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.

 

Table of Contents:		Page
1.	General Submission Guidelines...................................................................................	3
2.	Quarterly Claim Report Submission Data Field Names and Record Format.................	6
3.	IMPLIUCR Automated Application Processes (Navigational) Application Start Up Instructions and System Menu....................................................................................	9
	Import of Industry Claim Report File & Validation Process.........................................	10
4.	Diskette Labeling and Mailing Instructions..................................................................	14

 

General Submission Guidelines

 

1)         Data Collection Information

 

            a)         Data must be submitted on 3½" 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:

 

1)	Insurer Name,	39)	Person Responsible Title,
2)	Insurer FEIN,	40)	Contact Person Name,
3)	Claim ID,	41)	Contact Person Phone,
4)	Coverage Code,	42)	Contact Person Email Address,
5)	Injury Date,	43)	Attorney Name,
6)	Reported Date,	44)	Attorney City,
7)	Opened Date,	45)	Attorney State,
8)	Re-opened Date,	46)	Nature and Substance of Claim,
9)	Original Closure Date,	47)	Act or Omission Codes,
10)	Original Claim ID*,	48)	Severity of Injury Code,
11)	Insured Profession or Business Code,	49)	Date Claim Closed,
12)	Insured Profession Description,	50)	Disposition Code,
13)	Insured Practice Code,	51)	Settlement Code,
14)	Insured Name,	52)	Review Panel or Non-Binding
15)	Insured IL License Number,		Arbitration Code,
16)	Insured DOB,	53)	Binding Arbitration Code,
17)	Insured Specialty Code,	54)	Court Code,
18)	Insured Board Certified,	55)	Court County,
19)	Name of Board,	56)	Court Docket Number,
20)	Insured County,	57)	Amount Awarded by Circuit Court,
21)	Injury Place Code,	58)	Award Date,
22)	Injury Place Description,	59)	Circuit Court Appealed,
23)	Injury Place Location within	60)	Result of Appeal,
	Institution Code,	61)	Other Post-Trial Motions,
24)	Injury Place Location in	62)	Court Economic Damages Awarded,
	Institution Description,	63)	Court Non-Economic Damages
25)	Injury Place Institution Name,		Award,
26)	Injury Place County,	64)	Total Indemnity Paid/Payable by
27)	Injured Name,		Insurer,
28)	Injured Person's Gender,	65)	Economic Damages,
29)	Injured Person's Age Category,	66)	Non-Economic Damages,
30)	Injured Person's SSN,	67)	LAE to Defense Counsel,
31)	Injured Person's County Residence,	68)	All Other LAE,
32)	Total Number Defendants,	69)	Total Indemnity Insurer,
33)	Companion Claim ID A,	70)	Other Indemnity Deductible,
34)	Companion Claim ID B,	71)	Other Indemnity Excess Limits,
35)	Companion Claim ID C,	72)	Other Indemnity SIR,
36)	Companion Claim ID D,	73)	Other Indemnity Stop Loss,
37)	Companion Claim ID E,	74)	Claimed Medical Expense,
38)	Person Responsible,	75)	Claimed Wage Loss,

 

            * 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 3½" 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.

 

Pos/RI	Column Name	Type	Maximum Size
1/1a	Insurer Name	Text	50
2/1b	Insurer FEIN	Text	11
3/2a	Claim ID	Text	35
4/2b	Coverage Code	Text	2
5/2c	Injury Date	Text	10
6/2d	Reported Date	Text	10
7/2e	Opened Date	Text	10
8/2f	Re-opened Date	Text	10
9/2g	Original Closure Date	Text	10
10	Original Claim ID*	Text	35
11/3a	Insured Profession or Business Code	Text	37
12/3a	Insured Profession Description	Text	30
13/3b	Insured Practice Code	Text	2
14/3c	Insured Name	Text	64
	Format: "Last Suffix, First MI. Profession"
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
	Professional Designation (e.g., MD)	Text	4
15/3d	Insured License Number	Text	15
16/3e	Insured DOB	Text	10
17/3f	Insured Specialty Code	Text	5
18/3g	Insured Board Certified	Text	2
19/3g	Name of Board	Text	25
20/3h	Insured County	Text	30
21/4a	Injury Place	Text	59
22/4a	Injury Place Description	Text	30
23/4b	Injury Place Location within Institution Code Text	Text	2
24/4b	Injury Place Location in Institution Description Text	Text	25
25/4c	Injury Place Institution Name	Text	40
26/4d	Injury Place County	Text	30
27/5a	Injured Name	Text	59
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
28/5b	Injured Gender	Text	1
29/5c	Injured Person's Age Category	Text	1
30/5d	Injured Person's SSN	Text	11
31/5e	Injured Person's County Residence	Text	30
32/6a	Total Number Defendants	Text	4
33/6b	Companion Claim ID A	Text	35
34/6b	Companion Claim ID B	Text	35
35/6b	Companion Claim ID C	Text	35
36/6b	Companion Claim ID D	Text	35
37/6b	Companion Claim ID E	Text	35
38/7a	Person Responsible	Text	64
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
39/7b	Person Responsible Title	Text	30
40/7c	Contact Person	Text	100
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
41/7d	Contact Person Phone	Text	20
42/7e	Contact Person Email Address	Text	40
43/8a	Attorney Name/Law Firm	Text	64
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	1
	Period	Text	1
44/8b	Attorney City	Text	16
45/8c	Attorney State	Text	2
46/9a	Nature and Substance of Claim	Text	150
47/9b	Act or Omission Codes	Text	255
48/9c	Severity of Injury Code	Text	2
49/9d	Date Claim Closed	Text	10
50/9e	Disposition Code	Text	2
51/9f	Settlement Code	Text	2
52/9g	Review Panel or Non-Binding Arbitration Code	Text	2
53/9h	Binding Arbitration Code	Text	2
54/10a	Court Code	Text	2
55/10b	Court County	Text	35
56/10c	Court Docket Number	Text	40
57/10d	Amount Awarded by Circuit Court	Currency
58/10e	Award Date	Text	10
59/10f	Circuit Court Appealed	Text	1
60/10f	Result of Appeal	Text	25
61/10g	Other Post-Trial Motions	Text	25
62/10h	Court Economic Damages Awarded	Currency
63/10i	Court Non-Economic Damages Awarded	Currency
64/11a	Total Indemnity Paid/Payable by Insurer	Currency
65/11b	Economic Damages	Currency
66/11c	Non-Economic Damages	Currency
67/11d	LAE to Defense Counsel	Currency
68/11e	All Other LAE	Currency
69/11f	Total Indemnity Insurer	Currency
70/11g	Other Indemnity Insurer Deductible	Currency
71/11g	Other Indemnity Insurer Excess Limits	Currency
72/11g	Other Indemnity Insurer SIR	Currency
73/11g	Other Indemnity Insurer Stop Loss	Currency
74/11h	Claimed Medical Expense	Currency
75/11i	Claimed Wage Loss	Currency

 

* 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  and IMPLIUCR caption. Left mouse click on the IMPLIUCR caption to gain access to the System Main Window as displayed below.

 

 

 

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  will take you to a datasheet view (see Figure-2, page 13) from which you can correct indicated errors.

 

Left mouse clicking on this button  will print an error report similar to the one located in "IMPLIUCR Validation Process" (Figure -1).

 

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 1^st 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, 4^th Floor

Springfield IL 62767

Attn.:  Casualty Actuarial Section

 

(Source:  Added at 30 Ill. Reg. 19288, effective December 4, 2006)