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of the Commonwealth of Pennsylvania

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    EDI Implementation Guide & Supporting Documents

    The forms provided here are meant to assist Trading Partners who use EDI to report claim data to the Bureau of Workers' Compensation.

    EDI Claims Implementation Guide

    The Bureau of Workers' Compensation has published the Electronic Data Interchange (EDI) Claims Implementation Guide and its supporting documents. This version of the guide provides technical information, procedures and explanations to help claims administrators prepare and navigate future EDI processes.

    Submit any comments, questions and suggestions you have regarding the guide to the bureau’s EDI section via the Customer Service “Submit a Question” feature from the WCAIS Dashboard. We will consider your input as we make revisions to it in the future.

    Supporting Documents:

    EDI Forms Solution DN Mapping

    The following Forms Solution Data Element (DN) Mapping Reference Guides are being provided to assist filers with determining the appropriate fields to populate in the EDI transactions they use to issue the LIBC-495 (Notice of Compensation Payable), LIBC-501 (Notice of Temporary Compensation Payable), LIBC-496 (Notice of Workers’ Compensation Denial), or LIBC-502 (Notice Stopping Temporary Compensation). Unlike the below Crosswalk documents, the DN guides are the actual forms but with the DNs identified. These guides also provide information on mapping for specific code values, where more than one value could apply.

    LIBC-495 DN Mapping
    LIBC-496 DN Mapping
    LIBC-501 DN Mapping
    LIBC-502 DN Mapping

    EDI Crossover Documents

    The following code information regarding the LIBC forms is to assist filers with properly populating their EDI transaction data elements to match the forms in question.  Proper population ensures WCAIS is kept up to date and with accurate information on the official file. Submit any comments, questions and suggestions you have regarding the guide to the Bureau’s EDI section via the Customer Service “Submit a Question” feature from the WCAIS Dashboard.

    Note: Please continue to check for the posting of additional scenarios/revisions.

    LIBC-336LIBC-337LIBC-338LIBC-339
    LIBC-340LIBC-380LIBC-392aLIBC-494c
    LIBC-498
    		LIBC-751LIBC-755LIBC-757
    LIBC-761LIBC-762LIBC-763LIBC-764