Payment Processing Overview

Commonwealth of Pennsylvania Department of General Services RFP #6100036110 APPENDIX L APPENDIX L COPA WC - Claims Data Interface

Overview

Agencies under the Governor’s jurisdiction report work-related injuries through a self-service portal into the Commonwealth’s enterprise computer system. Injury claims data is entered by supervisors or approved workers’ compensation representatives. When a workers’ compensation representative enters the claim, it is entered from a paper form completed by the supervisor. The current form is available on the website and instructions are provided within this Appendix.

The workers’ compensation coordinator receives an e-mail notification through the enterprise computer system when a new claim is entered. This allows the coordinator to review the data and obtain any additional information that may be helpful to the Offeror before the claims information is interfaced to the Offeror.

Each night, with the exception of Saturday and Sunday, whether or not the workers’ compensation coordinator has reviewed the claim data, all claims data entered is batched into an interface file and made available to the Offeror. Incident only claims are not sent to the Offeror, but are maintained in the enterprise computer system in the event that the claimant needs to seek medical treatment or begins losing time from work at a later time.

For agencies that do not use the enterprise computer system, injury data is recorded on the paper claim form, and the form is either faxed or e-mailed as an attachment to the Offeror, or if the Offeror has an injury reporting tool, it could be entered to the Offeror’s system. The fax/e-mail options could be used in a rare case when the enterprise computer system would not be available.

Based on the claims data received, the Offeror shall complete and file the LIBC-344 form with the Bureau of Workers’ Compensation in accordance with their procedures, and a copy must be provided to the workers’ compensation coordinator and claimant.

Claim Changes

Workers’ compensation representatives and workers’ compensation coordinators have the ability to change claim data in the enterprise computer system after the data is interfaced. If data is changed, the entire claim is resent, and it is the responsibility of the Offeror to determine what data has changed so that the Offeror’s system can be updated. Recurrences of previously reported claims are not sent through the interface. Notification is typically provided directly to the adjuster by e-mail or telephone.

Interface Transfer File

Delivery of file occurs by FTP transfer from the Commonwealth’s Public FTP Server, using credentials provided by the Commonwealth. Files will be in an XML format provided by the Commonwealth, and named according to Commonwealth specifications. Files will be encrypted. Exact file formats will be provided by OA upon execution of the contract. Fields that will be transferred are at least those provided on the claim reporting form. The current file specifications are provided with this appendix for informational purposes.

of 7 Commonwealth of Pennsylvania Department of General Services RFP #6100036110 APPENDIX L

Testing Requirements

Commonwealth testing standards require Unit Testing along with end-to-end Integration testing by the Office of Administration, Bureau of Integrated Enterprise Systems to ensure all functionality and interfaces work properly. A formal signoff by the Commonwealth on full system testing is required to assure a quality implementation. The Offeror shall allow enough time to complete this testing and include this timeline in a full project plan that shall be submitted with the proposal. At a minimum the awarded offeror shall plan on all testing to be completed with formal signoff on system interfaces and functionality 30 days in advance of the implementation date. Should testing not be completed by this date due to awarded offeror delays, daily negotiations to solve the problems will begin between the Commonwealth and the Offeror’s project manager. Upon completion of successful system testing the Commonwealth will provide formal notification that system functionality and interface testing is complete and the system is acceptable.

of 7 Commonwealth of Pennsylvania Department of General Services RFP #6100036110 APPENDIX L Interface File Specifications

This specification is provided for information purposes. It is subject to modifications, and the final format specifications will be provided upon award of the contract.

HEADER: FIELD LENGTH Example Value

Record Type 6 Characters “HEADER” Constant value Create Date 8 Characters “07012007” (MMDDYYYY) Create Time 6 Characters “013000” (HHMMSS) As of Date 8 Characters “07012007” (MMDDYYYY) Contact Person Name 40 Characters “John Smith” Telephone Number 10 Characters “7177059295” Email Address 25 Characters “[email protected]” File Name 40 Characters “INTF_nnnn.BUS.PARTNER.OUT.DAT” Where nnnn is 4 char DFS FLOW object ID number, followed by a unique name(s), and extension OUT.DAT separated by dots. Record Count 8 Characters “00000230”(count = all data records + header record)

OUTPUT: SAP R/3 Field SAP Field Name Name Table Type Length Description Comments/Rules Position SUBTY P0082 CHAR 4 Subtype (Coverage Code) 1 RDATE P0082 DATS 8 Report on 5 PERNR P0000 NUMC 8 Personnel no 13 IDATE P0082 DATS 8 Date of Illness 21 Calculate: Q0008 CURR 13 Biweekly Salary at Injury Right justify with 2 decimal places 29 Use function P0008 implied. Pad with leading zeroes. module ZHR_GET_SA ( do not include or default zeros) L_ Per Diem wage type 1250.

RATES As of injury date NACHIN P0002 CHAR 40 Last name 42 VORNA P0002 CHAR 40 First name 82 MIDNM P0002 CHAR 40 Mid. Name 122 NAMZU P0002 CHAR 15 Suffix 162 PERID Q0002 CHAR 20 SSN Left justify 177

STRAS P0006 CHAR 60 Address line 1 Residence address 197 ORT01 P0006 CHAR 40 City/county Residence address 257 STATE P0006 CHAR 3 State Residence address 297 PSTLZ P0006 CHAR 10 Zip code Residence address 300 ZZ_COUNC P0006 CHAR 2 Residence County Residence address 310

AREAC Q0006 NUMC 3 Telephone number (area If blank will send 9’s in same format 312 code) Personal number as area code TELNR Q0006 CHAR 14 Telephone number Left justify 315 (Personal number) If blank will send 9’s in same format as telephone number GBDAT P0002 DATS 8 Birth date 329 GESCH P0002 CHAR 1 Gender U = Unknown 337 M = Male F = Female RCD05 P00082 CHAR 2 Marital status 338 RCD04 P00082 CHAR 2 Dependents 340 DAT01 P0041 DATS 8 Z1 (Current Svc Date) Find the date value for the 342 corresponding Z1 date type.

As of injury date

PERSK P0001 CHAR 2 EE Subgroup As of injury date 350

FT = Full time PT = Part time

VO = U9 ZZ = all others WERKS P0001 CHAR 4 Personnel area As of injury date 352 (Dept/Agency) STELL P0001 NUMC 8 Job Key As of injury date 356 T513S-STLTX T513S CHAR 25 Job key (text) 364 ORGEH P0001 NUMC 8 Organization unit As of injury date 389 T527X-ORGTX T527X CHAR 25 Organization unit (text) 397 P0006-STRAS Infotype 6 CHAR 30 House no/street (Work As of injury date 422 subtype 10 Location) P0006-LOCAT Infotype 6 CHAR 35 House no/street (Work As of injury date 452 subtype 10 Location) P0006-ORT01 Infotype 6 CHAR 20 City (Work Location) As of injury date 487 subtype 10 P0006-STATE Infotype 6 CHAR 3 Region (State) Work As of injury date 507 subtype 10 Location P0006-PSTLZ Infotype 6 CHAR 10 Post code (Zip) Work As of injury date 510 subtype 10 Location Q0006-AREAC Infotype 6 NUMC 3 Area Code (Work As of injury date 520 subtype 10 Location) If blank will send 9’s in same format as area code Q0006-TELNR Infotype 6 CHAR 22 Telephone no. (Work Left justify 523 subtype 10 location) As of injury date If blank will send 9’s in same format as telephone number CONTY V_T5UTZ CHAR 25 County (Work County) As of injury date 545 ITIME P0082 TIMS 6 Illness time 570 OTM05 P0082 TIMS 6 Shift Start Time 576 P1001STEXT Q1001 CHAR 40 Name (of Supervisor) As of injury date 582 AEDTM P0082 DATS 8 Last Changed On (Flag) This field is used by SAP for created 622 and changed records. Text - T01 250 All equipment….using 630 when accident occurred

Text - T02 250 How injury occurred 880 Text - T03 250 If not on premises, Separate fields for Address line 1, 1130 address of accident city, county, state, zip code (see bottom of list PAD_STRAS, PAD_ORT01, REGIO, PSTLZ_HR, COUNC) Text - T04 250 Medical Provider Info 1380 Text - T05 250 Additional Comments 1630 Average P0082- NUMC 7 AWW Right justify with 2 decimal places 1880 Weekly Wage AVGS implied. Pad with leading zeroes. RCD01 PA0082 CHAR 2 Y0 - Type of Claim 1887 ODT02 PA0082 DATS 8 Y1 - Date of Death 1889 ODT03 PA0082 DATS 8 Y2 - Date Employer 1897 Knew ODT04 PA0082 DATS 8 Y3 - Date of Illness 1905 ODT05 PA0082 DATS 8 Y4 - Last Day 1913 Worked/Paid JNF05 PA0082 CHAR 1 Y4 – Last Day Y=Yes/N=No 1921 Worked/Paid (yes/no) 1VDT06 PA0082 DATS 8 Y5 - Date Returned 1922 Work/Same Wage JNF06 PA0082 CHAR 1 Y5 - Date Return Y=Yes/N=No 1930 Work/Same Wage JNF07 PA0082 CHAR 1 Y6 - Injury on Y=Yes/N=No 1931 Premises/State REM07 PA0082 CHAR 20 Y6 - Injury on Premises 1932 /State JNF08 PA0082 CHAR 1 YA - Occur During OT? Y=Yes/N=No 1952 RCD09 PA0082 CHAR 2 Z0 - Injury Type Code 1953 RCD10 PA0082 CHAR 2 Z1 - Body Part Code 1955 RCD11 PA0082 CHAR 2 Z2 - Cause Code 1957 REM12 PA0082 CHAR 20 Z3 – Injury Type Info 1959

REM13 PA0082 CHAR 20 Z4 – Body Part Info 1979 REM14 PA0082 CHAR 20 Z5 – Cause Info 1999 RCD15 PA0082 CHAR 2 Z6 - Injury Type Code 2 2019 RCD16 PA0082 CHAR 2 Z7 - Body Part Code 2 2021 JNF17 PA0082 CHAR 1 ZA - Equipment Guards Y=Yes/N=No 2023 Provided? JNF18 PA0082 CHAR 1 ZB - Equipment Guards Y=Yes/N=No 2024 Used? JNF19 PA0082 CHAR 1 ZC - Tools Involved? Y=Yes/N=No 2025 JNF20 PA0082 CHAR 1 ZD – Mechanical Defect? Y=Yes/N=No 2026 JNF21 PA0082 CHAR 1 ZE - Unsafe Act? Y=Yes/N=No 2027 JNF22 PA0082 CHAR 1 ZF - Unsafe Condition? Y=Yes/N=No 2028 JNF23 PA0082 CHAR 1 ZG – Amputation? Y=Yes/N=No 2029 JNF24 PA0082 CHAR 1 ZH – Vehicle Accident? Y=Yes/N=No 2030 JNF25 PA0082 CHAR 1 ZI – Panel?/Init Y=Yes/N=No 2031 Treatment RCD25 PA0082 CHAR 2 ZI - Covered by 2032 Panel/treatment PAD_STRAS PA0082 CHAR 60 Street Address PAD_ORT01 PA0082 CHAR 40 City REGIO PA0082 CHAR 3 State PSTLZ_HR PA0082 CHAR 10 Zip Code COUNC PA0082 CHAR 3 County Code If out of state – display County of (state)