State of Maine 
Workers’ Compensation Board

Maine Electronic Data Interchange
(EDI)
POC R2.1 Implementation Guide

Table of Contents
Preface……………………………………………………………………………………3
Revisions Information……………………………………………………………………4
Acronyms………………………………………………………………………………...5
Websites………………………………………………………………………………….5
Electronic Data Interchange Rules……………………………………………………….6
WCB Forms Required……………………………………………………………………6
Electronic Data Reporting Format………………………………………………………..6
EDI Communication……………………………………………………………………...6
FTP Procedure to the Maine WCB……………………………………………………….6
Receiver Requirements…………………………………………………………………...6
Test File Naming Convention…………………………………………………………….6
Production File Naming Convention……………………………………………………..7
Transmission Times………………………………………………………………………7
Acknowledgement Reports……………………………………………………………….7
Requirements for Becoming an EDI Trading Partner…………………………………….8
TPP and Electronic Transmission Profile………………………………………………....8
Trading Partner ID List…………………………………………………………………...8
Information and Data Reported…………………………………………………………..8
POC Data Element Requirement Table…………………………………………………..9
Transaction Structure……………………………………………………………………..9
Triplicate Codes………………………………………………………………………......9
Paired Transactions………………………………………………………………………10
Transaction Sequencing………………………………………………………………….11
POC Data Element Conditionals and Business Rules……………………………….…..11
PC-1 Mandatory Conditional Data Element..……………………………………………11
PC-2 Mandatory Conditional Data Element……………………………………………..11
Default UIAN’s…………………………………………………………………………..12
POC Transaction Testing Requirements………………………………………………....13
POC Pre-testing Approval…………………………………………………………….…13
POC Electronic Format Testing…………………………………………………..……...13
POC Event Testing……………………………………………………………………....14
POC Test Completion and Approval………………………………………………….…15
Other Information…………………………………………………………………….….15
Glossary…………………………………………………………………………….……16

Preface

This Implementation Guide is designed to assist Insurers and Service Providers with the electronic filing of PC-1 and PC-2 records.  The guide will also serve as a tool during the EDI set up process for reporting POC records to the State of Maine Workers’ Compensation Board for new Trading Partners.  

If there are any questions about any of the information provided in this guide, please contact:
Paul J. Fortier
Deputy Director of Information Management
State of Maine Workers’ Compensation Board
27 State House Station
Augusta, ME 04333-0027
Phone:  207-287-3818
E-mail: paul.fortier@maine.gov

Or

Venessa Williams
Management Analyst I
State of Maine Workers’ Compensation Board
27 State House Station
Augusta, ME 04333-0027
Phone:	207-287-7197
E-mail:	venessa.williams@maine.gov

Revisions Information
Draft Release Date:  November 30, 2009
Original Publication Date:  November 2007

Acronyms
The following list will be useful when reading through this guide.  These acronyms are used often throughout the guide.
AKP		Acknowledgement Report	
DN		Data Element Number
EDI		Electronic Data Interchange
FEIN		Federal Employer Identification Number
FTP		File Transfer Protocol
IAIABC	International Association of Industrial Accident Boards and Commissions
TA		Transaction Accepted
TE		Transaction Accepted with Errors
TPP		Trading Partner Profile
TR		Transaction Rejected
WCB		Workers’ Compensation Board

Websites
The following links will take you to websites that are referred to multiple times within the Implementation Guide.  

State of Maine Worker’s Compensation Board Website:  http://www.maine.gov/wcb/departments/technology/electronic.htm
This link will bring you directly to the Maine WCB technology website.  You will find links to trading partner documents, information on the EDI Rules, and more.

IAIABC Website:  
http://www.iaiabc.org/edi/implementation.asp 
This link will bring you directly to the EDI Implementation page on IAIABC website.  You will find information such as release guides, trading partner tables, event tables, element requirement tables and more.  Please note that the State of Maine WCB supports the POC Release 2.1 Version of the IAIABC Implementation Guide.

IAIABC POC Rel 2.1 Information and Updates
http://www.maine.gov/wcb/departments/technology/coverage%20EDI%20updates.html
You will find updates and more information about Coverage EDI here.  The Maine WCB POC Implementation Guide is located here as well as the service provider information for POC.  The completed POC tables (element requirement, event and edit matrix) can also be found here.

Electronic Data Interchange Rules
The 121st Maine Legislature enacted legislation that requires the State of Maine Workers’ Compensation Board to adopt rules mandating electronic filing.  The legislation directed the Board to proceed by the consensus based rulemaking process.  A committee was
formed consisting of representatives from the insurance community, self insurers, WC Board of Directors, and WCB staff.  Recommendations were forwarded and unanimously approved by the Board of Directors. The following Rule was adopted on August 22, 2009 mandating Proof of Coverage to be filed electronically. The Rule can be found in Chapter 3 subsection 5 at the following link:  http://www.maine.gov/wcb/rules/90_351.rtf
WCB Coverage Forms Required
The State of Maine WCB will only accept submission of proof of coverage via electronic submission based on the IAIABC POC R2.1 standard.  
Electronic Data Reporting Format
The Maine WCB uses IAIABC POC Release 2.1 for all Coverage EDI submissions.  The IAIABC Implementation Guide contains helpful information such as Transaction Standards found in Section 2, Business and Technical Process Rules found in Section 4, Business Scenarios found in Section 5, and a Data Dictionary found in Section 6.  The guide can be found on the IAIABC website.
EDI Communication
The Maine WCB accepts two methods of communication: Approved EDI Service Providers or directly from the carrier.  Trading partners are required to indicate on their EDI Trading Partner Profile which method of communication they intend to use. All transactions will go through a secure FTP site.  
FTP Procedure to the Maine WCB
1.	Complete the Vendor Profile which can be found on the WCB website under Trading Partner Documents.
2.	Secure FTP/SSL specifications
Receiver Requirements
IP Address:	mom01.secure.maine.gov
Port:		21
Server Type:	FTP over SSL (explicit encryption)
Login Name/Password: Please contact Paul Fortier for your login name and password
Test File Naming Convention
Coverage Input File: <CTmmddyyyy.time of transmission>.  For example, if a test file is sent to the WCB on 11/18/07 at 11:45 a.m. the coverage input file will look like this: <CT11182007.1145>.  Immediately upon placing the file to your inbound directory on the WCB secure FTP site, the file is automatically moved to a trusted server and a second date is added by the WCB to indicate when the file was received from the carrier.  At that point, the file name will look like the following: <CT11182007.1145.111807>. 
Note:	The input file name must be capitalized.

Production File Naming Convention
Coverage Input File:  <CPmmddyyyy.time of transmission> For example, if a POC production file is sent to the WCB on 12/1/07 at 10:30 a.m., the file name will be: <CP12012007.1030>.  Immediately upon placing the file to your inbound directory on the WCB secure FTP site, the file is automatically moved to a trusted server and a second date is added by the WCB to indicate when the file was received from the carrier.  Following the example above, once the file is moved by the WCB from the inbound directory, the file name will now look like this: <CP12012007.1030.120107>. 
Note:	The input file name must be capitalized.
Transmission Times
The Maine WCB processes file transmissions for POC once per business day.

The processing time for production files is 8:00 a.m. Monday through Friday. 

Test files are processed at 12:30 p.m. Monday through Friday.
  
Note:  The Maine WCB does not process files over the weekend.  
Acknowledgement Reports:
For every file that is sent to the WCB, you will receive an AKP report confirming receipt of the file.  The AKP report will also contain information regarding each specific transaction record within the batch indicating whether the transaction was accepted (TA), accepted with errors (TE) or if it failed (TR).

Acknowledgement reports will be available in the outbound directory typically one hour after the process time.  

Production acknowledgement reports will have a file name in the following format: 
AKP*name of sender*date and time submitted by sender*date received by WCB.  Please note that the asterisks in the above example only indicate a new section.  There are no asterisks, spaces or dots in the AKP file name.  The AKP file name for the example production file above would look like the following: AKPLiberty12012007.1145120107

Test acknowledgement files typically will be available by 1:00 p.m. Monday through Friday.  The test AKP file name will be in the same format above with one exception.  Instead of using the sender name in the test AKP report, the word Test will be added after AKP.  To follow up the example used above for the test file name convention, the test AKP file name will look like the following: AKPTest11182007.1145111807

Note: Acknowledgement reports for batches sent Friday nights will not be available until Monday morning.

Requirements for Becoming an EDI Trading Partner
The trading partner documents must be completed and returned to the Maine WCB before testing can begin. There are two requirements for becoming an EDI Trading Partner:
1.	Complete the Trading Partner Profile and Electronic Transmission Profile
2.	Complete the Trading Partner Identification List (ID List)
These forms can be downloaded from the Maine WCB website.  Please complete the forms and e-mail them to Paul Fortier or Venessa Williams.
1.	TPP and Electronic Transmission Profile
The Maine WCB requires each sending entity to complete the Maine Electronic Trading Partner Profile and Transmission Profile.  The TPP provides pertinent information about the receiver, sender and transmission protocol.  

The Electronic Transmission Profile is a two part document.  The first part of the document contains information pertaining to the sender’s electronic transmission profile.  This document indicates how the trading partner will send data to the Maine WCB.  
The second part of the Electronic Transmission Profile contains the WCB’s information.  This part of the form contains information needed in order to address and forward your electronic transmissions to the Maine WCB.  

2.	Trading Partner ID List
All senders must fill out a Trading Partner ID List.  The form must include the sender’s FEIN, and postal code.  This information will be in the header record of every transaction.  The sender FEIN and postal code information are used to identify a valid sender of EDI information to the WCB.  Once the sender information is entered on the ID List, you must identify in the spaces provided any entities that may be sent in under the sender’s ID.  Please include the legal name of that entity, their FEIN and their type.
This list will be used to compile a table for each sender and the entities below it for the EDI edits to check against when receiving a POC record.  It is extremely important to report any changes or updates to the ID List as soon as they become effective.  If changes or updates are not reported to the WCB and a record is sent in for a FEIN that is not on the ID List, the transaction will reject.  

Information and Data Reported
Each piece of information for the electronic POC is defined as a data element.  Please refer to Section 6 of the IAIABC Coverage Release 2.1 EDI Implementation Guide for definitions of each data element.
POC Data Element Requirement Table
The Maine WCB POC Data Element Requirement Table is located on the WCB website under Coverage EDI Updates.  The table expresses the WCB’s requirements for both business and technical data.
Transaction Structure
The transaction structure is a technical identification for all transactions sent.  More detailed information on the structures can be found in the IAIABC Guide.   There is also more detailed information about triplicate codes, the three match data criteria as well as paired transactions.  Refer to Section 2 of the IAIABC Coverage Release 2.1 Implementation Guide for more information on proper transaction structure.  
Triplicate Codes 
A triplicate code is a code that identifies the type of coverage transaction that is sent to the WCB.  A triplicate code is made up of three key data elements; the Transaction Set Purpose Code (DN0300), the Transaction Set Type Code (DN0334), and the Transaction Reason Code (DN0303).  The triplicate code is found on the Insured Record (PC-1).   The following triplicate codes are currently accepted by the State of Maine WCB:

Triplicate Code	Type of Transaction	
00-05-01	Binder-w/Phys Loc	
00-05-80	Binder-No Phys Loc	
00-05-86	Binder-Employer w/o Juris Addr	
00-10-01	New Policy-w/Phys Loc	
00-10-80	New Policy-No Phys Loc	
00-10-86	New Policy-Employer w/o Juris Addr	
00-20-01	Renewal-w/Phys Location	
00-20-80	Renewal-No Phys Location	
00-20-86	Renewal-Employer w/o Juris Addr	
00-32-84	Change Insured Level data elements	
00-31-54	Add Location(s)	
00-31-87	Add Employer(s) w/no Juris Addr	
00-31-72	Add Jurisdiction -w/Phys Location	
00-31-80	Add Jurisdiction No Phys Location	
00-31-86	Add Jurisdiction-Employer w/o Juris Address	
00-33-56	Delete Location(s)	
00-33-87	Delete Employer w/o Juris Addr	
00-33-73	Delete Jurisdiction	
00-41-59	Cancel-Insurer/Non Payment	
00-41-71	Cancel-Insurer/Rewrite/Reissue	
00-41-64	Cancel-Insurer/Underwriting Reason	
00-41-69	Cancel-Insurer/Failure to Pay Deduct	
00-41-70	Cancel-Insurer/Misrep of Info on App	
00-42-60
	Cancel-Insured/Cov Placed Elsewhere	
00-42-61	Cancel-Insured/Duplicate Coverage	
00-42-63	Cancel-Insured/Business Sold	
00-42-62	Cancel-Insured/Change of Ownership	
00-42-45	Cancel-Insured/Out of Business	
00-42-01	Cancel-Insured/Reason Unknown	
00-70-01	Reinstatement	
00-50-01	Rewrite/Reissue-w/Phys Loc	
00-50-80	Rewrite/Reissue-No Phys Loc	
00-50-86	Rewrite/Reissue-Employer w/o Juris Address	

Paired Transactions
A paired transaction is a transaction in which two parts are required.  The first part of the transaction (04) will contain the information originally submitted on the policy and the second part (05) will contain the updated information being reported.  The following is a list of the paired transactions that are accepted by the Maine WCB:
Paired Transaction	Type of Transaction	
04-32-85
05-32-85	Change Employer Name, Address, 
Industry Code, # of Employees	
04-32-94
05-32-94	Change Name of Employer 
w/no jurisdiction address	
04-32-77
05-32-77	Change Employer FEIN
	
04-32-96
05-32-96	Change FEIN of Employer 
w/no jurisdiction address 	
04-32-78
05-32-78	Change Employer UI
	
04-32-95
05-32-95	Change Employer UI of 
Employer w/no jurisdiction address	
04-32-95
05-32-95	Change Employer UI of 
Employer w/no jurisdiction address 	
04-32-79
05-32-79	Change Policy Number 
	
04-32-76
04-33-76	Change Erroneous Insured FEIN
	
04-32-81
05-32-81	Change Erroneous Effective Date
	
04-32-82
05-32-82	Change Erroneous Expiration Date
	
04-32-83
05-32-83	Change Erroneous Expiration Date

Transaction Sequencing
Transaction sequencing refers to the order in which the triplicate codes must be submitted.  For example, a new binder requires that there is no previous transaction for the policy that is being submitted.  For more detailed information on transaction sequencing, please refer to Section 4 Business/Technical Process Rules of the IAIABC Implementation Guide.  
POC Data Element Conditionals and Business Rules
Business rules that apply to specific data elements are also required when the data element on the table contains the second indicator of “C” or Conditional.  There are two types of conditionals, Mandatory Conditional (MC) and Expected Conditional (EC).  The rules and specific data elements that are identified on the data element requirement table as conditional elements are below.
PC-1 Mandatory Conditional Data Element
MC data elements are mandatory data fields if the condition exists in the transaction.  To clarify what that means, look at the prior policy number below.  For the three trip codes provided, the prior policy number is a mandatory field only if there was a binder previously sent for the same insured.  

Data Element Name	Number	Condition	Trip Codes	

Prior Policy Number
	DN0324
	Mandatory if binder was previously sent for insured.
	00-10-01
00-10-80
00-10-86
	
PC-2 Mandatory Conditional Data Element
Data Element Name	Number	Condition	Trip Codes	
Employer UIAN
	DN0329	If the Employer is new to the State and/or not required to file unemployment insurance, the UIAN may not be known at the time statute requires new policy information to be sent to the WCB.*
	00-05-01
00-05-86
00-10-01
00-10-86
00-31-54
00-31-87
00-31-72
00-31-86	

Default UIAN’s
There are times when the Employer’s UIAN is required and is not known at the time the transaction needs to be submitted. Below are the two circumstances in which a default UIAN can be used.

1.	In the event that a policy needs to be submitted for a new employer and that employer has not been assigned a UIAN by the Maine Department of Labor (MDOL), a default UIAN assigned by the Maine WCB may be used.  The default UIAN to be used in such a case is 0000000002.  This is a default number and will tell the WCB that this employer has applied for, but has not yet been assigned an UIAN by the MDOL.  Once a UIAN has been assigned by the MDOL, the insurer is responsible for sending in a paired transaction using the triplicate code 04-32-78 and 05-32-78 to update the UIAN in the Maine WCB database.

2.	Some employers are exempt from paying unemployment tax and therefore, will never be assigned a permanent UIAN by the MDOL, but that employer is still required to provide workers’ compensation insurance in the state of Maine.  There are several types of exempt employment under the MDOL laws.  Please visit the MDOL website for more information and the laws pertaining to exempt employment.  The following link will take you directly to the MDOL website.  http://www.maine.gov/labor/unemployment/liabilityexemptions.html#agriculturallabor. 

In the event that a policy must be submitted to the Maine WCB for an exempt employer as stated by the MDOL law for exempt employment, the default UIAN 0000000003 can be used in the transaction.  This default number will tell the Maine WCB that the employer is exempt from paying unemployment tax in the state of Maine and no edits will be triggered requesting an UIAN from the insurer.

In all other circumstances a permanent UIAN issued by the MDOL must be submitted with any accompanying PC-2 transaction.  If the UIAN is unknown to the insurer, it is the responsibility of the insurer to obtain the correct and current UIAN from the employer/insured.  Any PC-2 transactions that do not have a valid UIAN will cause the PC-2 transaction record to reject.

POC Transaction Testing Requirements
All potential electronic transmission senders must pass testing requirements before the State of Maine WCB will accept specified EDI transmissions.  Any transmissions received from an unknown electronic sender will not be accepted, even if the transmission itself contains valid information.  The testing process consists of four steps:
1.	Pre-testing Approval
2.	Electronic Format Testing
3.	Event Testing
4.	Test Completion and Approval
1.	Pre-Testing Approval
The potential electronic filing trading partner must submit the following forms before submitting an electronic test file.  These forms can be found on the Maine WCB website.
1.	Trading Partner Profile
2.	Electronic Senders Profile
3.	Maine Electronic Senders ID List
The forms must be completed using the formats in this implementation guide as they have been customized to reflect information required by the Maine WCB.  

2.	Electronic Format Testing
The purpose of electronic format testing is to ensure proper file structure when a batch is submitted to the Maine WCB.  One transmission batch with a minimum of one PC-1 and one PC-2 record in the IAIABC Release 2.1 format will be required to validate the transmission and ensure proper file structure.  The transmission test batch must consist of at least one header and at least one PC-1, at least one PC-2 record and at least one trailer record which must pass all Maine WCB data element requirements.  The format test will validate the following items:
•	Transmission method sent
•	Header (HD1)
•	Data Element Format
•	Trailer (TR2)
•	PC-1-proper file length (585 bytes)
•	PC-2-proper file length (202 bytes)
•	Transmission method received-trading partner receipt of AKP    
•	Batch format of files sent is correct
•	Valid formatted data for all data fields
Maine will return an AKP record for each of the POC transmission test filings.  The AKP record will indicate if the transmission was successful or if it failed.  There are three statuses that can appear on the AKP record.  A TR indicates that the transaction was totally rejected.  A TE indicates that a transaction was accepted with errors and a TA indicates that the transaction was totally accepted.  If any header or PC record receives a TR status on the AKP record, it must be resubmitted until it receives either a TA or TE before moving on to the next step.  
3.	Event Testing
After the format test has been approved, the sender must initially submit a batch with at least 17 POC filings.  A minimum of three test files must be submitted.  Please refer to the table below for specific triplicate codes and quantity of each triplicate code required for event testing.  Each POC electronic submission must pass all event and data element requirements, which can be found on the WCB website under Coverage Updates.  Test submissions must consist of the following triplicate codes in the quantities specified:

Trip Code	Transaction Type	Number of Transactions	
00-10-01	New Policy-w/physical location	6	
04-32-77
05-32-77	Change Employer FEIN	1	
04-32-78
05-32-78	Change Employer UIAN	1	
04-32-79
05-32-79	Change Policy Number	1	
00-31-54	Add Location	1	
00-33-73	Delete Jurisdiction	1	
00-41-59	Cancel-Insurer/Nonpayment	1	
00-42-63	Cancel-Insured/Business Sold	1	
00-70-01	Reinstatement	1	
00-20-01	Renewal w/physical location	1	
00-41-71	Cancel Rewrite/Reissue 	1	
00-50-01	Rewrite/Reissue w/physical location	1	

In the first test file 6 new policy transactions must be submitted.  These new policy transactions will be used to test the other transaction types.  In order to test the other transaction types certain elements must be left out or invalid data must be submitted in certain elements.  In the first new policy transaction, an incorrect employer FEIN should be used.  In the second new policy transaction an incorrect employer UIAN must be used.  In the third new policy transaction, an incorrect policy number must be used.  When sending these incorrect data, please keep in mind that the employer UIAN and FEIN must be valid numbers in the Maine WCB database.  The intention is to submit a UIAN that doesn’t match the same employers FEIN and vice versa.

In the second test file, 3 change transactions to correct the incorrect data entered in the first test file must be submitted (see trip codes above).  All change transactions are paired transactions.  In the first part of the transaction, the 04, enter the information that was sent in the original transaction (i.e. incorrect FEIN, UIAN or policy number).  In the second part of the transaction, the 05, enter the changed/correct data in the fields that need to be updated.  

In the second test file, an add employer location transaction must be sent in one of the three new policies that were totally accepted from test file 1.  In a different accepted new policy transaction, send in a delete jurisdiction transaction.  The third new policy that was TA’d from the first test batch file needs to be canceled by the insurer due to non-payment.  

Please note that any transactions in the first test file that received a TR must be resubmitted and any that received a TE must be corrected in the second test file.  

The focus of the third test file will be to reinstate the policy that was canceled in the second test file.  Another cancel transaction to the policy that added an employer location must also be sent in the third test file.  The cancel transaction will be at the insured’s request because the business was sold.  A renewal policy with physical locations transaction should also be sent in the third test file.  Please renew one of the TA’d new policies that were submitted in the first test file.

The last part of the third test file is to submit a cancel rewrite/reissue transaction.  Take notice that in the table that there is a request for a cancel rewrite/reissue as well as a request for a rewrite/reissue with physical locations.  The only time that the Maine WCB will accept any rewrite/reissue policy is when there is a previous cancel rewrite/reissue transaction.  Conversely, if you send in a cancel rewrite/reissue, the next transaction must be a rewrite/reissue.  No other transaction will be accepted by the state following a cancel rewrite/reissue. When the cancel rewrite/reissue transaction is sent, the rewrite/reissue with physical locations transactions can be sent in the same test file.

Any outstanding TE’s or TR’s from the second test file must also be corrected and submitted with the third test file.  

4.	Test Completion and Approval
Once a TA is received on all POC’s submitted in the event testing, please contact Paul Fortier.  Paul will review all POC transactions submitted in the event testing and either request additional testing or approve for production.  Once approved for production, POC records may be submitted in the production environment via EDI using IAIABC Coverage Release 2.1 standards.  Please be sure to change the file name structure once approved for production from “CT” to “CP”.  

Other Information
Other useful information such as population restrictions, value table, technical rules and business scenarios can be found on the WCB website.  The Element Requirement Table, Edit Matrix and Event Table are also available on the Maine WCB website.

Glossary

Acknowledgement Record:  A transaction returned by the jurisdiction as a result of a report sent.  It contains enough data elements to identify the original transaction and any technical and business issues found with it.

Edit Matrix:  A table identifying edits to be applied to each data element.  

Element Requirement Table:  A specific list of requirement codes for each data element depending on transaction type and jurisdiction.
 
File:  A set of records containing one header record, one or more detail transactions, and one trailer record.  
 
Format:  The technical method used to exchange information.

Header:  Precedes each batch of data.  It is the first record in every batch.  It uniquely identifies the sender, receiver, the date and time the batch was prepared, whether the batch contains test or production data and the transaction types contained within the batch.  

IAIABC:  International Association of Industrial Accident Boards and Commissions is a group comprised of jurisdictions, insurance carriers, and vendors who are involved in workers’ compensation.

PC-1:  Insured Record

PC-2:  Employer Record

Production:  A trading partner is sending production data, or real claims.  The data is loaded into the jurisdiction production system.

Trading Partner:  An entity that has entered into an agreement with another entity to exchange data electronically

Trading Partner Agreement:  A set of expectations and responses between two entities exchanging data electronically.  These expectations include, but are not limited to, which transactions to send, which format to use, which data elements to include, when and where data elements are to be sent, , and testing to be performed.

Trailer:  Designates the end of a batch of transactions.  It provides a count of records and/or transactions within a batch.  The trailer record is used to ensure that the entire batch is complete and valid.

Transaction:	The communication of data that represents a single business event.  A transaction consists of at least one record.

Transmission:  Consists of one or more batches sent or received during a communication session.