EDI Claims-Payments Information

These documents are DRAFT and provided as a courtesy. All information contained in these documents is subject to change upon review and approval by the Workers’ Compensation Board of Directors.

There have been, and will be, training opportunities regarding the implementation of Phase III of IAIABC Release 3 payment transactions. For a complete listing of trainings and the related materials, please review the EDI Payments Training page.

The forms below have Maine specific information for EDI payments data elements based on IAIABC standards for Claims Release 3.

Questions Sent to Maine Regarding Trading Partner Tables- This document provides the questions generated in response to "Trading Partner Tables Draft 1.1" sent 5/27/2015 along with responses from WCB.

FROI Element Requirement Changes - This FROI Element Requirement Table and FROI Conditional Table show the proposed changes from the current rules and what is currently in production. The cells highlighted in yellow identify those data element that will be included in the proposed rule.

Event Table (Draft 1.3, 12/18/2015) - The Event Table identifies events for reporting SROI Payment information to the Maine Workers' Compensation Board, Maintenance Type Codes for events and circumstances under which a SROI transaction should be sent.

Element Requirement Table (Draft 1.3, 12/18/2015) The Element Requirement Table contains a list of data elements that are required for submission of a payments.

Edit Matrix Table (Draft 1.3, 12/18/2015) The Edit Matrix Table includes applied editing based on the IAIABC standards and Maine's Claims-Payments Denial data requirements.

Quick Code Reference List- The Quick Code Reference List is a convenient resource to let trading partners know what codes are valid.

Maine Implementation Guide

The Maine WCB Payments Implementation Guide is provided to assist Claim Administrators, Insurers and Self Insures with Maine specific information regarding Electronic Data Reporting to the State of Maine Workers Compensation Board.

Additionally the IAIABC Claims R3 Implemenation Guide provides detailed information regarding system information, code tables, scenarios, data elements, etc.
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