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Element Requirement Document
- FROI data requirement for file submission. This document identifies which
elements are mandatory, required, or optional. No claim will be accepted with
Mandatory errors.
FROI File Layout – Record layout for customer submitted First Report of Injury. Detailed information regarding field name, field length, record position, and field specific requirements.
Confirmation Report Layout (report format) – Output report that confirms a FROI was either added or updated presented in a printable report format. Report provides the WCBN for new claim submissions and for corrected FROI.
Confirmation Report Layout (database export format) - Output report that confirms a FROI was either added or updated in a database exported format. Report provides the WCBN for new claim submissions and for corrected FROI. Fields are delimited by the "^" character.
Sample Confirmation Report (report format)
Error Report Layout (report format) – Output report that contains information for each record (claim) that was submitted electronically in the FROI File presented in a printable report format. The report provides WCBN’s for all added or updated claims as well as any error/edit information. Error information will also be provided for rejected claims.
Error Report Layout (database export format) - Output report that contains information for each record (claim) that was submitted electronically in the FROI File presented in a database export format. The report provides WCBN’s for all added or updated claims as well as any error/edit information. Error information will also be provided for rejected claims. Fields are delimited by the "^" character.
Sample Error Report (report format)
FROI Edit Errors – Directory of EDI errors and field edit responses. Not all error/edit information requires follow up action on the part of sender.
FTP Procedures – Instructions for connection via the internet for FTP file transmitting/receiving and file naming convention information. Prior to connecting to the WCB system, a Vendor Profile form must be submitted.
Vendor Profile – Information required in order to setup vendor account.