State of Connecticut
Core-CT Project
Application:HRMS
Module:Human Resources
Business Process:Monitor Health & Safety/Workers Compensation
Requirement Number:HR454
Requirement Title:Ability to indicate a reoccurrence and the corresponding original claim number
Module Leads: Lina Simonu, Lisa Lagus
- Requirement Description
Describe the requirement (gap). Include a description of the delivered PeopleSoft functionality.
The State of Connecticut currently has the ability to indicate that an original claim is reoccurring. A parent Claim Number, reoccurrence checkbox, and a new wages indicator to indicate a new detailed 52 weeks of wages are needed to calculate the worker’s compensation rate, are used to indicate details of the reoccurrence. In order to identify the original claim number, the Agency HR Specialist manually reviews all of the claims filed for the employee within their agency to identify the parent Claim Number. PeopleSoft currently delivers a field on the incident page to indicate a reoccurrence but not on the claims pages. All claims will have incident details recorded for them in PeopleSoft.
- Business Need
Provide a justification for the requirement. Include information about frequency, volume, number of users impacted, etc.
A re-occurrence needs to be noted to establish if an incident is truly a reoccurrence or a new injury. It also must be noted for the TPA to manage care. The HR or Payroll Specialist need to know if an incident is a reoccurrence to decide what previous wages will be needed to calculate the rate.
- 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.
Instead of indicating the claim is a re-occurrence, the actual Original Claim Number will be indicated. This will eliminate the need for the legacy ‘Parent Claim Number’ field and the ‘Re-occurrence’ field. This will allow Agency personnel to easily identify whether a claim is a re-occurrence and provide the actual original claim number. All wages will be supplied to the TPA as of the new claim date, per requirement #HR452.
- 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 Agency HR Specialist and TPA would need to be trained to understand that if the Original Claim Number field is populated the claim is a result of a reoccurrence. The Agency HR Specialist will continue to populate the Original Claim Number as they have done for the parent Claim Number.
- Process Solutions
Describe the possible Process Solutions. Include a description of impacts and benefits of each solution.
Option 1. Use the Incident Page to identify a reoccurrence. Use the comment field on the Claims Provider page to enter the original claim number. The comments area is not a required field area therefore entering the original claim number may be missed. Also, if a query needed to be generated from the system to identify the original claim numbers, it may not be consistent, as not every Agency Specialist would remember to indicate the original claim number.
- 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): On-line
Complexity (Easy, Medium, Difficult): Easy
Description: Create a new 12 digit field to store the Original Claim Number. This field would be necessary only if a claim were to re-occur. The Agency HR Specialist would indicate the Original Claim Number on the Claims Detail page for tracking purposes. The Agency HR Specialists would need access to historical claim information to determine the original claim number in a re-occurrence situation. The process for supplying 52 weeks of salary information to the TPA is being addressed through requirement HR452, and will meet this requirement to capture new wage information for a reoccurrence.
1 of 111/12/18