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EDI Claims Information

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

 

Any new trading partner must fill out the Trading Partner Documents as the first step in the testing process.

Event Table updated- The Event Table contains claim events for reporting FROI and SROI Denials to the Maine Workers' Compensation Board, Maintenance Type Codes for events and circumstances under which a FROI and SROI Denial should be sent.

Element Requirement Table updated - The Element Requirement Table contains a list of data elements that are required for submission of a FROI and SROI Denial.

Edit Matrix Table updated - The Edit Matrix Table includes applied editing based on the IAIABC standards and Maine's FROI and SROI Denial data requirements; SROI Payment requirements will be presented as a later date.

Implementation Guides

The Maine WCB Claims 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.

The IAIABC Claims R3 Implementation Guide provides detailed information regarding system information, code tables, scenarios, data elements, etc.
Please note: By clicking the link above you will be leaving the MWCB website.

Other Claims Information

Claims EDI Error List - This list contains all of the active errors that can appear on a FROI or SROI acknowledgement report.

FROI Crosswalk - The FROI crosswalk is a copy of the paper FROI with IAIABC data element numbers corresponding to each box number of the paper FROI.

SROI Crosswalk - The SROI crosswalk is a copy of the paper Notice of Controversy (NOC) form with IAIABC data element numbers corresponding to each box number of the paper NOC form.

Frequently Asked Questions about EDI Claims