2010 NCCI Medical Data Call Bulletin

StoneRiver has prepared a bulletin for PowerSuite Claims customers regarding the new NCCI Medical Data Call. This document will cover your questions regarding the requirement and StoneRiver’s approach. For ISO customers, the data new NCCI Medical Data Call will be satisfied through the PowerSuite Claims WCTRP interface. For non-ISO customers, an enhancement will be required to replicate the ISO reporting function to NCCI. A design draft is complete and is under review. Background is below: The 2010 NCCI Medical Data Call (Call) is a new report defined by NCCI to collect Medical data to analyze pricing and cost containment solutions proposed by state regulators and legislatures. Eligibility applies to any carrier with at least 1% market share in any one applicable state over the past 3 years. Once a carrier meets the eligibility criteria, the carrier will be required to report for all applicable states in which it writes, even if an individual state’s market share is below the threshold. The Call begins with medical transactions occurring in 3rd quarter 2010, due to be reported to NCCI by December 31, 2010. All workers’ compensation claims, including medical only, in the applicable jurisdictions are included. Data is reported on a claim until medical transactions are no longer occurring for the claim; or, 30 years from the Date of Injury, whichever comes first. Affiliate Group Participation applies when an affiliate group is included in the Call, all companies that are aligned within that group are required to report under the Call. The carrier may report their data directly to NCCI, or they may authorize their vendor business partners (TPAs, medical bill review vendors, etc.) or other reporting services like ISO to report the data directly to NCCI for them. Data may be provided by an authorized vendor on behalf of an affiliate carrier or affiliate carrier group; however, quality and timeliness of the data is the responsibility of the carrier. Our customers who report to ISO can have the new NCCI Medical Data Call requirements managed by ISO and the WCTRP file interface. View entire Bulletin here. Please work through your account manager, sales person, or project lead if you have any questions, need further information, or are interested in participating as a partner for this enhancement. We can review the design specification with your company.