reserve categories and
click Process, the click Report.

Figure 7‑3: Claim History -
Payment Report

Letter History

Depending on a parameter set in the Maintenance section
for Forms/Letters, a record may be written to the history file each time a form
or letter is produced for a claim. If you have used this feature, then you may
query the database using the following dialog.

If you enter a Letter Code, the program will search for
records that contain the code and a date within the specified range. The note
shown on the list is the description that was entered when the document was
produced.

Note that the first time a document is generated the
record number is always “1”. The next time it is generated the number will be
“2” and so on.

Figure 7‑4: Claim History -
Letters

Reserves History

The ATS System keeps track of all changes to the
reserves for your
future reference. Use this History option to view the transactions. The dialog
shows six reserve categories. The number and labels will vary depending on how
your system has been set up.

By default, all changes will be listed from January 1,
1901 to the current date regardless of reserve category. To eliminate a
category from the list, remove the check by clicking the box.

Figure 7‑5: Claim History -
Reserves

Recoveries History

This option allows you to look up information on any
recovery that has been made for the specified claim. By default, all recoveries
will be displayed regardless of the reserve account or party involved when the
Process button is selected.

The selection criteria may be modified. For example, to
get a list of recoveries for reserve category #1 from a specific vendor, enter the vendor’s federal
ID number (by clicking Browse next to the Party box) and remove the checks from
every category except the first one.

Figure 7‑6: Claim History –
Recoveries

Audit

The Audit menu item provides access to a chronological
list of all actions that have taken place for the selected claim.

Figure 7‑7: Claim History – Audit

8.
Diary

The ATS Diary is a powerful tool that you may use to remind
yourself of things that need to be done. You can create “To Do” notes for
yourself and others that may or may not be related to a specific claim.
Depending on how the system has been set up, claim specific diary entries may
also be generated automatically.

For your convenience, the ATS Diary is available from a number of different
programs. In this chapter, we will assume that you have just logged in and
clicked the Diary button on the Menu Bar of the Console.
Refer to the Claims chapter for specific information on how this
feature may be used while you are editing a claim.

The ATS Diary

Clicking the Diary button will display your Activity
List. For example.

Figure 8‑1: Diary Activity
List

Note the column for LOB (Line of Business). If you have installed other
ATS products such as ATS/PAC Multi-line Liability or ATS/A&S Disability,
the diaries created using those products will appear on the list with the
corresponding icon. You may also have different data sources (databases) in use
especially if your company is a third-party administrator.

Changing the Display Order

By default, entries will be displayed in order by
their Target Date. The oldest entry will be at
the top of the list to make it easy to see which one needs to be addressed
first.

The default display order may not always be
convenient. To change the order, simply click on any of the column headings.
Click on the heading again to reverse the order.

Using the Filters

Filters are available at the top of each column of
the list to help you find specific diaries. In this example, we are searching
for diaries that contain “auto” anywhere in the subject, but you can also
search for those created by a specific user (adjuster), between certain target
dates or for a particular claim number.

Figure 8‑2: Diary List
Filter

Viewing Diary Entries

There are a variety of different lists available to
help you handle your diaries. They are:

·
Activity List

·
Due Today

·
Next 7 Days

·
Overdue

·
Reviewed

Since all diary entries appear on the Activity List, it is considered the
operator’s To Do list. It contains two types of entries. Typically, a diary
pertains to a specific claim or first report of injury, otherwise the entry is
considered a User diary and that Claim Number column is empty on the list. (You will find
that writing notes for yourself and others is a very handy feature.)

The Reviewed tab may be used to view your diaries
that are not on the other lists, but are still stored in the table as reviewed.

See also the Calendar section in this chapter for
information on another very handy way of viewing diaries.

The Supervisor’s Views

Operators with supervisor status have an extra set of
Menu options to list the diaries for the group of users for which they are the
manager or for all users when they have not been specified as a manager.
(Supervisors and their groups are defined with the ATS Security System.)

·
Group Activity List

·
Group Due Today

·
Group Overdue

·
Group Reviewed

Creating Diary Entries

ATS may be set up to generate claim-related diary
entries automatically, but you can also create diaries with the File-New menu
or toolbar button. This dialog will appear so you

The types of diaries are described as follows:

Type

Description

User
Diary

This
type of entry is not related to any particular claim. Typically, these are
notes to remind you of something to do such as a staff meeting, but you can
also create notes for other operators. (Refer to Reassigning Diary Entries section.)

Current
Claim

This
is the default option. The current claim is the claim or first report of
injury that has been highlighted on the Activity List.

Selected
Diary

This
option may be used to enter a diary for any claim. When selected, the LOB and Data Source fields will be enabled if
other ATS products and/or data sources have been installed.  (A Claim Selection dialog will appear when you click OK.)

A sample diary for a claim is shown below. Dates may
be typed in or entered with the Calendar button. You will be warned if the date
selected falls on a weekend or a holiday.

Figure 8‑3: Diary Entry
Screen

The Subject is the text to be displayed on the
Activity List. Entering a Message is
optional. When you finish entering the diary, click the Save and Close
button. The new diary will appear on your Activity List.

Selecting a Form/Letter

This is a very handy feature that may be used anytime
you know that a certain form or letter needs to be sent on a specific day. The
button next to the Letter Code field will list the documents that are
available for your use.

Button Actions Menu

There are a variety of operations that may be
performed from the button bar. They are:

1.
The Attach File
button will display the dialog shown below so you can attach any type of file
to the diary.

Figure 8‑4: Diary Attachment Dialog

Click the Browse button
to find the file you want. By default, the program will look in the user's My
Pictures folder. After selecting a file, click the Save button.

2.  The Detach
button is available if you wish to delete the file you attached previously.

3.   The Open
Claim button is available to display the case associated with the
current diary. If the diary pertains to a report of injury, that case will also
be opened.

4.   The Show
Notes button may be used to display the notes
pertaining to the claim or report of injury.

Editing Diary Entries

A diary may be opened and edited in the same dialog
that is used to create it originally. The subject or message for a diary entry
may be edited along with the Scheduled (Target) Date. (See the Reschedule
section in this chapter.)

Marking Diary Entries as Reviewed

A diary must be marked as reviewed before it can be
removed from the Activity List. To do this, edit the entry,
check the Reviewed box, and save the record. After you exit, the item will no
longer appear on the list. The Mark as Reviewed button is
available to users with Supervisor status so they can mark diaries as reviewed
without having to edit them.

The Reviewed Diaries option may be used to view
diaries that are not on the Activity List, but are still stored in the
table as reviewed, in case you wish to see the entries before they are purged.

Printing Diary Entries

The diary entries that appear on the current list may
be printed by using the Print button.

Reassigning Diary Entries

There are many reasons to reassign diary entries.
People may go on leave and need someone to handle their job temporarily, the
adjuster on a claim may change, or a person may leave for another job.

Click the Reassign Diary button to list the users who are able to
receive diaries. Make a selection and click OK. Afterwards, the entry will
appear on the other person’s Activity List, not yours.

Rescheduling Diary Entries

At times, it may be necessary to reschedule diary
entries. You can open the diary and change the Scheduled Date or click the
associated button. A window will open so you can enter the new (target) date.

The ATS Calendar

The Calendar will give you a rough idea of the amount
of work to be done on any given day. It is available from the Show menu or the
associated button. When the calendar opens, three months will appear the
current date (in blue) will be selected by default. The days which have a diary
appear in red.

In this example, the Preview Pane has been selected so
the contents of each diary will be displayed.

Diary Setup
Considerations

A system administrator should use the following
procedure to set up the ATS Diary features:

1.         The
Diary Transfer,
Diary Receive and Supervisor permissions must be set appropriately for each
user with the ATS System Security module. The Manager must also be indicated
for each user who is not a supervisor so the user’s diaries will appear on the
list for the appropriate group.

2.         The appropriate values must be set with the
Module Parameters screen in order to trigger the generation of claim-related
entries.

3.         The
WCSCAN02 program that generates the claim-related entries must be scheduled to
run each day.

4.         By default, diaries will appear in yellow
or red to indicate that they are due or overdue. When the Diary is selected from the ATS Explore, the
Diary/Scan menu is available to set the number of days before a diary will turn
color.

9.
Forms and Letters

Following is the process used to generate forms and letters in ATS.
The letters shown are just a sample and your specific letters will
depend on your state and custom requirements. Based on the Jurisdiction state
you will be presented with State Letters as well as any custom (User) letters.

Select
the letter you want to produce. Then click Open Selected.

Figure 9‑1: Forms and Letter List

The
letter will generate with defined fill fields.

Figure 9‑2: Sample Generated Form

Additional features such as underline and highlight are
available.

Once
you are done with your form, you may print, use Save
and Download to keep a local copy or email a copy, as well as
save the document to the file history.

Figure 9‑3: Form Output Options

10.
Reports

ATS Reports comes with a wide variety of standard
reports that are generally divided into the following categories:

·
Claims

·
Financial

·
Statistical

·
Government

·
User

However, additional categories may be available,
depending on the reports available, and new categories can be created, as
required.

In addition to standard reports, ATS provides the
option for a web-based Ad Hoc report tool as well as an Analytics reporting
tool (Tableau).

Users with the appropriate permission may access the
report menus. Those who are restricted to viewing claims for specific regions
and/or levels will also be restricted when producing reports.

This chapter will explain how to use the reporting
features. Details on specific reports and samples of the output are included in
the Appendix.

To access the Report module, select Reports
from the Menu Bar of the Console.

Figure 10‑1: Reports – Home

On the Home page you can select the Account (database) that
the report will use when it runs.

Figure 10‑2: Reports – Account Selection

Producing a Report

The following is an example of the output from the
“Activity Summary” report.

Figure 10‑3: Reports – Activity Summary Report Sample

Entering the Selection Criteria

All of the report screens operate the same way. They
are designed to help you enter the specifications you need to generate a
report. Selecting an item such as “Activity Summary” will display a screen with
the report parameters.

The following information is requested on the sample
form shown below.

Region Code

ATS allows you to group the departments or divisions
in your company into regions. If this feature is used, you may select a
specific region for reporting purposes.

When the default value of “ALL” is used, the program
will skip this initial selection process and start with the next item.

Note that if a user only has permission to view the
claims for a specific region, this field will be set to that value and can’t be
edited.

Level 1 Code

Each claim record contains the codes for the
employee’s levels. If you enter a specific code for level 1, the program will
read each claim record and select only those for that level.

If a user has permission to view the claims for a
specific region, only the levels in that region will be listed.

As Of

By default, financial information is based upon the
current date. A special valued as-of date may be used to generate some
information as it had been on a prior date. The program will provide a snapshot
of the Claim data based on the date entered.

Figure 10‑4: Reports –Activity Summary Parameter Entry
Example

Entering the Output Specifications

After completing the selection process, the program
will check for any specifications that indicate how to display the records such
as:

·
Display Totals Only

·
Print Level 2

·
Subtotals

Display Totals Only

Check the Display Totals Only box to produce a summary
report. Remove the check to display the details on the selected claims.

Note that if this box is checked, the details on the
closed claims will not appear even if you have used the option to include them.

Print Level 2

Some reports will group the selected claims by level 1
and then sort each of those groups by the level 2 code. In that case, the
default is to display the subtotals for level 2, but you may have the option of
removing the check in order to suppress them.

After selecting options and filling in the
parameters, the report can be generated immediately by clicking the Run
Report button or scheduled to run at a later time by clicking the
Schedule
button.

Valued As-of Reporting

At any time, you can pull up the record for a
particular claim and get the current reserves and paid to date figures broken down by
reserve category. The totals displayed on the Financial page are stored in the
claim record. The details on the specific transactions are stored separately in
history. (Reserve transactions are stored in a reserve history table while
payment, credit, and void details are in check history.) As each transaction
is saved, a routine is run to keep the claim and history in balance.

Since reports that include a Valued As-of Date field must be able to create a snapshot
of the claim on a specific date in the past, the financial transactions are
taken from history.

Suppose you want a report showing the reserves and payments the way they were on December 31,
2010. The following criteria will select all the transactions processed during
2003 for all claims opened since 1985. The reserve and payment transaction amounts (normally marked with an
asterisk) for the various categories will appear as though the report was run
on 12/31/2010 instead of the way they are today.

Open Dates

From 01/01/1985

Thru 12/31/2010

Transaction Dates

From 01/01/2010

Thru 12/31/2010

Valued As-of

12/31/2010

The Incurred, Total PTD, and Futures are always the
same as those that appear in the claim record. The payment transaction value includes only the payments
with Processed Dates within the specified range. Any credit or void applied to a payment after the as-of date will
not be reflected on the report. The reserve transaction value includes all
changes made up until the Valued As-of Date.

The Sort Order

Typically, the information in the reports is sorted
by the region and division (level 1) in which the claim occurred. When ”Include
all Items” is specified in both of the fields, the program will sort and group
the selected records by the region (if used) and then by the level 1 code found
in the claim. The records will then be displayed in order by the claimant’s
name or claim number.

The description of the report may indicate another
sort order. For example, the phrase “By Levels 1 and 2” indicates that the
selected records for each level 1 will also be sorted by the code for level 2.
In that case, the following order would be used if you have EASTERN, WESTERN,
NORTHERN, and SOUTHERN as regions, state codes as level 1, and ST0001, ST0002…
as level 2.

EASTERN / MA / ST0001

EASTERN / MA / ST0002

EASTERN / MA / ST0003… EASTERN / ME / ST0111

EASTERN / ME / ST0112…

Previewing a Report

When the report specifications have been entered,
select the Print Preview button on the toolbar to load the report
into the report viewer where it can be viewed and/or printed.

If you are printing from the Crystal Report Writer,
it is important to note that only the first page of the report is displayed
initially. If you click Print at that point, only that page will be printed.

You must go to the end of the report if you intend to
print all or selected pages. (Maximize the report so the Go to Last Page button
is available.)

Printing a Report

ATS reports may be printed by selecting the Print
button on the toolbar. A Print dialog will appear so you can specify which
printer to use, the number of copies, and the pages to be printed.

Exporting to Another Format

Click the Export button to select the specific format
you wish to use. Those that Crystal supports are listed below.

Using the Report Image Option

Reports produced by the ATS system may be stored in
an image file on the disk. The Image Reports list allows you to view, print,
delete, and/or email these files to someone else. There are a variety of ways
to find the report you want.

11.
Dashboards

The ATS System provides a dynamic dashboard system that provides the ability to view
information in graphical format with drill-down capabilities. Dashboards can be configured to display directly on the
Console and then expand to the full screen when
desired. Dashboards can also be accessed via the Dashboard option on the Console menu bar.

Viewer

Figure 11‑1: Dashboard Viewer

The Dashboard Viewer allows you to display interactive
dashboards that operate on data in real time. Subsets of data can be selected
and clicking on specific identifiers within the display will automatically
cause the other portions of the screen to display data based on the specified
identifier.

The left side of the viewer contains the menu of
available dashboards. The menu is broken down by Line of Business and then by category, such as Claims, Financial, etc.

The My Dashboards section of the menu contains any dashboards
created by you with the Designer.

Designer

The Dashboard designer allows authorized users to create new
dashboards that report on information that is meaningful to them.

Figure 11‑2: Dashboard Designer

In addition to the web-based designer, a more robust
Windows version is available.

12.
System Tables

There are a wide variety of easy-to-edit tables that
contain the company specific information available when pressing Ellipsis
button next to certain fields on the input screens.

The following chart briefly describes the items on the
Maintain menus. Each one is covered in detail in this chapter.

Menu Item     Submenu Item                       Contents
of Table

Organization

Organization                           Organizations
within the company

Region                                     Regions within the company

1st thru 3rd                             Levels
in the client’s hierarchy

Sub 2 and Sub 3                      A 4th and 5th pseudo level

Loss Act                                  Injury
act codes

Agency (Source)                     Source of accident codes

Body - Member                       Member of
body injured

Site                                          Site or part
of body injured

Cause                                      Cause/reason
for injury

Deductible                              Deductible
codes

Loss Coverage                                    Loss
coverage codes

Nature                                     Nature
of injury codes

OSHA                                     OSHA codes

Recovery Types                      Expected
recovery codes

Restrictions                             Restricted
duty codes

Severity                                   Severity
of injury codes

Type of Coverage                   Coverage
type codes

Type of Loss                           Loss
type codes

Type of Settlement                 Settlement type
codes

Carrier Tables                          EDI, NCCI and Traveler’sTables

Rsv/Payments/ Recoveries

Indemnity Pay Codes             Reserve / cost center account 1

Medical                                   Reserve
/ cost center account 2

Rehab                                      Reserve
/ cost center account 3

Expense                                   Reserve
/ cost center account 4

CC5 (Legal)                            Reserve
/ cost center account 5

CC6 (Other)                            Reserve
/ cost center account 6

Reserve Types                         Types
of reserve accounts

Reserve Change                      Reserve
account change codes

Recovery Type                        Recovery
type codes

Fed/State Withholding           Tax tables

Void Types                             Void transaction codes

Late Payment Reasons            Codes for EDI export purposes

Industry

SIC                                          Standard
industry codes

NAICS                                    North
American Industry Classification System codes

NCCI                                      National
Council on Compensation Insurance codes

NDC                                       National
Drug codes

Occupation                              Occupation
codes

Medical Fee

Override                                  Codes
to override fee schedule

DRG Codes (ICD-9)              DRG or ICD-9
diagnosis codes

Initial Treatment                     Initial
treatment codes

HMO/PPO                              HMO/PPO
provider codes

MOC                                       Managed care
organizations

UCR Percentile                       State UCR percentiles

Provider Specialty                   Vendor
specialty codes

Reason                                                Reason/referral
codes for Case Management module

Other

Relationship                            Relationship
to employee

State                                        State
specific information

County                                                Country codes for use on custom screens

Employment Status                 Employment
status codes

Location                                  Codes
for specific locations

Legal                                       Litigation codes

Forms/Letters

Common                                 Standard
ATS forms/letters

User                                         Client-specific
forms/letters

Letter Builder                         Editor
for creating HTML documents

User Defined

Tables                                      Lists
the client’s custom tables

TABLE Maintenance

The Maintenance portion of the system provides the
ability to modify the contents of various tables in the database that are used
to populate the values in lists.

Figure 12‑1: Table Maintenance – Table Selection

To maintain the values in a table, start by selecting
the Datasource where the data resides. Then select the name of the table you
want to access. A list of the records contained in the table will be displayed
along with all of the values each record contains.

Figure 12‑2: Table Maintenance – Table Contents List

To edit the values for a particular record, click the
Select button next to the list entry. This will open the corresponding editor
for records in the table.

Figure 12‑3: Table Maintenance – Sample Editor Screen

Organization Maintenance

This menu should be used to define the levels in your
company’s hierarchy that will be used to group claims for reporting purposes
and enter other information related to the employee. The options will be
covered in the order in which they appear on the menu:

·
Region

·
Level 1

·
Level 2

·
Level 3

·
Level 3 - Sub 2

·
Level 3 - Sub 3

·
Organization

Region

Regions may be associated with a specific level 1 or
state depending on the Region Mode set with Administer-Configuration-Module
Parameters. If a user has access to one or more regions and Region View has been set in the user's profile, the
operator may view/edit claim and employee records and process payments only in
the particular region(s). If these features are to be used, select this menu to
enter the region codes on the screen displayed below.

Note that ATS allows bank accounts to be set up for
specific regions in any or all of the ATS/Comp modules. When this feature is
used, these accounts must be set up with the Process-Trust Fund menu.

The fields are described as follows:

Field Name

Description

Code

The
code to identify the specific region.

Description

The
description of the region.

Trade
Name

The
trade (company) name if any.

DBA
Name

A
DBA name may be needed if the region is the Responsible Reporting Entity (RRE).

Mailing
Address/Phone

The
address and phone number for the region as needed for reporting purposes.

Bank
Account Numbers

If
this region has a specific bank account for any or all of the ATS/Comp
modules, enter the account number.

Employer

If
this is the only employer in the region, check this box and fill in the rest
of the information for reporting purposes.

Self-Insured

A
check indicates that the employer is self-insured.

Emp.
Fed ID

The
employer’s tax ID.

Physical
Address

The
employer’s address if it is different than the mailing address.

Location
Code

The
employer's location code should be entered if it is required on the first
report of injury.

Unemployment
Account Number

The
employer’s UIAN number.

Pay
Day

The day of the week the employees are paid
where 0 = Sun, 1 = Mon, 2 = Tues, 3 = Wed, 4 = Thurs, 5 = Fri, 6 = Sat, and 9
= Any Day.

If
AutoPay is used and the region is the employer, this
information and the day the (work) week ends will be used to schedule the
payments to be batched. (For details refer to the AutoPay Mode flag covered
in the Parameters-Application section of this chapter.)

Week
Ends On

The
day the work week ends should be entered if AutoPay is used and the level is the employer.

DOH Filing

When
New York’s Department of Health’s surcharge needs to be paid, either monthly
or annually.

Form
Type

The
type of payment to be issued: checks only, checks by
default, vouchers only, or vouchers by default.

Effective
From/Thru

The
date this region (fund, member, plan) before effective. If it’s no longer
use, enter the ending date.

CMS Reporter ID

The
reporter ID if this region is the RRE.

CMS Reporting Group

The
number of the group (from 1 to 12) assigned to the RRE.

CMS User

The
user responsible for creating the export files. A diary will be generated to
remind that person to make sure the necessary claims have been batched.

Levels 1 to 3

When generating reports, a client database is normally
sorted and broken up into groups depending on the values entered in the level
fields. Valid entries for these levels are created using the Maintain-
Organization menu.

Whenever levels are displayed on an input screen, they
will be labeled Division,
Dept (department) and Sub (sub-department) by default. A system
administer may customize these labels with the Application Parameters menu.

Although ATS will help you set up your level
categories initially, it is important to understand what is involved. For
example, suppose you are a nation-wide company of XYZ retail stores. The
company would be considered the client in the ATS System. If you have an RIS
department to administer the claims, your company would also be the ATS agent.
Since your organization is divided into geographical regions, you could use the
ATS region feature and levels as shown below. Although codes would be entered
in the database, the description is used here for clarity purposes.

Region            Level
1: Store             Level
2: Department

Western           Market
SF-CA                        Women’s Clothing

Eastern                        Wall Street-NY           Kitchen

Central                        Burlington-IA             Furniture

On a report, the claim information may be sorted and
grouped by region, store, and department as in:

Central

Burlington-IA

Furniture

claim
1

claim
20

claim
61

Appliances

claim
12

claim
35

Chicago-IL

Linens

claim
23

Eastern…

In another situation, an entity
such as the ABC school district may use the following two levels. Sites such as
classroom, employee parking lot, and bus would be entered as locations (instead
of level three) since there is a cost analysis by location available on the
statistical report menu.

Level 1:
Division        Level 2: Dept             Level 3: N/A

Administration            Accounting                 Employee Parking Lot

Instructional                Marshall
High School Classroom

Transportation             School
Buses               Bus1

The following screen is used to
enter information for Level 1. The label and functionality of the Grouper may
vary, but otherwise the level screens are similar. The Region, Bank Accounts, CMS and Ignore PPO fields are only available in
level 1.

Figure 12‑4: Organization Maintenance – Level 1 Entry

When a specific level is an employer, enter items such
as the Address, Fed. ID, SIC Code, and WC ID number if they are required on
your state-mandated forms and letters. The Pay Day and Week Ends On
should also be entered before scheduling payments with AutoPay.

The fields on the form are described as follows:

Field Name

Description

Code

The code used to reference a specific
level. When the policy feature is in use and the level is used in the policy
format code, do not use a hyphen in the level code. Otherwise, the claim
program will not be able to find a policy since hyphens are used to separate
the parts of the policy code. For example:

OK            CCC_ADM

Not OK
CCC-ADM

Name

The
name  of  the
level  such  as
ABC  Stores  or
a  functional  unit
like Administration. This name will appear in reports and on any input
screen where the level code is entered.

It
may also appear on state forms and letters if this level is the claimant’s employer.

DBA
Name

The
DBA name.

Mailing
Address

The
complete mailing address.

City

The
city.

State

The
state code.

Zip

The
zip or postal code.

Phone

The  phone
number.  Enter  10
digits  and  the
program  will  insert
the parentheses, space and dash.

Contacts

The
name of one to three contact people at this level.

ACC
Code

An
optional code that may be used by the accounting interface when making
payments.

ORG
Code

A
second accounting/organizational code that may be used for your own purposes.

Grouper

The
label and functionality of this field will vary. Refer to the Level Type
Feature section for details.

Effective
From/Thru

The
date this region (fund, member, plan) before effective. If it’s no longer
use, enter the ending date.

OSHA Establishment

Check
this box if this level is considered an OSHA workplace where the log will be kept.

Hours
Worked

This
is the total number of hours worked by all employees during the past year
that should be displayed on OSHA's Form 300A. This
number may be calculated by multiplying the number of full-time employees
times the number of hours worked/year (excluding vacations).

Avg
Number of Employees

This
is the annual average number of employees to be displayed on OSHA's Form 300A. This
number may be calculated by dividing the total number of payments made to
employees during the year by the number of pay periods.

The
following fields are only available on the level 1 screen:

Region

If
the Region by Level feature has been implemented, this field
will appear on the Level 1 form so the code associated with each level may be
entered. Refer to the Parameters-Option/Module and Region sections in this
chapter for information on using this feature.

Bank
Accounts

Payments
may be drawn against a bank account set up for each level. This feature may
be used in one or all of the ATS/Comp modules by entering the account number
in the appropriate field on this form. (Accounts must also be set up using
the Finance-Edit Trust Fund menu.)

Captive

A
check indicates that this level is a captive.

Ignore
PPO

(ATS/Med
only) Check this box if the Claims program should ignore the provider’s HMO/PPO discount when calculating the benefit amount
to be paid. The field has no effect in ATS/Comp.

The
following information should be supplied if the level is an employer:

Employer

Check this box if this level is an
employer. The system will use this flag to determine who the employer is when
filling out an Employer's First Report of Injury and some of the state-mandated forms and
letters. The program will
look for the employer by checking in the following order:

·
Level 3 (starting with Sub 3 and Sub 2) Level 2

·
Level 1

·
Region State Client

Self-Insured

Check
this box if the employer is self-insured.

Fed
ID

The
employer’s tax ID number.

Location

The
location code or number required by the state.

Physical
Address

The
physical address if it’s different from the mailing address. Include city,
state, and zip for reporting purposes.

UIAN

The
employer’s unemployment account number.

Mileage

The
amount paid for an office visit as a whole number of cents/mile (without a
decimal).

Total
Employees

The
total number of employees at this level should be entered if it is needed on
a state-mandated report.

Pay
Day

The
day of the week the employees are paid where 0=Sun, 1=Mon, 2=Tues, 3=Wed,
4=Thurs, 5=Fri, 6=Sat, and 9=Any Day. If AutoPay is used, this information and the day the
(work) week ends on will be used to schedule the payments to be batched. (For
details refer to the AutoPay Mode flag covered in the Parameters-Application
section of this chapter.)

Week
Ends On

The
day the work week ends should be entered if AutoPay is used.

WC
ID

The
workers' comp or state ID number.

WC
Phone

The
phone number of the Workers’ Comp Board.

WC
Address

The
address of the Workers’ Comp Board.

SIC

The
SIC code for the business done at this level.

NAICS Code

The
North American Industry Classification System code for this level.

DOH Filing

When
New York’s Department of Health’s surcharge needs to be paid, either monthly
or annually.

Fiscal
Year

The
start of the fiscal year in a MMDD format as 0101 or 0701.

CMS Reporter ID

The
reporter ID if this region is the RRE.

CMS Reporting Group

The
number of the group (from 1 to 12) assigned to the RRE.

CMS User

The
user responsible for creating the export files. A diary will be generated to
remind that person to make sure the necessary claims have been batched.

Level Type Feature

The label and functionality of the Grouper field will
vary depending on whether the Level Type value has been set to “Validate”,
"Backfill” the default, or "None” in the Application Parameters. If this field contains:

1.    Validate -
the Claim and Employee programs will use the level 1 entry to
determine which item(s) are valid for the subsequent levels and generate the
selection lists accordingly.

In this case, the label for the next level will appear
on the form (e.g. the level 1 Grouper field would be labeled Dept by default). Clicking the Ellipsis button will
display a dialog with a list of the available codes for level 2.

Select the item(s) that are associated or valid for
the specified level and click Add. The first entry in the top
list box will be marked with an asterisk (*) to indicate that it is the primary
code that will appear on the input form. To move another item to the top of the
list, highlight the entry and click the Make Primary
button. Clicking Remove will take the selected item off the list.

The Grouper is labeled “N/A” in level 3 since it provides
no function when the Validate feature is used.

2.    Backfill -
the Grouper field will be used to link specific levels in the client’s
hierarchy as in the following example:

Code               Grouper

Level 1            ABCST1         ABCST

Level 2            CA123                        ABCST1

Level 3            101                  CA123

In level 1, "Grouper" will appear as the
label and the contents of the field may be used for grouping similar levels on
a custom, adhoc report. In the example above, “ABCST” would group information
on all the ABC Stores (ABCST<n>) together.

In levels 2 and 3, the label for the previous level
will appear on the form (e.g. Division on the form for level 2 and Dept for level 3). Clicking <F4> will display
a list of the available codes. Select the one associated with the current
level. In the example, “ABCST1” would be entered as the Grouper in the record
for level CA123.

When you are entering a new claim or employee record,
you can enter the code for level 3 (101) and the program will use the value in
the Grouper field to fill in the codes for the other levels (CA123 and ABCST1)
automatically.

Sub 2 /
Sub 3

These menu options may be used if you have more than
three levels in your company's hierarchy. The codes are entered on a screen
similar to the one used for Level 3.

Sub 2 and sub 3 are referred to as pseudo levels 4
and 5 since the Level Type feature that validates or backfills levels 1 through
3 does not recognize these codes.

The claim forms that you are using must be modified in
order to use these codes.

Loss Maintenance

Loss codes are entered in the claim to describe the
agency, body site, cause and nature of the claimant’s injury or illness since
this information is required on many state forms. A system  administrator may  change
the  labels  for  these
codes  with  the
Application Parameters menu so different text may appear on your
input forms.

Special cost analyses by the standard loss codes mentioned above may be produced using Statistical
Reports to determine if there are any trends that need to be addressed.

You may have a custom set of claim forms that allow
you to enter additional codes. All of the codes on the menu are briefly
described on the following chart.

Loss Codes

Description

Act

The
act which caused the injury or accident.

Agency (Source)

The
source of the accident for further breakdown of the cause such as slippery
floor.

Body
Site

The
part of the body which was injured such as the abdomen.

Body
Member

The
member of the body which was injured.

Cause

The
reason for accident (e.g. slip and fall).

Deductible

The
coverage deductible codes.

Loss
Coverage

The
codes for the loss coverage plans.

Nature

The
nature of injuries such as sprained or broken.

OSHA

The
Occupational Safety and Health Administration codes.

Recovery
Types

The
codes which indicate the degree of recovery that is expected.

Restricted
Duty

The
codes which describe the type of restricted duty.

Severity

The
codes which identify the severity of the injury.

Type
of Coverage

The
codes which identify the type of coverage.

Type
of Loss

The
codes which identify the type of loss.

Type
of Settlement

The
codes which identify the type of settlement that was granted.

The screen used to maintain the Cause codes is shown below. The same one is used for
all the loss code tables except for the OSHA and restriction screens that only contain a
code and description.

Figure 12‑5: Loss Maintenance – Cause Code
Entry

Note the NCCI code above. Unless you normally use NCCI
codes, you must select a code equivalent
to the cause, site and nature codes you use in-house if you report
transactions to the state via EDI.

The loss code menu options prompt for the following
information:

Field Name

Description

Code

The
code used to describe the accident or injury. Description                         The description
associated with the code.

Grouper

A
value that may be used to sort and group records for reporting purposes. For
example, you might enter ACTS_GOD as the Grouper code for wind, earthquake,
lightning etc.

Effective
From/Thru

The
range of dates the code was effective.

Exclude
from Web

Check
this box if the code should not be available on the list.

Carrier Codes

The
fields for the insurance carriers are disabled unless your system has been
setup to use them. In that case, the codes for the carriers you deal with
must exist in the appropriate carrier table before you can associate them
with a specific loss code.

Carrier Tables

Suppose you need certain loss codes for reporting/exporting purposes, but you do
not use them internally. In that case, you would have to add the codes in the
appropriate carrier table so that they can be entered into the standard loss
tables for cross reference purposes. To do this:

1.
Select the List option on the Loss-Carrier Tables menu and pick the desired table.

2.
Enter the codes you need.

3.
Enable the appropriate field (e.g. NCCI Code) on your loss screen. (A system
administrator has the authority to do this.)

4.
Modify the record for each code by entering the
equivalent carrier’s code.

Typically, the Data Export program will
search for the appropriate carrier code. If the field is empty, the program
will use the Code that you use in-house.

Reserves/Payment/Recovery Maintenance

The ATS System uses the information in a set of
tables to classify the different types of reserve, payment and recovery transactions that may be made.
Before discussing the various tables in this group, it is important to clarify
some of the terminology that is used in this manual.

Term

Description

Reserve
Type Codes

These refer to the types of cost center or
payment categories. By default, ATS supports four
reserve categories, but this number may be increased to six with the
Tables-Parameters-Application menu.

The
names of the first four categories should be indemnity, medical, rehab, and
expense. Categories five and six are normally legal and other, but may be
changed. Labels for the categories are entered with the Reserve Types option
on this menu.

Cost
Center Codes

Payment codes related to a specific cost
center. These items are normally labeled “”CC” or “Pay Code” on the ATS input
screens.

The
options will be covered in the order in which they appear on the menu:

·
Indemnity

·
Medical

·
Rehabilitation

·
Expense

·
Legal

·
Other

·
Reserve Types

·
Reserve Changes

·
Recovery Types

·
Void Types

·
Late payment Codes

·
Federal/State Withholding

Cost Center Codes

Cost Center codes are also referred to as payment codes in the ATS System since they are used to
track payments against particular categories of reserve accounts. All categories
of cost center codes are entered on a screen identical to the one shown below.

Figure 12‑6: Payment Maintenance – Cost Center Code
Entry

The following information is stored for each of the
cost centers:

Field Name

Description

Code

The
cost center or payment code. These items are normally labeled “Pay
Code” on the ATS
screens.

Description

The
description of the code.

Group

The
code used in making time loss payments (TD), calculating the
loss of earning percentage (LEP) or grouping similar items together on a
report. See the notes below.

1099 - Misc Amount Type Code

Enter
values of income (3), medical (6), non-employee compensation (7), gross proceeds
to an attorney (C) if the pay code refers to a 1099 reportable item. Contact your accounting
department if you have questions about entering these values to ensure that
the amount on a vendor’s 1099 return is
correct.

Sub Type

This
value will be used to generate New York’s C-8 report. The special payment categories may be either “L” (Lump Sum), “D”
(Death), or “F” (Disfigurement).

Report
Grouper

Special codes needed to classify payments
for some specific reporting purposes.

ATS support will
let you know when you will need to use this field.

Category

Many
states require employers to submit certain payment information. If you have to produce this
type of report, it is important to enter the associated category for the
payments that need to be included.

The Grouper Field

1.
The Days Lost and OSHA Days are calculated when comp payments are
made for an indemnity or rehab pay code that contains “TD” in the Grouper field. (Note
that TTD and PTD are valid
TD codes.)

2.
AutoPay may also be used to schedule permanent
disability payments when the Grouper field in the pay code contains “PD”.

3.
Several of the standard reports review the check
history table and total the benefits paid to date. In order for this feature to
work correctly, the appropriate benefit type code must have been entered in the
Grouper field for the pay codes. For reserve category #1 (indemnity) this code
may be either “TD”
or “PD”.
Only TD is recognized for pay codes in reserve category #3 (rehab).

Reserve Types

The ATS System can maintain up to six cost centers or
reserve accounts. The first four categories should be used since they are required
for state reporting purposes. Their names should not be changed. They will
appear whenever the reserves are displayed on input forms and reports.

Cost Center

Payments Related To

1

Indemnity

2

Medical

3

Rehabilitation

4

Expense

5

Legal
or state statutory benefits such as California’s 4850

6

Other
categories that are not already defined

In order to use five or six reserve categories, a
parameter must be set in Application Parameters. The names of these
categories are normally “Legal” and “Other”, but they may be changed.

Selecting the claim type is one of the first things
done when entering a new claim. If either indemnity or medical is specified,
the program will check to see if there are any default reserve values. In the
example above, $500 will automatically be displayed as the medical reserves for a new medical claim. No medical reserves
will be entered for indemnity claims.

Reserve Change

Whenever the reserves for a claim are changed, the program will ask
the operator to select a code to explain why the change was made before the
record can be saved. The History module may be used to view this information
along with who made the change and when.

This option is provided so you may enter the Reserve
Change codes you need along with their descriptions.

Some sample codes are listed below.

001        Reserve
Adjustment

001N     Initial
Reserve - New Claim

002        Time Loss

003        Surgery
Scheduled

004        Second
Surgery

005        Surgery
Unsuccessful

006        Healing
Delay - Injury Related

007        Healing
Delay - Other Medical

008        Residuals
Predicted by Medical

009        Residuals
Greater than Predicted

010        Vocational
Assistance Needed

011        Recovery
Granted

012        Litigation - Additional Comp

013        Change in
Compensation Rate

014        Change of
Physician

015        Unsuccessful
RTW

016        Change of
Diagnosis

017        Benefit Reduction

018
Recalculation - PTDs and Fatals

019        Reopening
Reserve

020
Administrative Delay

021        Reduction -
Submitted for Close

022        Reduced-Residual less than Predicted

023        Reduced -
Successful RTW

024        Reduced -
Medically Stable

Recovery Type

This option displays the following form so you can
enter the codes for the types of recovery transactions that can be made.

Void Types

This option displays the following form so that you
can enter the codes to classify the types of void transactions that can be made.

Late Payment
Reasons

The states that accept reports electronically require
a code to indicate a reason for issuing an initial indemnity payment more than 14 days after the date of injury.
This menu option is provided so you can enter the appropriate code when you are
making the payment.

The valid codes are:

L1   No excuse

L2   Late notification
employer

L3   Late notification
employee

L4   Late notification
jurisdiction transfer

L5   Late notification
health care provider

L6   Late notification
assigned risk

L7   Late
investigation

L8   Technical
processing delay computer failure

L9   Manual processing
delay

LA   Intermittent lost
time prior to first payment

C1   Coverage lack of
information

E1   Wrongful
determination of no coverage

E2   Errors from
employer

E3   Errors from employee

E4   Errors from
jurisdiction

E5   Errors from
health care provider

E6   Errors from other
claim administrator/IA/TPA

D1   Dispute
concerning coverage

D2   Dispute
concerning compensability in whole

D3   Dispute
concerning compensability in part

D4   Dispute
concerning disability in whole

D5   Dispute
concerning disability in part

D6   Dispute
concerning impairment

Federal/State Withholding

These menus have been provided primarily for use with
the ATS/A&S Disability module where taxes need to be withheld from the
employee’s benefits. Although the Claim program uses Maine’s state tax table to
calculate the benefit rate, the input screens have not been included in this
manual since ATS personnel maintain the tables on a yearly basis.

Medical Fee Maintenance

This menu is provided for ATS customers who make
payments with the optional, add-on Medical Fee module although some of the codes for initial
treatment and managed care organizational (MCO) may be used when entering a
claim or an employer's First Report of Injury.

Each of these menu items will be covered in the
following sections:

Menu Item

Description

Override

The
codes to use when a payment is different from the amount based upon the
RVS or UCR codes.

DRG Codes (ICD-9)

The
DRG or ICD-9 codes to be used when entering a new claim.

Initial Treatment

The
codes used to categorize the initial treatment that was provided.

HMO/PPO

The
HMO/PPO providers that your vendors use.

MCO

The
managed care organizational type codes.

UCR Percentile

The
usual and customary reimbursement (UCR) percentile for
specific states.

Provider Specialty

The
codes to describe a vendor’s specialty.

ATS maintains the tables with the Relative Value
Schedule (RVS) codes and fee schedules for the individual states so these options do
not appear on the menu.

Override

When making a payment with the Medical Fee module, you may enter an override code to
explain the reason why the amount paid is different than the amount the
provider charged for the item. The following screen is used to enter and/or
edit these codes.

DRG Codes (ICD-9)

The ATS System comes with the standard ICD-9 table that contains the physician’s diagnosis
or procedure (CPT)
codes that may be entered when making a payment with the Medical Fee module. ICD-9 codes may also be used when
tracking the care provided to the claimant with the optional Case Management module. The table also contains cause of
injury codes. The cause and diagnosis codes will both be required when
submitting a claim for a Medicare beneficiary to the CMS (Centers for Medicare and Medicaid Services).

This is a BIG table with over 12,000 records. Each
record only contains the code and description so there is no reason to search
for and/or view them. Contact ATS support if you would like a listing of the
codes.

Initial Treatment

When entering a new claim or an employers’ First
Report of Injury, codes may be specified to
indicate the type of initial treatment that was provided. A table for these
codes is maintained using the following screen.

The valid codes for reporting to the state are:

00     NO
MEDICAL TREATMENT

01     MINOR BY
EMPLOYER

02
MINOR/HOSPITAL

03
EMERGENCY CARE

04
HOSPITALIZED 24 HOURS

05     FUTURE
MAJOR MEDICAL/LOSS TIME ANTICIPATED

HMO/PPO

The ATS System allows you to maintain a list of HMO
and PPO providers that may be associated with a particular vendor. When making a payment with the optional Medical Fee module, the program will check to see if the
specified vendor has an HMO/PPO with Valid From/Thru dates that cover the From
date in the payment record. If so, it will look in the HMO/PPO’s record for an
alternate Rate Table (the RVS
fee schedule) to be used to calculate the acceptable amount for the item that
was billed. Note that the code fields at the bottom of the screen are used in
the ATS Group Health product. A sample provider record is shown below.

Enter the data as described below:

Field Name

Description

Code

The
HMO/PPO code.

Description

The
description used to identify the HMO/PPO.

Valid
From/Thru

The
range of dates covered by this provider.

Discount

Any
discount to be applied when calculating the acceptable amount to be paid.

Rate
Table

The
alternate rate table to be used when making payments with the Medical Fee module. If this field is empty, either the
table for the vendor’s state or the
state specified as the Fee State Code with the Tables-Parameters- Option/
Module menu will be used by default. See the Medical Fee-Bill Review section for details.

Message

A
message to be displayed during the payment process.

Code
Fields

The
fields at the bottom of the screen are used in the ATS Group Health product.

Managed Care Organizations

Managed Care Organization (MCO) codes may be specified in
the optional, add-on Case Management or First Report of Injury modules. A table for these codes is maintained
using the following screen.

UCR Percentile

The Bill Review program in the Medical Fee module may use a third party product to track
the state’s usual and customary reimbursement (UCR) percentile by zip code
instead of, or in conjunction with, the state’s RVS fee schedule. To use this
feature, a percentile between 1 and 8 must be entered for the state. (Please
refer to the Finance-Medical Fee section for detailed information on setup and
usage.)

The ATS Group Health Claims program may also use a third party UCR product to calculate benefit payments. In that
case, enter the GH Percentile.

Referral Reasons

The Reason Codes option on the menu displays the following
screen so the codes to explain why a referral has been made may be entered for
use in tracking the claimant’s medical treatment with the optional Case
Management module.

Provider’s Specialty

This standard table provided so you can enter the
providers specialty in the vendor’s record. Each record
contains a code, classification and specialization as you can see on the list.
Use the Search button if you want to view a particular item.

Industry Maintenance

Access is provided to standard industry tables that
have been purchased and converted for use in the ATS System. Normally, the
codes should not need to be edited.

SIC –
Standard Industry Classification

The ATS System comes with a table of Standard Industry
Classification (SIC) codes since the code for the
employer is often required on state mandated forms and letters. This menu option displays
the following form so you can view and/or enter the SIC code you need to
identify the nature of business in the appropriate record(s) for the employer.
If there are equivalent North American Industry Classification System (NAICS) codes, they may be entered
for cross-reference purposes.

NAIC – North American Industry Classification System

This menu
option may be used to view and/or enter the North American Industry
Classification System (NAICS) codes. The form used to
maintain this table is similar to the one shown above.

NCCI –
National Council on Compensation Insurance

The job classification codes in this table are from
the National Council on Compensation Insurance, Inc. (NCCI). They are available for use
in the Employer’s Report of Injury module.

NDC – National
Drug Code

The National Drug Code table has been provided for use when tracking
the care provided to the claimant with the optional Case Management module. Use the Search button if you want to view a particular item.

Occupation

ATS provides you with a table for storing occupation
or job codes. When these codes are associated with specific claims, reports can
be generated to determine any trends that should be addressed.

The form below is used to enter your codes. Note the
fields for some of the insurance carriers. Suppose you deal with Travelers and
need to send them data. In that case, enter the equivalent code if it is
different from the one you entered in the first field. The data export program
will check the Traveler Code field. If the field is empty, the program will
assume that it should use the data in the Code field.

This table contains the following information. If you
plan to use special carrier codes, you must use the appropriate options on the
Carrier Tables menu to enter the codes before they can
be displayed on the selection lists.

Field Name

Description

Code

The
code that is used internally to identify a specific occupation.

Description

The
description used to identify the occupation.

Grouper

A
value that may be used to sort or group similar occupations for reporting
purposes. For example, occupations might be grouped by payment type (salaried, hourly…). Nurses might be
grouped by shift number and so on.

Effective
From/Thru

The
period in which the code should be on the selection list.

Exclude
From Web

A
check indicates that the code should not be listed on the Web.

Carrier Codes

The
equivalent code for the carrier(s) if it is different from the one you use
internally.

Other Maintenance

Employment Status

A special table is provided to store the employment
status codes you wish to use. A sample is shown below.

The fields on the form are described as follows:

Field Name

Description

Code

The
code for the employment status may be numbers such as 01, 02, 03, etc. or
letters like “FT” (full-time), “TEMP” (temporary), and “VOL” (volunteer).

Description

The
description of the employment code.

Full
Time

Check
this box if the code is used for a full-time position. Since a variety of
codes such as "FULL", "F", and "FT" may be used
to indicate "FULL-TIME", ATS programs will use this value to
determine whether a position is full-time for reporting purposes.

Effective
From/Thru

The
period in which the code is valid.

Exclude
from Web

A
check indicates that the code should not be listed on the Web.

EDI Code

If you are sending claims to the state via
EDI, enter an EDI code
for each code you use in-house, The valid codes are:

·
Regular Employee

·
PT Employee

·
Seasonal

·
Unemployed

·
Volunteer Worker

·
On Strike

·
FT Disabled

·
Apprenticeship

·
PT Retired

·
Piece Worker

·
Other

Relationship

This menu option is provided so you can enter the
relationship codes you need to use when filling out a record on an employee’s
dependent.

If you will be reporting claims for Medicare beneficiaries to the CMS, enter the following codes:

Code            Description

F
Family Member, Individual Name Provided

O
Other, Individual Name Provided

X
Estate, Entity Name Provided (e.g. "The Estate of John Doe")

Y
Family, Entity Name Provided (e.g. "The Family of John Doe")

Z
Other, Entity Name Provided (e.g. "The Trust of John Doe")

Location

This menu option may be used to enter the codes you
need in order to indicate the location where the accident/injury occurred. If
you produce OSHA logs, it is important to note that the
location of the accident will appear on the report.

The Grouper field may be used to group similar
locations for ad hoc reporting purposes. For example, you may have a number of
register aisles with codes 18 though 24. If REG is entered as the Grouper in
these records, all the claims for accidents that occurred in any of these
locations could be grouped together on a custom report.

Litigation Codes

This menu is provided for clients who wish to use
special litigation codes in a claim. The Grouper may be used to sort records in
a custom report.

Restricted Duty

This menu option allows you to enter special codes
that may be used to describe the limitations that could apply to a claimant’s
Restricted Days due to an accident or illness.

This table contains the following:

Field Name

Description

Code

A
code such as “NL” to indicate the type of restriction.

Description

The
description of the code where “NL” might be “NO LIFTING”.

State Codes

This menu option displays the following form so you
may enter the state specific information that will be used throughout the ATS
System.

The specific fields are described as follows:

Field Name

Description

Code

The
code for a specific state or province.

Description

The
name of the state or province.

OWCP
Schedule

Check
this box if the Bill Review program should compare the state schedule
with the OWCP schedule for federal claims.

Fee
Schedule

Check
this box if the state has a fee schedule. (This information is used in the
Medical Fee module.)

State
Days

The
number of days in the state’s work week which is used to calculate the
claimant’s lost work days when making time loss (indemnity) payments.

OSHA Days

The
number of days in the OSHA week which will be used to calculate the
lost OSHA days when making time loss payments. This number should be seven
since OSHA now uses a calendar year.

Waiting
Period

The
default number of days in the state’s waiting period is 7. Verify that the
correct number has been entered for the state(s) you deal with.

This
value (and the next one) must exist before the Pay Waiting Period set with the Administer-Configuration-Diary/Scan Parameters
menu will be used to generate diary entries.

The
Waiting Period and Before Paid values will also be used to
determine whether the waiting period has been paid when calculating the Lost
OSHA Days for the OSHA 300 and the appropriate
dates when the Auto Compensation button has been selected to schedule new
auto payments.

Before
Paid

The
number of days before the waiting period may be paid. The default is 21.

Subro
Statute

The
days before the state’s statute expires should be entered if the
corresponding field set with the Tables-Parameters-Diary/Scan menu is to be
used to generate a diary.

Check
Summary

Check this box so the program will examine
each indemnity payment and enter a transaction record whenever
there are changes in the Comp benefit period (e.g. the rate or benefit type
changed).

This
feature is required to produce some state reports such as New York’s SI-4 and C8. When used, a Comp Period button will
appear in the AutoPay and History modules so you can review the changes.

Region

A
region code should be entered if the Region by State feature has been set up with the
Tables-Parameters-Option/Module menu.

Hospital
Tax

The
hospital tax percentage should be entered when required for state reporting
purposes.

Care
Tax

A
state care tax percentage to be applied when making payments with the Medical
Fee Module.

Federal
District #

The
number of the federal district in which this state is located. No Fault
Insurance            Check this box if
the state mandates no fault insurance.

No
Fault Limit

The
limit set by the state.

Claim
Screen

The
name of a custom screen to use when a claim is for this particular state of
jurisdiction.

ER
Screen

The
name of a custom screen to be used to enter reports of injury for the
specified state.

EDI Release

The
number 1 or 3 to indicate which IAIABC release the state supports.

EDI Sender

EDI Receiver

The federal ID number and ZIP code for the
party sending and receiving the EDI information.

This
data is required in order to transmit the records electronically.

EDI Trading Partner

The
ID number assigned to you by the state. Depending on the state, this number
may be an element in the name of the export file.

Employer

Check
this box if there is only one employer in the specified state.

Name

Address

The
name and address for the employer that should be used on state forms and
letters.

Fed
ID #

The
employer’s federal ID number.

Self-Insured

Check
this box if the employer is self-insured. Entering the From and Thru dates
the employer was/is self-insured is optional.

Wage Statement

The
code for the state’s wage statement.

Pay
Day

The day of the week the employees are paid
where 0=Sun, 1=Mon, 2=Tues, 3=Wed, 4=Thurs, 5=Fri, 6=Sat and 9=Any Day.

If
AutoPay is used and the state record identifies the
employer, the Pay Day will determine how to schedule the print dates
depending on the AutoPay Mode set with the Tables-Parameters-Application
menu.

WC
ID

The
employer’s workers’ comp or state ID number.

WC
Address

The
worker’s compensation or OWCP address.

DBA
Name

The
DBA name of the employer if one exists.

CMS Reporter ID

The
Reporter ID if the employer is an RRE.

CMS Reporting Group

The
group number (from 1 to 12) assigned to the RRE.

CMS User

The
user responsible for creating the export files.

Ongoing
Responsibility

Check
this box if the state mandates that employers assume responsibility for all
medicals for the employee’s lifetime.

13.
Index

100%
Dependent, 21

1099,
iii, 11, 23, 24, 25, 26, 27, 135

Active,
ix, 12, 24, 59

Activity
List, x, 107, 108, 109, 110, 111, 112

Adjuster,
18, 41, 90

Agency,
45, 122, 132

Agent,
32, 33

AKA,
iii, 15, 19

Alternate
Claim Number, 90

Application
Parameters, 29, 37, 40, 45, 48, 55, 56, 69, 75, 76, 77, 81, 82, 83, 93, 127,
130, 131, 136

Attachment,
x, 64, 111

Attachments,
iv, 63

Audit,
iv, vi, x, 64, 67, 101, 105, 106

Auto
Close, 56, 69

Auto
Setup, iv, 57, 79, 80, 81, 83

AutoPay,
iii, x, 42, 44, 46, 57, 78, 79, 82, 83, 126, 128, 130, 135, 144, 145

Bank
Account, 17, 25, 126

Basic
Pay, 42

Batch,
iv, vi, ix, x, 36, 37, 44, 69, 70, 71, 77, 78, 81, 82, 88, 89, 90, 96, 97, 99

Batched
Payments, v, 74, 87, 94, 96

Benefit,
43, 68, 76, 79, 81, 136

Benefit
Type, 43, 68, 81

Bill
Review, 25, 61, 74, 91, 140, 144

Biller
ID, 24

Birth
Date, 15, 21

body
parts, 45, 48, 71

Body
Parts, iv, 45, 46, 71

Body
Site, 45, 49, 61, 71, 132

Bundling,
v, 91, 93, 94

care
tax, 144

carrier,
ix, 32, 48, 72, 122, 133, 141, 142

Case
Management, 51, 123, 139, 140, 141

Cause,
ix, xi, 10, 42, 45, 46, 61, 122, 132

Central
Index Bureau, 60

Checks,
v, 86, 90

CIB,
60

claim
number, 11, 16, 33, 34, 37, 38, 44, 52, 54, 55, 74, 88, 95, 97, 108, 119

Claim
Number, 34, 37, 38, 44, 55, 90, 108

Claim
Selection, x, 55, 109

Claim
Type, 38, 41, 50, 54

Claimants,
18, 20

Claims,
i, iii, v, ix, x, 4, 5, 12, 16, 24, 34, 39, 55, 56, 78, 89, 98, 107, 115, 120,
129, 140

Close
Claim, iv, 69

Closed
Date, 42

CMS,
iv, 16, 20, 22, 40, 42, 44, 45, 48, 52, 53, 71, 72, 126, 128, 130, 139, 143,
145

Combine
Vendor, 26

Console,
2, 3, 35, 58, 107, 115, 120

cost
center codes, viii, 134

Country,
24, 123

CPT,
92, 93, 94, 139

Credit
No Check, v, 85

Credits,
v, 49, 74, 84

Cumulative
Limit, 83, 84

dashboard,
5, 120

Dashboard,
xi, 5, 120, 121

Dashboards,
vii, 3, 120

date
of birth, 15

Date
of Injury, 42, 61, 72

Day
of Injury Paid, 29

Days
per Week, 29

DBA
Name, 24, 126, 128, 145

Death
Date, 42

dependent,
20, 21, 22, 42, 57, 75, 80, 142

Dependents,
iii, 16, 20, 22, 42, 43, 57

Dept,
16, 29, 30, 40, 126, 127, 130, 131

Diary,
iii, vi, vii, x, 5, 34, 42, 58, 59, 107, 108, 109, 110, 111, 112, 144

direct
deposit, 14

Direct
Deposit, 17, 25

District,
24, 144

Division,
16, 29, 40, 126, 127, 131

Document
Manager, x, 73

DOH,
26, 126, 130

DRG
codes, viii, 123, 138, 139

EDI,
iv, ix, x, 34, 36, 37, 47, 69, 70, 78, 122, 123, 132, 142, 144, 145

EDI
Date, 34

EDI
Export, iv, 34, 37, 69

EFC,
iv, x, 73

Electronic
Filing Cabinet, 73

E-mail,
24

employee,
9, 14, 15, 16, 17, 18, 19, 20, 21, 22, 26

Employee,
ix, 14, 16, 17, 18, 19, 20, 21, 28, 35, 39, 55, 127, 130, 142

Employee
#, 16

employees,
15

Employees,
14

Employer’s
Report, ii, iii, ix, 18, 19, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 45,
141

Employment
Type, 16

EOB,
94, 95

Examiner
#, 25

Exemptions,
16

Explanation
of Benefits, v, x, 91, 94, 95

Fatal
Injury, 31

fee
schedule, 144

fee
schedules, 94, 138

Fee
Schedules, v, 94

Firm
Name, 52

First
Day Lost, 80, 81

First
Report of Injury, 15, 28, 32, 34, 42, 129, 138, 139, 140

forms
and letters, 66, 113, 128, 129, 141, 145

Forms
and Letters, vii, 113

FROI,
28, 29, 33, 35

garnished,
16, 58

Gender,
21, 71

General
Payments, iii, iv, 60, 74

HICN,
16, 44, 71

Hire
Date, 15

History,
iv, vi, x, 49, 54, 60, 64, 65, 66, 83, 85, 86, 87, 101, 102, 103, 104, 105,
106, 136, 144

HMO/PPO,
viii, 26, 91, 123, 129, 138, 139, 140

hospital
tax, 144

Hospitalized,
48

Hours
per Day, 29

IAIABC,
28, 29, 30, 31, 32, 40, 43, 144

ICD-9,
viii, 45, 46, 48, 72, 92, 123, 138, 139

Injury
Date, 6, 30, 37, 38, 41, 42, 54

Injury
Time, 41

Insurance
Services Offices, 60

Invoice
Number, 78

ISO,
iii, x, 46, 60

Key
Map, ix, 8

Knowledge
Date, 30

Last
Work Date, 30

Legal
Firms, x, 51, 52

Letter
Code, 103, 110

Line
of Business, 107, 120

Litigation,
viii, x, 48, 51, 52, 53, 71, 123, 136, 143

LOB,
62, 107, 109

Location
Code, 24, 126

Login,
1

Longshoreman,
48

loss
codes, 3, 31, 45, 131, 133

Loss
Codes, ix, 31, 32, 131

Lost
Time, 48

Managed
Care Organization, 140

Marital
Status, 15

maximum
medical improvement, 47

MCO,
138, 140

Medical
Fee, iii, v, viii, 25, 26, 61, 90, 91, 93, 123, 138, 139, 140, 144

Medicare,
16, 20, 42, 44, 48, 71, 72, 139, 143

Medicare
Beneficary, 44

MMI,
47, 78

NAICS,
123, 130, 141

national
council on compensation insurance, viii, 123, 141

national
drug code, viii, 141

Nature,
45, 49, 61, 122, 132

NCCI,
viii, 29, 48, 122, 123, 132, 133, 141

NDC,
viii, 123, 141

Next
Check, 80, 81, 82, 83

north
american industry classification system, viii, 123, 130, 141

Notes,
iii, iv, x, 17, 26, 34, 53, 61, 62, 64, 111

NPI,
24

Occupation,
viii, 16, 123, 141

One
Time Limit, 83, 84

Open
Date, 38, 42, 54

ORM,
44, 72

OSHA,
33, 42, 45, 46, 47, 48, 71, 77, 82, 122, 129, 132, 135, 143, 144

Paid
as Billed, 26

Pay
Code, 24, 80, 81, 90, 134

Pay
Period, 15, 81

Pay
Type, 75

Payee,
51, 80, 88, 90, 92, 96

payment,
20, 26, 27, 42, 43, 44, 47, 49, 51, 53, 57, 60, 65, 68, 72, 74, 75, 76, 77, 78,
79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 93, 94, 95, 96, 97, 98, 99,
101, 118, 126, 133, 134, 135, 137, 138, 139, 140, 142, 144

Payment
Code, 77, 91

PD,
42, 43, 68, 76, 77, 79, 81, 87, 135

PERI,
25, 46

Policy,
iv, 32, 33, 37, 41, 70

Post,
v, vi, 89, 99

PPS,
26

Primary
Vendor, 25, 26

Print
Name, 24

Privacy
Case, 47

PTD,
86, 118, 135

Query
Employee Changes, 18

Rate
Table, 93, 139, 140

reason
codes, 140

rebatch,
100

Rebatch,
vi, x, 100

Recoveries,
v, vi, x, 49, 65, 74, 87, 101, 105, 122

Recovery
Type, viii, 86, 122, 137

Region,
v, vii, 11, 18, 30, 36, 88, 90, 97, 116, 122, 125, 127, 128, 129, 144

Region
by Level, 18, 129

Region
View, 18, 36, 88, 98, 125

regions,
122, 125

Rehabilitation,
48, 134, 135

Relationship,
viii, 21, 123, 142

Reopen
Date, 42

Report
Date, 42

Report
Purpose Code, 30

Reserve
Category, 86, 90, 101

Reserve
Change, v, viii, 49, 54, 83, 84, 122, 136

reserve
worksheet, 67, 68, 69

Reserve
Worksheet, iv, x, 49, 67, 68

reserves,
5, 41, 42, 49, 50, 54, 56, 64, 66, 67, 68, 69, 74, 75, 76, 81, 82, 83, 84, 89,
93, 94, 98, 104, 118, 135, 136

Reserves,
iv, v, vi, viii, x, 5, 6, 48, 49, 50, 68, 69, 74, 75, 76, 82, 83, 93, 94, 101,
104, 133

Restricted
Work Days, 46, 70

Routing
Number, 17, 25

RRE,
44, 71, 72, 126, 130, 145

Rsv
Category, 24

RTW,
46, 136, 137

Salary
Continued, 29

Search,
iii, ix, 11, 17, 18, 24, 35, 39, 55, 60, 140, 141

Settlement,
53, 71, 73, 122, 132

SI-4,
48, 144

SIC,
viii, 123, 128, 130, 141

Specialty,
viii, 25, 92, 123, 138, 140

SSN,
15, 16, 17, 21, 28, 34, 52, 71

Stair
Step Reserves, 76, 93

standard
industry classification, viii, 141

Stanford
Reserve Estimate, 49

State
Claim Number, 33

State
of Hire, 29

state
of jurisdiction, 21, 28, 29, 33, 41, 43, 44, 57, 59, 70, 81, 82, 144

State
of Jurisdiction, ix, 36, 39, 40, 70

State/Federal
Levy, 24

Status
Bar, 2, 4

Student,
21

Sub,
viii, 16, 29, 30, 40, 122, 125, 126, 129, 131, 135

Subrogation,
48

Supervisor,
vi, 16, 108, 111, 112

Suspension,
46

Target
Date, 107

Tax
ID, 23, 26, 27

TD,
42, 43, 47, 69, 76, 77, 79, 81, 82, 87, 135

Term
Date, 15

third-party
administrator, 32, 107

Third-party
administrators, 67

tile,
3, 5

Tile,
4

Time
of Injury, 30

TIN
Notice, 25

TPA,
32, 138

TPOC,
iv, 53, 71, 72, 73

Trade
Name, 126

transitional
work, 47

TW,
46, 47, 71

Type
of Rep, 22

UCR,
viii, 91, 92, 94, 123, 138, 140

Unbundling,
v, 93, 94

Valued
As-of, vii, 118

vendor,
8, 10, 23, 24, 25, 26, 27, 51, 52, 54, 60, 75, 76, 78, 80, 85, 86, 90, 91, 92,
95, 105, 135, 138, 139, 140

Vendor
Code, 24, 75, 85, 86, 92

void,
65, 86, 87, 90, 118, 137

Void,
viii, 87, 122, 134, 137

Voucher,
88, 97

Vouchers,
v, 86, 90

W-9,
25

Wage,
15, 29, 43, 48, 76, 145

waiting
period, 48, 80, 81, 144

Work
Status, 25