La. Admin. Code tit. 40 § I-2539

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2539 - Annual Maintenance

A. To ensure that the reimbursement for the procedures are as fair as possible, the Office of Workers' Compensation will require the self insured employer or carrier to submit the following information for claims incurred in the preceding period. This information will be reviewed and any changes to the maximum allowable reimbursement rates will be published.

B. Information Required. The information required for calculation of the reimbursement schedule will include:

Information	Field Length	Type
FIP-Parish Code	3	Numeric
Provider Name	35	Alpha Numeric
Charge Amount	10	Numeric
Type of Service: Medical vs. Surgical*	30	Alpha
Length of Stay	4	Numeric
IP/OP indicator	1	Alpha
*The diagnosis/procedure code requiring the greatest resource consumption (severity) should be used to assign the correct category.

C. Communication Format. The following is the current format, however, the Office of Workers' Compensation will establish the format on an annual basis to facilitate the review:

1. magnetic tape;

a. tape 9-tract, 8.5 inch to 10.5 inch reels with silver mylar reflector (standard reels) with write-ring removed;

b. recording density-1600 or 6250 bytes per inch;

c. recording code-Extended Binary Coded Decimal Interchange Code (EBCDIC);

d. header record must identify submitter and position of each field in the record;

e. tape must have a leading tape mark and an end of file mark. The external label must identify the submitter, the date submitted, the tape number with identification of the total number of tapes submitted and the descriptive narrative of the information contained within the records;

2. diskettes:

a. a 5.25 inch diskette (floppy disk) that is IBM PC-DOS compatible with the following attributes:

i. double sided;

ii. double density;

iii. soft sectored;

iv. 9 sectors per track; and

v. 40 tracks per diskette;

b. a 3.5 inch, 720K diskette, that is IBM PC-DOS compatible with the following attributes:

i. double sided; and

ii. double density;

c. the external label must identify the submitter, the date submitted, the diskette number with identification of the total number of diskettes submitted and the descriptive narrative of the information contained within the records.

La. Admin. Code tit. 40, § I-2539

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.