1. Workers’ Compensation Automation and Integration System WCAIS: Delivering the Standard of Excellence to the Pennsylvania Workers’ Compensation Community 2013 Annual Workers’ Compensation Conference

2. Workers’ Compensation Automation and Integration System WCAIS is a Web-based information system integrating the business functions of three Labor & Industry program areas: Bureau of Workers’ Compensation (BWC) Workers’ Compensation Office of Adjudication (WCOA) Workers’ Compensation Appeal Board (WCAB)

3. Workers’ Compensation Automation and Integration System Release 1 went live on Sept. 17, 2012, at www.wcais.pa.gov As of that date, parties could perform the following functions: Self-registration Dashboard File an appeal File a WCAB petition Contact HelpLine online

4. Workers’ Compensation Automation and Integration System Release 2 will go live in September 2013 At that point, parties will be able to perform the following functions: Access claim information and download records File SFR applications online Review your hearing and mediation schedules Review claim summaries and evidence Review WCJ decisions and correspondence online File WCOA petitions and answers File briefs, requests and correspondence

5. Workers’ Compensation Automation and Integration System Integrated Workers’ Compensation System BWC WCOA WCAB Web-based application All program areas and external workers’ compensation community connect via Internet Around-the-clock access to WCAIS Designed to deliver Best experience in usability Fewer clicks during navigation Embedded tools into the application Ability to share data with other users WCAIS System

6. Workers’ Compensation Automation and Integration System WCAIS Key Features and Benefits Eliminates Paper Integrates Program Areas Business Process Improvements 24/7 Online Access for Workers’ Compensation Community Improved Reporting Capabilities Accessibility, Reports, Workflow WCAIS Workflow/Task Generation Automates Manual Processes

7. Workers’ Compensation Automation and Integration System WCAIS Home Page

8. Workers’ Compensation Automation and Integration System

10. Dashboard

11. Workers’ Compensation Automation and Integration System The alerts section displays messages to the users set by the commonwealth staff. For example, the system is going to be down for maintenance or WCAB hearings have been cancelled due to inclement weather The correspondence section displays any correspondence sent by the Commonwealth to the logged in user. The electronic correspondence is received in lieu of paper if that preference is set by the user. The dashboard widgets can be customized by the logged-in user. The user can choose to see a summary of his/her claims, disputes, appeals or WCAB petitions The “My Appeals” widget displays a summary of all appeals that the logged-in user is an interested party to. The user can select the appeal number and the system will display the summary for the selected appeal.

12. Workers’ Compensation Automation and Integration System WCAB Process Flow Submit and review appeals and WCAB petitions Conduct hearings and assign commissioners Receive and review requests Circulate and publish opinions Interested parties file appeals and WCAB petitions online or in the mail WCAB staff reviews and processes the submitted appeal or WCAB petition WCAIS schedules the appeal and/or WCAB petition for a hearing WCAB Commissioners conduct hearings and document notes WCAIS assigns a commissioner based on who was at the hearing Interested parties submit requests online or in the mail WCAB Staff review and process the requests WCAB commissioners/ opinion writers draft the opinion The opinion is circulated to the reviewing WCAB commissioners for voting WCAIS publishes the majority opinion to interested parties and the publishing company Key Commonwealth staff WC community WCAIS

13. Workers’ Compensation Automation and Integration System HelpLine Process Flow Submit HelpLine tickets Process and manage HelpLine tickets Process and manage HelpLine tickets Member of worker’s compensation community submits a inquiry online or calls the HelpLine BWC HelpLine staff reviews the inquiry/issue WCAIS generates a ticket reference BWC HelpLine staff updates the ticket with a response to the inquiry/issue Member of worker’s compensation community reviews the updated tickets and resolutions online Key Commonwealth staff WC community WCAIS

14. Workers’ Compensation Automation and Integration System EDI Overview EDI = Electronic Data Interchange Exchange of information in a standard format between computers without any human intermediary Standardized business practices which permit the flow of information between organizations with limited or no human intervention System-to-system communications EDI is an electronic way of sending information that is currently being sent by paper to BWC Determines if the incoming transaction will create a new claim or update an existing claim

15. Workers’ Compensation Automation and Integration System EDI will be used to report ALL claim events, however, the following forms continue to be required to be sent, by upload or mail, to BWC: Agreement for Compensation for Disability or Permanent Injury LIBC-336 Supplemental Agreement for Compensation for Disability or Permanent Injury LIBC-337 Agreement for Compensation for Death LIBC-338 Supplemental Agreement for Compensation for Death LIBC-339 Agreement to Stop Weekly Workers’ Compensation Payments (Final Receipt) LIBC-340 Third Party Settlement LIBC-380 Statement of Wages LIBC-494 A/C Notice of Compensation Payable LIBC-495 Notice of Workers’ Compensation Denial LIBC-496 Notice of Temporary Compensation Payable LIBC-501 Notice Stopping Temporary Compensation LIBC-502 Notification of Suspension or Modification LIBC-751

16. Workers’ Compensation Automation and Integration System Claims Process Flow Submit FROI and SROI data Submit and review agreements Submission and review of OD petitions and SFR applications Processing payments/ reimbursements ACSR and 21 day compliance Submit and process record requests Insurers and TPAs submit FROI and SROI data through EDI or the WCAIS Web portal WCAIS updates claim and interested party data and sends the acknowledgment back to the Insurer or TPA Insurers and defendant/ employers review claim data and upload agreements for specific claims BWC Staff reviews claim data and approves the uploaded agreements WCAIS provides an integrated view of all claim information Insurers, TPAs and attorneys submit SFR applications online and claimants submit petitions online or by mail BWC RAEO clerk and OCC staff reviews OD Petitions and makes determinations on payments BWC RAEO SFR and OCC staff reviews SFR applications and makes determinations on reimbursements BWC RAEO staff processes payments/ reimbursements for OD, fatal OD, subsequent injury, SFR, 305.1 and 306(h) WCAIS processes payrolls/reimbursem ents to insurers and claimants and /or attorney WCAIS runs a batch process to generate the quarterly 21-Day Compliance Report, which is posted on the insurer profile WCAIS runs a batch process to generate the yearly ACSR Report, which is posted on the insurer profile Member of worker’s compensation community submits a records request by mail or fax WCAIS provides the list of possible claim documents for staff to select from BWC records staff processes the record requests Key Commonwealth staff WC community WCAIS

17. Workers’ Compensation Automation and Integration System View Claim information

18. Workers’ Compensation Automation and Integration System The “Claim Summary” screen is a one-stop place for interested parties to view all claim information, and any related disputes, appeals, health care services requests, payments, SFR applications, EDI transaction information, and documents and correspondences for the claim

19. Workers’ Compensation Automation and Integration System Health care Services Process Flow Submit medical fee reviews Apply to be a utilization review organization Submit request for utilization review Apply to be an impairment rating evaluation physician Submit request for impairment rating evaluation Health care providers submit a request for a medical fee review online or in the mail WCAIS completes the fee review calculations BWC health care staff reviews and approves / denies the medical fee review request Organizations apply to become a utilization review organization (URO) online BWC health care staff reviews and approves / denies the request Insurers submit a request for a utilization review online or in the mail WCAIS assigns the request to a URO The assigned URO submits their determination for the utilization review online Key Commonwealth staff WC community WCAIS Physicians apply to become an impairment rating evaluation (IRE) physician online BWC health care staff reviews and approves / denies the request Insurers submit a request for an impairment rating evaluation of a claimant/ employee online or in the mail WCAIS assigns an IRE physician to the request The assigned IRE physician submits their determination of the claimant/ employee online

20. Workers’ Compensation Automation and Integration System Self Insurance Process Flow Submit and review self-insurance applications Submit security documents Submit and review group fund applications Insurers submit annual assessments Defendant/employers submit an application for initial SI status/renewal online WCAIS processes the application and creates the SI program BWC SI staff members review the application and issue a determination Self-insured employers submit security documents BWC SI financial analyst reviews security documents and enters data into WCAIS Key Commonwealth staff WC community WCAIS Group fund applicant submits group fund application WCAIS processes the application and creates the SI program BWC SI staff reviews the application and issues a determination Self-insured employers and insurers submit yearly assessment data online or in the mail WCAIS calculates the annual assessment amounts and sends the assessment notice to insurers and self-insured employers BWC assessment staff reviews the assessment data and makes adjustments where needed

21. Workers’ Compensation Automation and Integration System Compliance Process Flow Submit certificate of insurance Perform insurance Investigations Perform fee review and child labor investigations Submit and review exceptions Defendant/ employers submit their certificate of insurance online WCAIS receives insurance coverage and defendant/employer data from the PCRB and UCTS BWC compliance staff creates a compliance case against a defendant/employer The BWC compliance investigator completes the investigation on the defendant/employer The BWC compliance investigator/ manager/ OCC staff performs investigations for fee review and child labor Defendant/ employers submit exceptions online or in the mail BWC compliance staff reviews the submitted exception and approves/rejects the request Key Commonwealth staff WC community WCAIS

22. Workers’ Compensation Automation and Integration System WCOA Process Flow Receive and process petitions Schedule and conduct events Receive and process requests Receive and process exhibits Manage brief schedules and receive briefs Create and issue decisions Interested parties submit petitions online or in the mail WCOA petitions staff reviews and processes the petition WCAIS assigns a judge and creates the dispute WCOA judge secretaries schedule and reschedule all event types WCOA judges conduct events and capture notes WCOA field office staff document scheduled interpreters and court reporters Interested parties submit requests online or in the mail WCOA judge secretaries/ judges review and process requests Key Commonwealth staff WC community WCAIS Interested parties submit exhibits online, in person or in the mail WCOA judge secretaries/ judges enter the exhibits into WCAIS WCAIS maintains the electronic case file that is accessible to WCOA staff and interested parties Judge secretaries/ judges set brief schedules in WCAIS Interested parties submit briefs online, in person or in the mail WCAIS determines when the dispute is moved to “Waiting for Decision” based on the brief schedule Judge secretaries and clerk typist’s create the decision document Judges review and approve the decision for circulation WCAIS circulates the approved judge’s decision

23. Workers’ Compensation Automation and Integration System View Dispute Summary

24. Workers’ Compensation Automation and Integration System The dispute summary provides details to a selected dispute on a claim. The user can view submitted petitions and file answers. The user can view information for past and upcoming hearings and mediations, view and submit requests, view and submit exhibits, view the list of witnesses, view the brief schedule set by the judge and submit a brief, view circulated decisions and view any submitted documents or correspondence related to the dispute.

25. Workers’ Compensation Automation and Integration System Together, we will set the standard of excellence in service to the Pennsylvania workers’ compensation community

26. Workers’ Compensation Automation and Integration System To register to use WCAIS, go to www.wcais.pa.govwww.wcais.pa.gov For more information about WCAIS: Visit the WCAIS project website at www.dli.state.pa.us/WCAISwww.dli.state.pa.us/WCAIS Email the project team at RA-LI-PA-WCAIS-UP@pa.gov