Alaska Department of Labor and Workforce Development (ADOL) EDI

EDI mandated First Report of Injury (FROI) and Subsequent Report of Injury (SROI) reporting will begin implementing as of the mandatory Release 3 Implementation Date. Compliance with FROI and SROI reporting requirements is required on the date a trading partner begins to provide services and/or write workers’ compensation coverage in Alaska, as of the mandatory Release 3 Implementation Date. ADOL’s mandatory Release 3 Implementation Date will be published in the near future, which is targeted for 3Q 2012.

Note: For open claims with JCNs assigned, an MTC UR must first be submitted before any electronic SROIs can be submitted. Please refer to the Transition from Paper to Release 3 (PDF) document listed below for additional information.

Download the ADOL Claims Release 3 Requirements using the sections below.

The ADOL FROI Event Table, SROI Event Table and SROI Periodic Event Table are designed to provide information integral for a sender to understand the receiver’s EDI reporting requirements. The Event Table relates EDI information to the circumstances under which the information is initiated as well as the timeframes for sending the information. These circumstances and timeframes reflect legislative mandates and specifications relative to reporting requirements based on various criteria.

Download the Event Table Here

The ADOL FROI SROI Element Requirements Table provides the ADOL FROI and SROI business data element requirements. The Table defines the data element requirements for the FROI and SROI records to the Maintenance Type Code (MTC) level. Further, the Element Requirements Table provides data element requirements that differ based on Report Type (MTC) criteria established on the ADOL Event Table.

Mandatory/Conditional and Expected/Conditional data elements are normally optional, but become mandatory under conditions established by the receiver. If the defined condition exists, the data element becomes mandatory and mandatory rules apply. The ADOL FROI SROI Conditional Data Element Table represents the ADOL FROI SROI data elements that are Mandatory/Conditional and Expected/Conditional and the conditions that apply.

The Benefit Requirements & Requirement Conditions table provides the ADOL SROI Benefit Data Element Requirements. Refer to the ADOL Benefit Data Element Requirements Conditions for the specific data element M/C (Mandatory/Conditional) conditions and to the Edit Matrix for the edits that will be applied based on the data element requirements.

Download the Element Requirements Here

This table provides the ADOL MTC sequencing. The table conveys to the trading partner the sequencing rules that clarify how ADOL will apply Edit 063 - Invalid Event Sequence.

Download the Sequencing Rules Here

The ADOL Match Data is used to identify a transaction as a new claim, to create or "match" to an existing claim for duplicate checking, updating and processing. On a specific claim, a primary "match" data element value may or can change and prevent a match. For this reason, ADOL has identified primary “match” data element(s) and secondary “match” data elements. When there is no match on one of the primary “match" data elements (usually on a change or correction transaction), secondary "match" data elements are used to match a claim. When a match is found on the primary or secondary “match" data elements, Nature of Injury and Cause of Injury are used as ‘additional’ confirmation that the claim is a duplicate for situations where there may be multiple injuries for the same Date of Injury.

Download the Match Data Table Here

The ADOL Edit Matrix, based on the ADOL Element Requirement Table, conveys which data elements have edits that may be applied to them and provides the standard error messages associated with these edits.

Download the Edit Matrix Here

The ADOL FROI/SROI Population Restrictions Table elaborates on the data elements specific data population or accepted values for standard error messages. The ‘Population Restriction’ listed for each Data Element on this table is associated with a specific Error Message. The Population Restrictions Table communicates the Data Element Number (DN), Data Element Name, Error Message Number, Error Message Text and Population Restriction. The Population Restriction column in the table indicates the specific reason for the generation of the error messages indicated, including MTC limitation, if applicable.

Download the Populations Restrictions Table Here

The Valid Values Table identifies the code values that are not statutorily valid in the jurisdiction. A 'N' in the capture column indicates that the data element is not captured in the jurisdiction. A 'Y' in the capture column indicates that the data element is captured by the jurisdiction. A code value that has been grayed out indicates that the code is 'Not Statutorily Valid' by the jurisdiction. Jurisdictions may return Error Message-‘042-Not Statutorily Valid’ on grayed out values. The code values that are not grayed out are the code values that are statutorily valid and will be processed by the jurisdiction. See Section 2 for statutorily valid codes that are valid but will not be processed by jurisdiction.

Download the Valid Values Table Here

Alaska's EDI implementation will not accept any paper forms on claims with dates of injury prior to or after their EDI implementation. All reporting should be submitted electronically, where applicable, effective on the EDI implementation date projected for February 2012. Alaska will require EDI reporting on all open claims as of the EDI implementation date per their Event Table requirement for FROI UR.

Download the Paper Transition Instructions Here

Form to MTC Crosswalk Worksheet provides the information to assist with the transition from reporting on paper to electronic reporting by providing the paper form number as it applies to the Maintenance Type Code (MTC). The worksheet contains a quick reference including the definitions for each MTC and a column to note the paper form that was formerly used to convey the information that will now be sent electronically.

Download the Form to MTC Crosswalk Here

This information represents the changes to the Implementation Guide from Version 1.0 to future versions.

Download the Track Changes Document Here