A claim is considered to be acquired when a new Claim Administrator has taken over claims from a prior Claim Administrator.
The new Claim Administrator may receive these claims in an open or closed status and may be required to file the proper acquiring FROI transaction. Use this training aid to guide you through the process of determining what, if any, transactions are required after an acquisition.
The Interpreting EDI Reporting Requirements training aid was developed to give you an overview of how to read and interpret the Edit Matrix, Event Table and Element Requirements Table from within Virginia’s EDI Implementation Guide.
The medical community regions map displays the location within the community for providers of medical services. The zip code for the location where medical services are rendered determines the medical community region.
An occupational disease is a disease arising out of and in the course of employment, but not an ordinary disease of life to which the general public is exposed outside of the employment.
The Occupational Disease Training Aid covers the following:
The Medical Fee Dispute Resolution Process provides instructions for providers and payers when there is a dispute for medical dates of service prior to 01/01/2018.
The Medical Fee Schedule Update Notice provides instruction and notification for amendments made to the schedules.
The ADR Brochure provides a useful overview of the four basic dispute resolution services offered by the Commission’s ADR Department -- Full and Final Mediation, Issue Mediation, Issue Facilitation, and Orientation Sessions -- as well as contact information for more learning.
This is an example of a Variance Notification. Upon receipt, Claim Administrators should check the file payment history against the award history. If there are any payment discrepancies, submission of an EDI transaction will be required to reconcile.
