HR452 Ability to Send File from PS to TPA

State of Connecticut

Core-CT Project

Application:HRMS

Module:Human Resources

Business Process:Monitor Health & Safety/Workers Compensation

Requirement Number:HR452

Requirement Title:Ability to send claim and incident Data, payroll data, and TL data to the TPA from PeopleSoft

Module Leads: Lina Simonu, Lisa Lagus

Requirement Description

Describe the requirement (gap). Include a description of the delivered PeopleSoft functionality.

The State of Connecticut processes Worker’s Compensation Claims through a Third Party Administrator, TPA. Currently, a custom State of Connecticut worker’s compensation system, AWCS, exists to store claim and incident data information for State of Connecticut employees. The current TPA has access to record claims directly into the AWCS system 24 hours a day, 7 days a week and enters claim and incident information based on a phone call from an Agency Supervisor. PeopleSoft includes a Health and Safety module that has the ability to record claim and incident information. The Agency HR Specialist would have the responsibility of entering this information following notification of an incident from the Agency Supervisor. This information needs to be sent to the TPA in order for them to begin processing the claim. In addition, as changes occur to an employee within the system that would impact their pay, such as an annual increase, the information is transmitted to the TPA. PeopleSoft does not have a delivered interface to send worker’s compensation claim and incident data to a third party system.

Business Need

Provide a justification for the requirement. Include information about frequency, volume, number of users impacted, etc.

Worker’s compensation information needs to be sent to a third party administrator on a timely basis in order for them to begin processing the claim. The claim number must contractually be assigned by the State of Connecticut. In addition the type of claim is required, as all claims must be reported to the third party in the event that they may eventually result in a medical or lost time claim. The Detailed Gross pay for the last 52 weeks since the claim date and the Calculated Average Gross pay for eligible earnings codes for the last 52 weeks since the claim date must be sent in order for the TPA to determine the rate of worker’s compensation pay to award the employee if the claim is approved. The Worker’s Compensation Tax Filing Status and Exemptions are also required in calculating the rate. And finally, in order for the TPA to calculate the reimbursement amount (First Check) for the Agency that continues to pay the employee while the claim is being settled, they must know the actual amount paid to the employee during that period through the reported time in Time and Labor. The sum of hours, amount and Time Reporting Codes reported through time and labor using worker’s compensation codes or leave codes as of the claim date will provide that information.

Required By: (Y/N)

Federal ____Agency ____Bargaining Unit __

State Statutory ____State Regulatory ____State Procedural __Y__

Requirement Priority

Medium(High, Medium, Low – please see “Requirements Prioritization Criteria”)

Recommended Solution

Enter an “X” next to the appropriate category

______Process Solution

___Option Number

___X__Application Modification

_1_Option Number

Explanation for Recommendation

Provide reasons for recommendation. Please do not re-state the description of the solution itself.

Because the State of Connecticut has contracted out the payment of Worker’s Compensation payments, the TPA must have all of the appropriate employee claim and incident details, payroll data, and time and labor information to accurately determine the worker’s compensation payment and settle the claim.

Organizational Impact of Recommendation

Describe the changes to the organization that result from the recommended solution. Include a description of any role, process, statute, or bargaining unit agreement affected.

The TPA would no longer have access to the State’s Worker’s Compensation system AWCS or PeopleSoft. The Agency HR Specialist would be responsible for recording all of the claim and incident details in a timely manner. The Supervisor contacting the TPA of the incident and claim initially would also need to ensure that the Agency HR Specialist is also aware of the incident and claim in order to ensure the claim is recorded to begin processing the claim.

Process Solutions

Describe the possible Process Solutions. Include a description of impacts and benefits of each solution.

Option 1. None identified.

Application Modifications

Describe the possible Application Modifications. Include a description of impacts and benefits of each solution.

Option 1.

Modification Type (On-line, Batch, Interface, Report, Workflow): Interface

Complexity (Easy, Medium, Difficult): Difficult

Description: Create an interface that would contain Claim Data and Incident Data from the PeopleSoft Health and Safety module to the TPA on a periodic basis for new or updated claims. The interface should contain the claim number and incident number and details about the claim including the following:

- The type of claim (lost time, medical, report only).

- Detailed Gross pay for the last 52 weeks since the claim date.

- The Calculated Average Gross pay for eligible earnings codes for the last 52 weeks since the claim date.

- Worker’s Compensation Tax Filing Status and Exemptions.

- Sum of hours, amount and Time Reporting Code reported through time and labor using worker’s compensation codes or leave codes as of the claim date.

- Calculated Worker’s Compensation Rate, or modified rate if the employee is receiving a claim type of 100% and has received a pay rate change such as an annual increase.

Option 2.

Modification Type (On-line, Batch, Interface, Report, Workflow: Batch & Interface

Complexity (Easy, Medium, Difficult): Medium/ Difficult

Description: Create a batch program that would load claim and incident data from TPA into PeopleSoft. The claim number and incident number would be assigned at this time in PeopleSoft. Updates to claim and incident information would need to be sent back to the TPA with additional employee payroll and time and labor information through a second interface from PeopleSoft to TPA on a periodic basis. The interface should contain the claim number and incident number and details about the claim including the following: