Comparison of Multiple (Cross) Data Types

Transcription

1 NCCI S Comparison of Multiple (Cross) Data Types January 26 29, 2016 Palm Beach County Convention Center West Palm Beach, FL

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3 Comparison of Multiple (Cross) Data Types Presented by: Julie Gonzalez and Renee Retterath Objective Provide an understanding of the connections between data types and how data is compared for validation and usage. 2 1

4 Agenda Data Types and Uses Data Comparison and Reconciliation Data Relationships Case Study 3 Data Types and Uses 2

5 Data Type Overview Unit Statistical Policy DCI Financial Calls Medical Data Call 5 Policy Data Policy Data Information obtained from a workers compensation Policy Data Information and employers obtained liability from a workers policy compensation and employers liability policy Carrier Code State Premium Record AL 01 Policy Number WC12345 Losses Subject to Deductible Medical Losses 01 Policy Effective Date 3/1/2013 Class Code 8810 Primary Name ABC Acme Exposure Premium $10,000 $80 Primary FEIN Rate $

6 Unit Statistical Data Unit Statistical Data Audited exposure, premium, and valued loss information reported for all states covered on a policy Carrier Code Policy Number Policy Effective Date WC /1/2013 Class Code Exposure Premium Rate Claim # 8810 $12,500 $100 $ Exposure State AL 01 Accident Date 1/1/2014 Primary Name ABC Acme Jurisdiction State 23 (MS) Primary FEIN Type of Deductible Medical Losses 01 7 Detailed Claim Information WCCDCI Records Detailed Claim Information (DCI) Data derived from a sampling WCIO of Manual indemnity Section (lost time) claims Carrier Code Claim # Policy Number WC12345 Accident Date 1/1/2014 Policy Effective Date 3/1/2013 Jurisdiction State MS

7 Medical Call Data Medical Call Data Medical bill detail associated with medical services Carrier Code Claim # Policy Number WC12345 Accident Date 1/1/2014 Policy Effective Date 3/1/2013 Jurisdiction State MS 23 9 Financial Call Data Financial Call Data Aggregated premiums, loss data, and expenses submitted annually Carrier Code Exposure State AL 01 Policy Effective Date 3/1/2013 Policy Number WC12345 Accident Date 1/1/2014 Claim #

8 Data Type and Uses Review Which Data Type Exposure and premium are estimated Is reported at the bill line detail Is aggregated premiums, loss data, and expenses Includes both exposure and jurisdiction states Sampling of indemnity claims Answers Financial Calls DCI Policy Data Medical Data Call Unit Statistical Data 11 Data Relationships 6

9 Data Relationships Policy Information Claim Information Indemnity and Medical Amounts DCI Policy Unit Policy Information Claim Information Medical Amounts Medical Policy Information Class/Statistical Codes Exposure Policy Information Claim Information Class/Statistical Codes Loss Amounts Financial 13 Data Relationships Expected Unit Policy Expected 1st Report Open Claim Expected Subsequent DCI Unit Expected 1st Report Open Claim Expected Subsequent NAIC Data Financial Expected Financial NAIC Data Medical Expected Medical 14 7

10 Elements That Drive Expected Unit Report Control Identifies expected Unit Statistical data based on: Policy Effective Date Policy Number Carrier Code Exposure State on State Premium Record DCI Death and PT claims and sampling % of unit reports Financial Calls Expected on Data Manager Dashboard 15 Data Type Comparison Overview Data Type Valuation Due Subsequent Reporting Policy Within 30 Days of Policy Effective Date Unit 18 Months After Policy Effective Date 20 Months After Policy Effective Date Up to 10 Report Levels DCI 18 Months After Reported to Insurer Date 21 Months After Reported to Insurer Date Up to 11 Report Levels Medical By End of Quarter Following Transaction Up to 30 Years After Accident Date Financial December 31 By April 1 of Year Following Valuation Up to 31 Years (Policy Calls) Up to 30 Years (Cal Accident Calls) 16 8

11 Comparative View of DCI and Unit Claims Claims that close between the date the unit 1st report is due and the due date of the DCI 1st valuation level 7/1/2013 Policy Effective Date (PED) Claim Occurs on 3/31/2014 6/30/2014 Policy Expiration Date 1/2015 unit 1st report valued at 18 months after PED Open Claim Reported on Unit Is Expected for DCI 10/2013 1/2014 4/2014 7/ /2014 1/2015 4/2015 7/ /2015 Claim Reported to Insurer (RTI) 4/1/2014 Claim Closes 7/1/ /2015 DCI 1st valuation level valued at 18 months after RTI DCI 1st report expected volumes are developed estimates using Unit Statistical data. 17 Comparative View of Financial Call and Unit Statistical Data 7/1/2013 Policy Effective Date (PED) Claim occurs on 3/31/2014 6/30/2014 Policy Expiration Date 1/2015 Unit 1st Report valued at 18 months after PED Open claim reported on unit 10/2013 1/2014 4/2014 7/ /2014 1/2015 4/2015 7/ /2015 Financial Call Valued as of 12/31/2013 Financial Call Valued as of 12/31/2014 Claim Closes 7/1/

12 Data Connections Data Element/ Data Category Policy Data Unit Data Policy Number, Policy Effective Date, Carrier Code, Policy Information Primary Name, FEIN Exposure State State Premium Record Exposure Record Class/Statistical Codes Initial Final Exposure/Premium Estimated Audited Rate Should Be Consistent 19 Data Connections Data Element/ Data Category Unit Data DCI Data Policy Information Claim Information Policy Number, Policy Effective Date, Carrier Code Jurisdiction State, Claim Number, Accident Date Loss Amounts Vocational Rehabilitation Incurred and Paid Indemnity and Medical, Part/Nature/Cause Included in Incurred and Paid Indemnity Incurred Indemnity, Indemnity Benefit Amount by Type, Incurred and Paid Medical, Part/Nature/Cause Amount by Type of Vocational Rehabilitation Expense 20 10

13 Injury Type Versus Benefit Type Unit Report Injury Type Code Under each jurisdiction s law corresponding to carrier s estimate, as of the valuation date, of the ultimate injury type of the claim Does not have to correspond to the type of benefit being paid as of the valuation date Example: If temporary total payments have been made on a claim with permanent partial reserves, report the claim as a permanent partial claim DCI Benefit Type Code Type of benefits paid to the claimant as of the valuation date 21 Data Connections Data Element/ Data Category Unit Data Medical Data Policy Information Policy Number, Policy Effective Date, Carrier Code Claim Information Jurisdiction State, Claim Number, Accident Date Medical Loss Amounts Incurred and Paid Medical Paid Medical at the Bill Line Detail 22 11

14 Data Connections Call 3 (Policy Year) Call 5 (Calendar/ Accident Year) Call 8 (Reconciliation Report) NAIC Page 14 (WC) Unit Statistical Data 23 Financial Call and Unit Statistical Data Comparisons 24 12

15 Comparison to NAIC Annual Statement Call 8 Reconciliation Report Reconciles calendar year financial data reported to NCCI with data reported on the carrier s NAIC Annual Statement, Statutory Page 14 Financial data fields compared include: Net earned premium Paid and incurred losses Defense and Cost Containment Expenses (DCCE) Paid 25 Comparison to NAIC Annual Statement Experience excluded from the Financial Calls is reflected as reconciliation items: 26 13

16 Data Connections Unit Data Financial Call Data Carrier Code and Exposure State PED and Accident Date Deductible (Small and Large) Carrier Code and Exposure State Policy Year Call Large Deductible Call Calendar- Accident Year Call Included or Excluded Experience 27 Data Connections Unit Data Financial Call Data Class and Statistical Codes Premium and Rate ALAE Medical and Indemnity Losses (Incurred and Paid) Loss Amount and Catastrophe Number Earned Premium DSR Level, Company Standard DCCE Medical and Indemnity Losses (Paid and Case Outstanding) Call 31 includes $500,000 or more loss and ELE catastrophes Indemnity Claim Counts 28 14

17 Mapping Examples Consistent Fields Data Type Policy Number Policy Effective Date Carrier Code Claim Number Accident Date Policy Unit DCI Medical Financial IMPORTANT: Report each of these fields the same for the life of the policy

18 Examples of Mapping Reconciliation Classification Code Carrier Assigns applicable class code on policy Claims Assigns applicable class code on loss Reconciliation from classification assigned on claim to match classification with exposure on unit Classification Code reported on unit to NCCI 31 Classification/Statistical Codes Coal Mining Classification Codes Black Lung Disease Statistical Codes Supplemental Disease Statistical Codes (Occupational Disease) F-Classification Codes Maritime and FELA Classification Codes Statistical Codes Net, Company Standard, DSR 32 16

19 Examples of Reporting Differences Financial Call Data Excludes Experience from Calls 3/5 Large Deductible policies USL&HW, FELA Underground Coal Mine Stat Codes effects of stat code data in premium calculations vary Not all premium components will have a stat code, but may need to be reported Retrospective Adjustments report in Net premium only Repatriation report in Net premium only Includes Experience Unit Statistical Data Large Deductible policies USL&HW, FELA Underground Coal Mine Report all applicable stat codes Not all premium components will have a stat code No stat code for Retrospective Adjustments No stat code for Repatriation Not a comprehensive list of Financial Call experience/data inclusions/exclusions. Please refer to the Financial Call Reporting Guidebook for more details. 33 Examples of Mapping Reconciliation Incurred Loss Carrier Sets reserves Claims Makes a payment Reconciliation creates Incurred Loss (Paid + Reserve) Incurred Loss reported on unit to NCCI 34 17

20 WCIO Data Mapping Example Carrier Source System Unit DCI Open Open Open Closed Closed Closed Reopened Open Reopened Closed Reopened Became Medical Only 35 Data Standards Claim Number Example Claim Unmatched Link/Key Data Administrators Dental WC12345 MAL456 NCCI Reported Data Medical Bill Reviewers 12345XYZ Pharmacy Insurer? TPA Data Warehouse 23456XYZ Hospital 36 18

21 Data Standards Claim Number Example Claim Correct Link/Key Data Administrators Dental WC12345 WC12345 NCCI Reported Data WC12345 WC12345 Medical Bill WC12345 Reviewers Pharmacy WC12345 Insurer TPA Data Warehouse WC12345 Hospital 37 Data Relationships Review True or False? Policy Effective Date is reported consistently across all data types except DCI Valuation and due dates are the same for all data types Exposure is reported as estimated for Policy and audited for Unit Statistical Allocated Loss Adjustment Expense (ALAE) reported in Unit Statistical data correlates to the Defense and Cost Containment Expense (DCCE) reported in the Financial Calls 38 19

22 Thank You 20

23 Supplemental Information

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25 Presenter Biographies Julie Gonzalez, AIDM, has been employed at NCCI since As a data consultant and project manager in the Data Services Department, her main responsibilities include managing NCCI s Data Educational Program, overseeing major compliance projects, developing new data reporting requirements, and enhancing NCCI s external training programs and data tools. In addition, Julie actively participates on industry committees and association forums to forge industry relationships and provide subject matter expertise. Prior to joining Data Services, Julie was a senior underwriting analyst, responsible for filing workers compensation rules and programs, and managing the appeals board mechanism for several NCCI states. Julie has earned both her Associate in Commercial Underwriting (AU) and Associate Insurance Data Manager (AIDM) designations. Renee Retterath has worked at NCCI for 13 years and is a senior data consultant in the Data Quality and Compliance Department. She is responsible for the development, implementation, and monitoring of the various quality assurance programs for the collection and validation of customer data. Renee has a master of science degree in school psychology from the University of Wisconsin- Stout.