Section 928.EXHIBIT C   Illinois Medical Professional Liability Insurance Uniform Claims Reporting (IMPLIUCR) – Data Entry 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)

Data Entry 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 data entry claim reporting.

 

Table of Contents:		Page
1.	Application Start Up Instructions and System Menu......................................	3
2.	Main Menu..................................................................................................	4
3.	Claims Report Maintenance Menu................................................................	5
4.	Uniform Claims Report Maintenance.............................................................	6
5.	Person Responsible and Contact Person Information Lists.............................	7
6.	Quarterly Reporting Process.........................................................................	8
7.	Claim Report Field Types and Maximum Lengths..........................................	10
8.	Quarterly Submission Mailing Instructions.....................................................	13

 

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.

 

Main Menu

 

The Illinois Department of Financial and Professional Regulation-Division of Insurance  (IDFPR-DOI) "IMPLIUCR Requirements Main Menu", shown above, is the starting point from which you can enter Claims Report information into a Medical Malpractice Database.

 

 

Left mouse click on this button to gain access to the Claims Report Maintenance Menu for reporting Claim Reports.

 

 

Left mouse click on this button to process submitted claims report files. See IMPLIUCR Industry Reporting Requirements User Guide, batch processing, for help.

 

Claim Reporting Maintenance Menu

      Left mouse click on this button to create new Open Claim Reports.

 

      Left mouse click on this button to close an Open Claim Report.

 

      Left mouse click on this button to Re-open a Closed Claim Report.

 

      Left mouse click on this button to close a Re-opened Claim Report.

 

               Left mouse click on this button to make changes to an Open Claim Report or a Re-opened Closed Claim Report or to Re-open a Closed Claim Report.

 

                  Left mouse click on this button to process add/update/delete changes to Person Responsible list.

 

                  Left mouse click on this button to process add/update/delete changes to the Contact  Person Information list.

 

                        Left mouse click on this button to gain access to the Quarterly Reporting Process for submission of Claim Reports to the IDFPR-Division of Insurance.

 

                        Left mouse click on this button to return to the "IMPLIUCR Requirements Main Menu".

 

Uniform Claims Reporting

 

You can get to this window via the "IMPLIUCR – Claims Report Maintenance Menu".

 

 

      Left mouse click on this button to save the report information you have typed into the claim.

 

      Left mouse click on this button to see a preview of the claim and to print a copy of that claim or to add a claim to the database.

 

      Left mouse click on this button to gain access to Field definitions and Specifications.

 

      Left mouse click on this button located at the bottom of the claim or this button   located in the top right hand corner of the claim to close the claim.  If changes to the claim have been made you will be prompted to save those changes.  If you respond no and do not save changes they will be lost.

 

      Left mouse click on this button to delete a record.  Once a record is deleted it cannot be retrieved again.

 

Person Responsible and Contact Person Information Lists

 

 

 

You can get to these windows via the "IMPLIUCR – Claims Report Maintenance Menu".  Building and maintaining current Person Responsible and Contact Person information files will aid in the data entry process for opening a new claims report (see figure below).

 

To add/change a record, type in report information, then left mouse click on the record navigation buttons , "Shift + Enter" keys, or the enabled close button at the top right corner of this window to effect a change or new record addition.

 

To delete a record, left mouse click on the vertical record selector box containing the black twisty  , and then press the delete key. You must reenter data that is mistakenly deleted.

 

Picture Extract of Claim Report Data Entry Window:

 

 

 Left mouse click on the twisty button, next to "Person Responsible for Preparing Report", for gaining access to a list of Responsible Person and Title.

 

 

 Left mouse click on the twisty button, next to "Contact Person", for gaining access to a list of Responsible Person and Title.

 

Quarterly Reporting Process

 

You can get to this window for generating a quarterly claims report file by left mouse clicking on the "Generate Quarterly Report" button displayed on the "IMPLIUCR – Claims Report Maintenance Menu" window.  First: select quarter from drop down list. Then, if needed, change the reporting year.  All claims with an open, re-opened, closed date, and any claim with a maintenance date that falls within the reporting quarter will be selected for submission to the IDFPR-Division of Insurance. 

 

Left mouse click on the  button next to "View Selected Quarterly Claim Reports" for gaining access to a datasheet view of claim reports.

 

Left mouse click on the  button next to "Generate Quarterly Claim Report File" for gaining access to a browser "Save As" window (see Figure-1 page 9).

 

 

Claim reports can only be viewed.  Cannot delete, or modify displayed data.  Each row consists of an individual claim report.

 

Computer Disk File Structures and Naming Conventions

 

Each disk submitted shall contain a physical file for Uniform Claim 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-1stQtr2005.txt

(Figure-1)

 

From this browser "Save As" window, you will be able to save selected claim reports file for submission to the IDFPR-Division of Insurance.

 

Claim Report Field Types and Maximum Lengths

 

For Field/Data Definitions & 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.

 

RI	Field Name	Type	Maximum Length
1a)	Insurer Name	Text	50
1b)	Insurer FEIN	Text	11
2a)	Claim ID	Text	35
2b)	Coverage Code	Text	2
2c)	Injury Date	Text	10
2d)	Reported Date	Text	10
2e)	Opened Date	Text	10
2f)	Re-opened Date	Text	10
2g)	Original Closure Date	Text	10
3a)	Insured Profession Code	Text	37
	Insured Profession Description	Text	30
3b)	Insured Practice Code	Text	2
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
3d)	Insured License Number	Text	15
3e)	Insured Date of Birth	Text	2
3f)	Insured Specialty Code	Text	5
3g)	Insured Board Certified	Text	2
	Name of Board	Text	25
3h)	Insured County	Text	30
4a)	Injury Place	Text	59
	Injury Place Description	Text	30
4b)	Injury Place Location within Institution Code	Text	2
	Injury Place Location in Institution Description	Text	25
4c)	Injury Place Institution Name	Text	40
4d)	Injury Place County	Text	30
5a)	Injured Name	Text	59
	Format: "Last Suffix, First MI."
	Last	Text	40
	Suffix	Text	4
	Comma	Text	1
	First	Text	15
	MI	Text	2
	Period	Text	1
5b)	Injured Gender	Text	1
5c)	Injured Person's Age Category	Text	10
5d)	Injured Person's SSN	Text	11
5e)	Injured Person's County Residence	Text	30
6a)	Total Number Defendants	Text	4
6b)	Companion Claim ID A	Text	35
	Companion Claim ID B	Text	35
	Companion Claim ID C	Text	35
	Companion Claim ID D	Text	35
	Companion Claim ID E	Text	35
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
7b)	Person Responsible Title	Text	30
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
7d)	Contact Person Phone	Text	20
7e)	Contact Person Email Address	Text	40
8a)	Attorney Name	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
8b)	Attorney City	Text	16
8c)	Attorney State	Text	2
9a)	Nature and Substance of Claim	Text	150
9b)	Act or Omission Codes	Text	255
9c)	Severity Injury Code	Text	2
9d)	Date Claim Closed	Text	10
9e)	Disposition Code	Text	2
9f)	Settlement Code	Text	2
9g)	Review Code	Text	2
9h)	Arbitration Code	Text	2
10a)	Court Code	Text	2
10b)	Court County	Text	35
10c)	Court Docket Number	Text	40
10d)	Amount Awarded by Circuit Court	Currency
10e)	Award Date	Text	10
10f)	Circuit Court Appealed	Text	1
	Result of Appeal	Text	25
10g)	Other Post-Trial Motions	Text	25
10h)	Economic Damages	Currency
10i)	Non-Economic Damages	Currency
11a)	Total Indemnity Paid/Payable by Insurer	Currency
11b)	Economic Damages	Currency
11c)	Non-Economic Damages	Currency
11d)	LAE to Defense Counsel	Currency
11e)	All Other LAE	Currency
11f)	Total Indemnity Insurer	Currency
11g)	Other Indemnity Insurer Deductible	Currency
	Other Indemnity Insurer Excess Limits	Currency
	Other Indemnity Insurer SIR	Currency
	Other Indemnity Insurer Stop Loss	Currency
11h)	Claimed Medical Expense	Currency
11i)	Claimed Wage Loss	Currency

 

Quarterly Submission 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 shall 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:  Amended at 30 Ill. Reg. 19288, effective December 4, 2006)