HR467 Ability to Interface TPA with PS

State of Connecticut

Core-CT Project

Application:HRMS

Module:Human Resources

Business Process:Monitor Health and Safety / Worker’s Compensation

Requirement Number:HR467

Requirement Title:Ability to send worker’s comp information from the Third Party Administrator to PeopleSoft

Module Leads: Lina Simonu, Lisa Lagus

1. Requirement Description

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

The State of Connecticut currently uses the Third Party Administrator staff to accept incident reports phoned in. Currently, the TPA staff enters this initial information into AWCS. Claim notes and other claim information is also recorded in AWCS by the TPA. Medical claim information is stored on the TPA’s system. In addition, the TPA sends the financial disbursement information made by the TPA on behalf of the State to AWCS in report form and for storage on-line in AWCS. PeopleSoft as delivered, has the ability to store medical costs and comments, however, actual payments made to employees are not delivered in the Health and Safety module. In addition, there is not a delivered interface to receive this information from the TPA.

1. Business Need

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

The worker’s comp call is recorded in the TPA system but the claim id and all claim data are assigned and recorded in PeopleSoft. This information must either be entered in both the TPA and PeopleSoft systems or transmitted through an interface.

1. Required By: (Y/N)

Federal ___Agency _Y__Bargaining Unit __

State Statutory State Regulatory ____State Procedural __Y__

1. Requirement Priority

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

1. Recommended Solution

Enter an “X” next to the appropriate category

___X__Process Solution

_1_Option Number

______Application Modification

___Option Number

1. Explanation for Recommendation

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

The State and TPA will maintain their current process as long as they have access to PeopleSoft and may enter and assign the claim number directly in PeopleSoft. Because the financial disbursement information is for auditing purposes only, the information will exist in the TPA system and could be accessed by all agencies there. All agencies will now have access to the TPA system, with the new TPA to review this information online, therefore storing this information in PeopleSoft would duplicate the TPA’s efforts.

1. 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 will need to be trained to use PeopleSoft’s Monitor Health and Safety module in order to enter Worker’s Compensation Claims. In addition, the TPA will need to notify the Agency that a new claim has been filed. Agency HR Specialists and /or Payroll Specialist will need to review actual financial disbursement information on the TPA system or through a report provided by the TPA.

1. Process Solutions

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

Option 1. Continue the current process in which the TPA enters the claim and incident directly into PeopleSoft. The TPA would be responsible for notifying the Agency Health & Safety specialist that the claim had been filed.

Option 2. Establish a change in the State work flow involving the initial call-in. The TPA could e-mail the information reported on the call-in. Medical information and claim notes could be also be shared via e-mail. The claim entry would be originate in PeopleSoft where the Claim and Incident numbers could be assigned.

Option 3.

1. 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 load claim and medical information from the TPA to PeopleSoft. If a new claim was being transmitted by the TPA to PeopleSoft, the Claim Number and Incident Number in PeopleSoft would need to be assigned through the program. If an existing claim and incident number are found, the information in the file is loaded to the appropriate record. The file should include claim details including PeopleSoft employee id, name, claim number, incident number, effective date, comments, medical charges, and the calculated claim rate. The TPA will calculate the rate based on the information sent by the custom PeopleSoft interface identified in Requirement #HR453. If the calculated TPA and PeopleSoft worker’s compensation rate’s do not match an error file should be produced indicating that fact. The details of what is sent is being determined as the State of Connecticut has recently contracted with a new TPA, GAB Robins, and the final layouts have not been determined. Financial Disbursements would continue to be sent and not loaded into PeopleSoft, but stored in a file format, should they need to be reviewed. Otherwise, the TPA would be responsible for supplying each agency with a report with the information, as the current TPA does today.

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