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TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION SUBCHAPTER l: PROVISIONS APPLICABLE TO ALL COMPANIES PART 928 MEDICAL MALPRACTICE DATA BASE SECTION 928.EXHIBIT D ILLINOIS MEDICAL PROFESSIONAL LIABILITY INSURANCE UNIFORM CLAIMS REPORTING (IMPLIUCR) BATCH REPORTING REQUIREMENTS AND NAVIGATIONAL USER'S GUIDE Section 928.EXHIBIT D Illinois Medical Professional Liability Insurance Uniform Claims Reporting (IMPLIUCR) – Batch Reporting Requirements and Navigational User's Guide
State of Illinois Department of Financial and Professional Regulation Division of Insurance
May 2006
Illinois Medical Professional Liability Insurance Uniform Claims Reporting (IMPLIUCR) Batch Requirements and Navigational User's Guide
To assist insurers and other reporting entities with electronic reporting, the Illinois Department of Financial and Professional Regulation-Division of Insurance (DOI) has created an electronic reporting application, which will be provided free of charge. Reporting entities will choose one of the two processes depending on how they prefer to file. One process will allow for data entry claim reporting and contain drop downs with choices. The other process will allow for batch reporting. This is the navigational user's guide for batch reporting.
General Submission Guidelines
1) Data Collection Information
a) Data must be submitted on 3˝" size diskette or compact disk (CD-R/RW).
b) Disks must conform to the filing specifications contained within this document.
2) Guidelines for Data Collection
a) Submission of data files must meet the filing specifications prescribed in this document.
b) DOI has created an electronic reporting application to help reporting entities enter and edit data and to create the quarterly claims report data file.
To access the on-line user guides for the electronic reporting applications, you must download Adobe Acrobat Reader software from URL: http://www.adobe.com/products/acrobat/main.html to access the on-line user guides.
c) If you have not received a copy of the electronic reporting application, you can download the software from the following URL: http://www.ins.state.il.us/exe/IMPLIUCRzip.exe
3) Data Format Standards To simplify aspects of the data collection process for the DOI, data and file formats for diskettes will consist of a delimited common ASCII representation.
4) File Description and Reporting Requirements (edit program process).
DOI has adopted the following specifications to be used in formatting the claims report data file information prior to using the "edit program".
Tab or Comma delimited file:
· File one report for each defendant you insure. · Include claims closed without payment. · When an item calls for a dollar amount and no amount is involved, enter 0 in the space. · Record all amounts in whole dollars. · All dates shall be in the format MM/DD/YYYY and have leading zeroes. Example: 01/01/2001 = January 1, 2001 · All names of individuals shall follow the following format: Last Name Suffix, First Name MI. (e.g., Public Jr, John Q.) · Insured Individual's name format: Last Name Suffix, First Name MI. Professional Designation (e.g., Public Jr, John Q. MD) · All fields for a given record, including fields that contain no data, shall have a Tab or Comma with a "full quote" text qualifier separator. There are a total of 75 fields that must be accounted for in each record (report).
General Submission Guidelines
Each of the following fields must have a Tab or Comma separator:
* If claim re-opened and a new Claim ID was assigned.
Examples using fields 1, 2, 3, 4, 5, 6, 7, 8
Example Tab delimited file: InsurerName[tab]12-1234567[tab]220BBA[tab]1[tab]01/09/2001[tab]01/09/2001[tab]01/09/2001[tab]01/09/2001[tab] etc …
Example Comma delimited (with a "full quote" text qualifier) file: "InsurerName","12-1234567","220BBA","1","01/09/2001","01/09/2001","01/09/2001","01/09/2001" etc …
5) Disk types
Disks submitted to the DOI shall be the 3˝" size or Compact Disk (CD-R/RW) from an IBM Personal computer or compatible. Disks will not be returned.
6) Computer Disk File Structures and Naming Conventions
Each disk submitted shall contain a physical file for Uniform Claims Reports.
A disk file name will be made up of two portions, a data name and an extension. The extension name will always be "txt". The file name of each file on the diskette will be:
DOI-IMPLIUCR and the Quarter and year being filed
Example with additional information: DOI-IMPLIUCR-1stQtr2004.txt
NOTE: The submission file on the disk will be created for you by the IMPLIUCR.MDE application.
7) TO BEGIN: Load the application (see installation instructions). Then import the claims data file Open/ClosedClaimsData.txt) you created. Use the "Validate Batch File of IMPLI Uniform Claims Reports" button on the IMPLIUCR application's main menu to import and validate your data.
Quarterly Claim Report Submission – Data Field Names and Report Format
For Field/Data Definitions and Requirements see Exhibit B of this Part.
Company FEIN and Claim ID (Key Fields) are combined to make a unique claim report. RI = Reporting Instructions numbering system reference.
* If claim reopened and a new Claim ID was assigned.
Application Start Up Instructions and System Menu
Application Startup Instructions
Left mouse click on Start, mouse over the Programs menu caption, look for the IMPLIUCR caption and mouse over.
To the right of the IMPLIUCR
caption you should see the ACCESS key ICON
Left mouse click on the "OK" button to gain access to the IMPLIUCR Main Menu. Left mouse click on the "Cancel" button to exit this application.
Import of Industry Claim Reports and Validation Process
(Figure-1)
The IDFPR-Division of Insurance "IMPLIUCR Requirements Main Menu", shown above, is the starting point from which you can enter hard copy claims report information into a medical malpractice database or process batch quarterly claims report data.
Left mouse click on this button to process submitted claims report files.
Left mouse on this button to gain access to the data entry processes for reporting claim reports. (See IMPLIUCR Online Industry User's Guide for help.)
The IDFPR-Division of Insurance "IMPLIUCR Validation Process" window, shown above, is the starting point from which you can validate multiple claim reports. First select quarterly reporting period and enter reporting year if needed. Then process a claim data report file by entering the entire path and file name with extension. Example: "C:\IMPLIUCR\ClosedClaims1stQtrData.txt", or use the "BROWSE" button to select a file name (see Figure-2 below). Selecting the file you wish to process you will automatically return to the "IMPLIUCR Validation Process", where you can left mouse click on the "Process Report Data" button, if enabled, to begin the validation process. A list of ERRORS and associated Claim Numbers, if any, will be displayed when the import and validation process has completed. Left mouse clicking on any displayed Claim Number with errors will take you to a claim report maintenance window (see Figure-1, page 13) from which you can correct indicated errors.
Left mouse clicking on this
button
Left mouse clicking on this
button
If there are no errors displayed, the "Create Disk" button will be activated (see Figure-1, page 14). Left mouse clicking on the "Create Disk" button will pop-up a save file browser (see Figure-2, page 14).
(Figure-2)
(Figure-1)
From this Maintenance Process you must correct all highlighted claim report fields to effect a change to the list of errors on previous displayed error list. Or you can gain access to a table view of the data to correct indicated errors. However, errors will not be highlighted in this table view.
(Figure-2)
(Figure-1)
Left mouse click on the "Create Diskette" button to save validated claim report(s) to a text file, Quarterly Reporting Period, for submission to the IDFPR-Division of Insurance.
(Figure-2)
From this browser "Save As" window, you will be able to save a selected claim report file for submission to the IDFPR Division of Insurance.
Diskette Labeling and Mailing Instructions
Disk Instructions
Disks must be clearly identified by external labels containing all of the following information:
Insurer Name Insurer FEIN Number Disk File Name Filing Date Disk Contact Person and Telephone number
Example:
ABC Insurance Company of America 2005 1st Qtr Open/Closed Report Data Date: 3/31/2005 Joe Smith (800) 555-1234
Mailing Requirements
The disk(s) should be enclosed in rigid protective packaging that will prevent bending and other destructive exposures that might be experienced in normal mail handling.
The outer package should be clearly labeled to indicate computer diskettes are enclosed.
Address submission to: Illinois Department of Financial and Professional Regulation Division of Insurance IMPLIUCR data 320 West Washington, 4th Floor Springfield IL 62767 Attn.: Casualty Actuarial Section
(Source: Added at 30 Ill. Reg. 19288, effective December 4, 2006) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||