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(continued)
Note: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.
s 8613. Cable Fault Locating and Testing.
(a) Employees involved in using high voltages to locate trouble or test cables shall be instructed in the precautions necessary for their own safety, and the safety of other employees.
(b) Before the voltage is applied, cable conductors shall be isolated. Employees shall be warned, by such techniques as briefing and tagging at all affected locations, to stay clear while the voltage is applied.
Note: Authority and reference cited: Section 142.3, Labor Code.
s 8614. Grounding for Employee Protection -Pole Lines.
(a) Power Conductors. Electric power conductors and equipment shall be considered as energized unless the employee can visually determine that they are bonded to one of the grounds listed in Subsection (d) of this Section.
(b) Nonworking Open Wire. Nonworking open wire communications lines shall be bonded to one of the grounds listed in Subsection (d) of this Section.
(c) Vertical Power Conduit, Power Ground Wires and Street Light Fixtures.
(1) Metal power conduit, exposed vertical power ground wires, and street light fixtures which are below communications attachments or less than 20 inches above these attachments, shall be considered energized and shall be tested for voltage unless the employee can visually determine that they are bonded to the communications suspension strand or cable sheath.
(2) If no hazardous voltage is shown by the voltage test, a temporary bond shall be placed between such street light fixture, exposed vertical power grounding conductor, or metallic power conduit and the communications cable strand. Temporary bonds used for this purpose shall have sufficient conductivity to carry at least 500 amperes for a period of one second without fusing.
(d) Suitable Protective Grounding. Acceptable grounds for protective grounding are as follows:
(1) A vertical ground wire which has been tested, found safe, and is connected to a power system multigrounded neutral or the grounded neutral of a power secondary system where there are at least three services connected;
(2) Communications cable sheath or shield and its supporting strand where the sheath or shield is:
(A) Bonded to an underground or buried cable which is connected to a central office ground, or
(B) Bonded to an underground metallic piping system, or,
(C) Bonded to a power system multigrounded neutral or grounded neutral of a power secondary system which has at least three services connected;
(3) Guys which are bonded to the grounds specified in Subsection (d)(1) and (2) of this Section and which have continuity uninterrupted by an insulator; and
(4) If all of the preceding grounds are not available, arrays of driven ground rods where the resultant resistance to ground will be low enough to eliminate danger to personnel or permit prompt operation of protective devices.
(e) Attaching and Removing Temporary Bonds. When attaching grounds (bonds), the first attachment shall be made to the protective ground. When removing bonds, the connection to the line or equipment shall be removed first. Insulating gloves shall be worn during these operations.
(f) Temporary Grounding of Suspension Strand.
(1) The suspension strand shall be grounded to the existing grounds listed in Subsection (d) of this Section when being placed on jointly used poles and while performing work during thunderstorms.
(2) Where unsupported power crossings are encountered, the strand shall be bonded to an existing ground listed in Subsection (d) of this Section as close as possible to the crossing. This bonding is not required where crossings are made on a common crossing pole unless there is an upward change in grade at the pole. (Tie-down stress on the strand.) In this case, the bonding shall be at an adjacent pole.
(3) Where roller-type bonds are used, they shall be restrained so as to avoid stressing the electrical connections.
(4) Bonds between the suspension strand and the existing ground shall be at least No. 6 AWG copper.
(5) Temporary bonds shall be left in place until the strand has been tensioned, dead-ended, and permanently grounded.
Exception: The installation of insulated strand.
(g) Antenna Work-Radio Transmitting Stations 3-30 MHZ.
(1) Prior to grounding a radio transmitting station antenna, the employer shall ensure that the person in charge:
(A) Prepares and signs a danger tag,
(B) Requests the transmitting technician to shut down the transmitter and to ground the antenna with its grounding switch,
(C) Is notified by the transmitting technician that the transmitter has been shut down, and
(D) Tags the antenna ground switch personally in the presence of the transmitting technician after the antenna has been grounded by the transmitting technician.
(2) Power shall not be applied to the antenna, nor shall the grounding switch be opened under any circumstances while the tag is affixed.
(A) Where no grounding switches are provided, grounding sticks shall be used, one on each side of line, and tags shall be placed on the grounding sticks, antenna switch, or plate power switch in a conspicuous place.
(B) When necessary to further reduce excessive radio frequency pickup, ground sticks or short circuits shall be placed directly on the transmission lines near the transmitter in addition to the regular grounding switches.
(C) In other cases, the antenna lines may be disconnected from ground and the transmitter to reduce pickup at the point in the field.
(3) All radio frequency line wires shall be tested for pickup with an insulated probe before they are handled either with bare hands or with metal tools.
(4) The employer shall require that the transmitting technician warn the riggers about adjacent lines which are, or may become, energized.
(5) The employer shall require that when antenna work has been completed, the person in charge of the job returns to the transmitter, notifies the transmitting technician in charge that work has been completed, and personally removes the tag(s) previously attached.
Note: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.
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s 8615. Overhead Lines.
(a) Handling Suspension Strand.
(1) The employer shall ensure that when handling cable suspension strand which is being installed on poles carrying exposed energized power conductors, employees shall wear insulating gloves and shall avoid body contact with the strand until after it has been tensioned, dead-ended and permanently grounded.
(2) The strand shall be restrained against inadvertent upward movement during installation:
(A) On joint-use poles, where there is an upward change in grade at the pole, and
(B) On non-joint-use poles, where the line crosses under energized power conductors.
(b) Need for Testing Wood Poles.
Unless temporary guys or braces are attached, the following poles shall be tested in accordance with Subsection (c) of this Section and determined to be safe before employees are permitted to climb them:
(1) Dead-end poles, except properly braced or guyed "Y" or "T" cable junction poles,
(2) Straight line poles which are not storm guyed and where adjacent span lengths exceed 165 feet.
(3) Poles at which there is a downward change in grade and which are not guyed or braced corner poles or cable junction poles.
(4) Poles which support only telephone drop wire, and
(5) Poles which carry less than ten communication line wires. On joint-use poles, one power line wire shall be considered as two communication wires for purposes of this subsection.
(6) Poles at which the cable strand or guy tension is to be changed.
(c) Pole Inspection and Tests.
(1) Employers shall establish an effective written pole inspection and testing program and all involved employees shall be trained therein.
(2) Prior to climbing erected poles or other elevated structures intended to support overhead lines or equipment, a qualified person(s) shall conduct inspections and tests as required by Section 8615(b) to assure that such poles or structures are in safe condition for the work to be performed.
(3) Where poles or structures are determined to be unsafe for climbing, they shall be marked and not be climbed until made safe by guying, bracing, or other adequate means.
(d) Test Requirements for Cable Suspension Strand.
(1) Before attaching a splicing platform to a cable suspension strand, the strand shall be tested and determined to have strength sufficient to support the weight of the platform and the employee. Where the strand crosses above power conductors or railroad tracks it may not be tested but shall be inspected in accordance with Subsection (f) of this Section.
(2) The following method or an equivalent method shall be used for testing the strength of the strand: A rope, at least 3/8-inch in diameter, shall be thrown over the strand. On joint lines, the rope shall be passed over the strand using tree pruner handles or a wire raising tool. If two employees are present, both shall grip the double rope and slowly transfer their entire weight to the rope and attempt to raise themselves off the ground. If only one employee is present, one end of the rope which has been passed over the strand shall be tied to the bumper of the truck, or other equally secure anchorage. The employee then shall grasp the other end of the rope and attempt to raise off the ground.
(e) Inspection of Strand. Where strand passes over electric power conductors or railroad tracks, it shall be inspected from an elevated working position at each pole supporting the span in question. The strand shall not be used to support any splicing platform, scaffold or cable car, if any of the following conditions exist:
(1) Corrosion so that no galvanizing can be detected,
(2) One or more wires of the strand are broken,
(3) Worn spots, or
(4) Burn marks such as those caused by contact with electric power conductors.
(f)(1) Elevated Work Platforms. Unless standard railings meeting the requirements of Section 3209 of the General Industry Safety Orders are provided, personal fall protection devices as specified in subsection (g) shall be used while working on elevated work platforms including aerial splicing platforms, pole platforms, ladder platforms, pole balconies and pole seats.
(2) Ladder Platform. A ladder platform shall consist of a supporting surface not less than 9 inches by 18 inches. The rear edge of the platform and the support member shall be equipped to lock the platform to the ladder rungs.
(3) Pole Platform. A pole platform shall consist of a supporting surface not less than 10 inches by 40 inches equipped at one end with a hinged chain binder for securing the platform to a pole. A brace shall be provided from the pole to the underside of the platform.
(4) Splicing Platform. An aerial splicing platform shall consist of a supporting surface approximately 3 feet by 4 feet furnished with fiber or synthetic ropes for suspending the platform, detachable guy ropes for anchoring it, and a device for raising and lowering it with a handline.
(g) Fall Protection. When work is performed at elevated locations more than 4 feet (1.2 meters) above ground on poles, towers or similar structures, the employer shall require the employees to use either fall arrest equipment, work positioning equipment, or travel restricting equipment, if other fall protection methods have not been provided (e.g., guardrails, safety nets, etc.). The use of body belts for fall arrest systems is prohibited.
Exception: Point to point travel by a qualified person, unless conditions such as ice, high winds (as defined in Section 2951(f) of the High Voltage Electrical Safety Orders), design of the structure, or other conditions (e.g., chemical contaminants) prevent the employee from gaining a firm hand or foothold while traveling.
(h) Installing and Removing Wire and Cable. Before installing or removing wire or cable, the pole or structure shall be guyed, braced, or otherwise supported, as necessary, to prevent failure of the pole or structure.
(i) Handling Poles Near Energized High-Voltage Conductors and Equipment. Except qualified electrical workers complying with Article 36 of High-Voltage Electrical Safety Orders:
(1) Joint-use poles shall not be set, moved, or removed where the nominal voltage of open electrical power conductors exceeds 34.5kV phase to phase (20kV to ground).
(2) In joint lines where the power voltage is greater than 600 volts but less than 34.5kV phase to phase (20kV to ground), poles being placed, moved, or removed shall be insulated with either a rubber insulating blanket, a fiberglass box guide, or equivalent protective equipment. Work procedures shall be developed and employed to minimize the possibility of the pole and the protective equipment from contacting the power conductors. The guard or insulating material used to protect the pole shall meet the appropriate 3- minute proof test voltage requirements contained in the ASTM-D-1048-1981, which are hereby incorporated by reference.
(3) Where poles are being removed, insulation of the pole is not required if the pole is cut off 2 feet or more below the lowest power conductor and also cut off near the ground line.
(4) Suitable insulating gloves shall be worn when handling the pole with either hands or tools, when there exists a possibility that the pole may contact an energized high-voltage conductor.
(5) During pole handling operations, employees standing on the ground shall not be permitted to step onto or contact equipment or machinery while working near energized high-voltage conductors or equipment unless the employees are using suitable protective equipment for the voltages involved.
(j) Metal Tapes and Ropes.
(1) Metal measuring tapes, metal measuring ropes, or tapes containing conductive strands shall not be used when working near exposed energized parts.
(2) Where it is necessary to measure clearances from energized parts, only nonconductive devices shall be used.
Note: Authority cited: Section 142.3, Labor Code. Reference: Section 142.3, Labor Code.
s 8616. Underground Lines.
The provisions of this section apply to the guarding of manholes and street openings, and to the ventilation and testing for gas in manholes and unvented vaults, where telecommunications field work is performed on or with underground lines.
(a) Guarding Manholes and Street Openings.
(1) When covers of manholes or vaults are removed, the opening shall be promptly guarded by a railing, temporary cover, or other suitable temporary barrier which is appropriate to prevent an accidental fall through the opening and to protect employees working in the manhole from foreign objects entering the manhole.
(2) While work is being performed in the manhole, a person with basic first-aid training shall be immediately available to render assistance if there is cause for believing that a hazard exists, and if the requirements contained in Section 8604(a) and Subsection (a)(1) of this Section do not adequately protect the employee(s). Examples of manhole worksite hazards which shall be considered to constitute a hazard include, but are not limited to:
(A) Manhole worksites where hazards are created by traffic patterns that cannot be corrected by provisions of Section 8604(a) and Section 8616(a)(1).
(B) Manhole worksites that are subject to unusual water hazards that cannot be abated by conventional means.
(C) Manhole worksites that are occupied jointly with power utilities as described in Subsection (c) of this Section.
(D) Where combustible or explosive gas vapors have been initially detected at an explosive level.
(E) Where toxic or otherwise hazardous substances are used in such quantities that the work operations or inadvertent spills would create unsafe airborne concentrations or other bodily injury exposures.
(F) Where open flame torches are used in the work procedure.
(G) Where hazardous substances: -i.e. pesticides, herbicides, etc. are encountered.
(H) When employees are required to perform extended night work in manholes, except where constant voice communication is maintained with other person(s) who can render ready assistance. This shall not prohibit performing emergency trouble work without assistance providing the work can be performed safely.
(b) Requirements Prior to Entering Manholes and Unvented Vaults.
(1) Before an employee enters a manhole or unvented vault, the following steps shall be taken:
(A) The employer shall determine that a confined space condition as defined in General Industry Safety Orders Article 108 is non-existent. If a confined space condition exists, the requirements of Article 108 shall be followed. Otherwise, the requirements set forth herein shall be followed.
(B) The internal atmosphere shall be tested for combustible gas and, except when continuous forced ventilation is provided, the atmosphere shall also be tested for oxygen deficiency.
(C) When unsafe conditions are detected by testing or other means, the work area shall be ventilated by mechanical means and otherwise made safe before entry.
(2) An adequate continuous supply of air shall be provided while work is performed in unvented vaults and manholes under any of the following conditions:
(A) Where combustible or explosive gas vapors have been initially detected and subsequently reduced to a safe level by ventilation,
(B) Where organic solvents are used in the work procedure,
(C) Where open flame torches are used in the work procedure,
(D) Where the manhole or vault is located in that portion of a public right-of-way open to vehicular traffic and/or exposed to a seepage of gas or gases, or
(E) Where a toxic gas or oxygen deficiency is found.
Exception: Work in central office cable vaults that are adequately ventilated.
(c) Manhole Platform. A manhole platform shall consist of nominal 2-inch by 12- inch lumber of a grade no less than that of a "Structural Plank" as defined (see Lumber) in Section 1504 "Definition" of the Construction Safety Orders, or other nonconductive material of equal strength.
(d) Joint Power and Telecommunication Manholes. While work is being performed in a manhole occupied jointly by an electric utility and a telecommunication utility, an employee with basic first-aid training shall be available in the immediate vicinity to render emergency assistance as may be required. The employee whose presence is required in the immediate vicinity for the purposes of rendering emergency assistance is not to be precluded from occasionally entering a manhole to provide assistance other than in an emergency.
(e) Ladders. Metal ladders having non-skid rungs, wooden ladders or portable reinforced plastic ladders shall be used to enter and exit manholes exceeding 4 feet in depth.
(f) Flames. When open flames are used in manholes, the following precautions shall be taken to protect against the accumulation of combustible gas:
(1) A test for combustible gas shall be made immediately before using the open flame device, and at least once per hour while using the device; and
(2) A fuel tank (e.g., acetylene) may not be in the manhole unless in actual use.
Note: Authority and reference cited: Section 142.3, Labor Code.
s 8617. Eye Protection.
(a) Microwave. Employers shall require that employees do not look into an open waveguide which is connected to an energized source of microwave radiation.
(b) Fiber Optics. Employers shall require that employees do not look:
(1) Into the beam of an operating laser diode beam, or
(2) Into the end of an optical fiber emitting sufficient energy to cause damage to the eye.
Note: Authority and reference cited: Section 142.3, Labor Code.
s 8618. Microwave Transmission.
(a) Hazardous Area. Accessible areas associated with microwave communication systems where the electromagnetic radiation level exceeds the radiation exposure limits given in Section 5085 of the General Industry Safety Orders shall be posted as described in that Section. The lower half of the warning symbol shall include the following:
Radiation in this area may exceed hazard limitations and special precautions are required. Obtain specific instruction before entering.
(b) Protective Measures. When an employee works in an area where the electromagnetic radiation exceeds the radiation protection guide, the employer shall institute measures that ensure that the employee's exposure is not greater than that permitted by the radiation guide. Such measures shall include, but not be limited to, those of an administrative or engineering nature or those involving personal protective equipment.
Note: Authority and reference cited: Section 142.3, Labor Code.
Note: Authority cited: Sections 123, 123.5, 123.6 and 133, Labor Code. Reference: Chapters 402 and 414, Statutes of 1980.
s 9700. Authority.
This article is adopted to implement the Workers' Compensation Information System mandated by Sections 138.6 and 138.7 of the Labor Code.
Note: Authority cited: Sections 133, 138.6 and 138.7, Labor Code. Reference: Sections 138.6 and 138.7, Labor Code.
s 9701. Definitions.
(a) The following definitions apply in this article:
Bona Fide Statistical Research. The analysis of existing workers' compensation data for the purpose of developing or contributing to basic knowledge regarding the California workers' compensation system.
California EDI Implementation Guide for First and Subsequent Reports of Injury. California EDI Implementation Guide, Version 2.1, dated February 2006, contains California specific reporting requirements and information excerpted from the IAIABC EDI Implementation Guide for First, Subsequent, Acknowledgment Detail, Header & Trailer Records, Release 1, issued February 15, 2002, by the International Association of Industrial Accident Boards and Commissions. The California EDI Implementation Guide for First and Subsequent Reports of Injury, Version 2.1, dated February 2006, is posted on the Division's Web site at http://www.dir.ca.gov/dwc/WCIS.htm, will be made available by the Division of Workers' Compensation upon request, and is incorporated by reference.
California EDI Implementation Guide for Medical Bill Payment Records. California EDI Implementation Guide for Medical Bill Payment Records, Version 1.0, dated December 2005, contains the California-specific protocols and excerpts from the IAIABC EDI Implementation Guide for Medical Bill Payment Records, explains the technical design and functionality of the WCIS system, testing options for the trading partners, instructions regarding the data elements for medical billing, and copies of the required medical billing electronic forms. The California EDI Implementation Guide for Medical Bill Payment Records, Version 1.0, dated December 2005, is posted on the Division's Web site at http://www.dir.ca.gov/dwc/WCIS.htm, will be made available by the Division of Workers' Compensation upon request, and is incorporated by reference.
Claim. An injury as defined in Division 4 of the Labor Code, occurring on or after March 1, 2000, that has resulted in the receipt of one or more of the following by a claims administrator:
(1) Employer's Report of Occupational Injury or Illness, as required by Title 8, California Code of Regulations ss 14004-14005.
(2) Doctor's First Report of Occupational Injury or Illness, as required by Title 8, California Code of Regulations ss 14006-14007.
(3) Application for Adjudication filed with the Workers' Compensation Appeals Board under Labor Code s 5500 and Title 8, California Code of Regulations s 10408.
(4) Any information indicating that the injury requires medical treatment by a physician as defined in Labor Code s 3209.3.
Claims Administrator. A self-administered insurer providing security for the payment of compensation required by Divisions 4 and 4.5 of the Labor Code, a self-administered self-insured employer, California Insurance Guarantee Association (CIGA), or a third-party claims administrator for a self-insured employer, insurer, legally uninsured employer, or joint powers authority.
Claims Administrator's Agents. Any entity contracted by the claims administrator to assist in adjusting the claim(s) including third party administrators, bill reviewers, utilization review vendors, and electronic data interchange vendors.
Closed Claim. A claim in which future payment of indemnity benefits and/or provision of medical benefits cannot be reasonably expected to be due.
Data Elements. Information identified by data number (DN) and defined in the dictionary of the IAIABC EDI Implementation Guide, Release 1. Data elements set forth in Section 9702 must be transmitted on all claims, where applicable, as indicated in Section 9702. The data elements set forth in the IAIABC EDI Implementation Guide, Release 1 that are not enumerated in Section 9702 are optional and may, but need not be, submitted on any or all claims.
Electronic Data Interchange. ( "EDI"). A computer to computer exchange of data or information in a standardized format acceptable to the Administrative Director.
Health Care Organization ( "HCO"). Any entity certified as a health care organization by the Administrative Director pursuant to Labor Code Sections 4600.5 and 4600.6.
IAIABC EDI Implementation Guide, Release 1. EDI Implementation Guide for First, Subsequent, Acknowledgment Detail, Header & Trailer Records, Release 1, issued February 15, 2002, by the International Association of Industrial Accident Boards and Commissions. Sections 4, 5, 6, and the Appendix of EDI Implementation Guide, Release 1, are linked to the Division's Web site at http://www.dir.ca.gov/dwc/WCIS.htm, and are hereby incorporated by reference.
IAIABC EDI Implementation Guide for Medical Bill Payment Records. IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 1, approved July 4, 2002, by the International Association of Industrial Accident Boards and Commissions. Sections 1 through 3, and 5 through 11 of the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 1, are linked to the Division's Web site at http://www.dir.ca.gov/dwc/WCIS.htm, and are incorporated by reference.
Indemnity Benefits. Payments conferred, including those made by settlement, for any of the following: temporary disability indemnity, permanent disability indemnity, death benefits, vocational rehabilitation maintenance allowance, and employer-paid salary in lieu of compensation.
Individually Identifiable Information. Any data concerning an injury or claim that is linked to a uniquely identifiable employee, employer, claims administrator, or any other person or entity.
International Association of Industrial Accident Boards and Commissions ( "IAIABC"). A professional association of workers' compensation specialists, located at 5610 Medical Circle, Suite 14, Madison, Wisconsin 53711, which is, in addition to other activities, engaged in the production and publication of EDI standards for filing workers' compensation information. Note: IAIABC asserts ownership of such EDI standards which are published in various ways and include Implementation Guides with instructions on their use, technical and business specifications and coding information to permit the transfer of data between regulatory bodies and regulated entities in a uniform and consistent manner.
WCIS. The Workers' Compensation Information System established pursuant to sections 138.6 and 138.7 of the Labor Code.
Note: Authority cited: Sections 133, 138.6 and 138.7, Labor Code. Reference: Sections 138.6 and 138.7, Labor Code.
s 9702. Electronic Data Reporting.
(a) Each claims administrator shall transmit data elements, by electronic data interchange in the manner set forth in the California EDI Implementation Guide for First and Subsequent Reports of Injury and the California EDI Implementation Guide for Medical Bill Payment Records, to the WCIS by the dates specified in this section. Each claims administrator shall, at a minimum, provide complete, valid, accurate data for the data elements set forth in this section. The data elements required in subdivisions (b), (c), (d) and (e) are taken from California EDI Implementation Guide for First and Subsequent Reports of Injury and the California EDI Implementation Guide for Medical Bill Payment Records. Claims administrators shall only transmit the data elements that are set forth in the California EDI Implementation Guide for First and Subsequent Reports of Injury and the California EDI Implementation Guide for Medical Bill Payment Records. Each transmission of data elements shall include appropriate header and trailer records as set forth in the California EDI Implementation Guide for First and Subsequent Reports of Injury and the California EDI Implementation Guide for Medical Bill Payment Records.
(1) The Administrative Director, upon written request, may grant a claims administrator either a partial or total variance in reporting all or part of the data elements required pursuant to subdivision (e) of this section. Any variance granted by the Administrative Director under this subdivision shall be set forth in writing.
(A) A partial variance requested on the basis that the claims administrator is unable to transmit some of the required data elements to the WCIS shall be granted for a six month period only if all of the following are shown:
1. a documented showing that compliance with the reporting deadlines set forth in subdivision (e) would cause undue hardship to the claims administrator;
2. a documented showing that any medical data elements currently being transmitted by the claims administrator or the claims administrator's agent to public or private research or statistical entities shall be reported by the claims administrator to the WCIS; and
3. submission of a plan, prior to the applicable deadline set forth in subdivision (e), documenting the means by which the claims administrator will ensure full compliance with the data reporting within six months from the request.
(B) A partial variance requested on the basis that the claims administrator is unable to report some of the required data elements to the WCIS because the data elements are not available to the claims administrator or the claims administrator's agent shall be granted for a six month period only if all of the following are shown:
1. a documented showing that compliance with the reporting deadlines set forth in subdivision (e) would cause undue hardship to the claims administrator;
2. a documented showing that any medical data elements currently being transmitted by the claims administrator or the claims administrator's agent to public or private research or statistical entities shall be reported by the claims administrator to the WCIS;
3. a documented showing that the claims administrator will submit to the WCIS the medical data elements available to the claims administrator or the claims administrator's agents; and
4. submission of a plan, prior to the applicable deadline set forth in subdivision (e), documenting the means by which the claims administrator will ensure full compliance with the data reporting within six months from the request.
(C) A total variance shall be granted for a twelve month period if all of the following are shown:
1. a documented showing that compliance with the reporting deadlines set forth in subdivision (e) would cause undue hardship to the claims administrator;
2. a documented showing that the claims administrator has not contracted with a bill review company to review medical bills submitted by providers in its workers' compensation claims;
3. a documented showing that the claims administrator is unable to transmit medical data to public or private research or statistical entities; and
4. submission of a plan, prior to the applicable deadline set forth in subdivision (e), documenting the means by which the claims administrator will ensure full compliance with the data reporting within twelve months from the request.
(2) "Undue hardship" shall be determined based upon a review of the documentation submitted by the claims administrator. The documentation shall include: the claims administrator's total required expenses; the reporting cost per claim if transmitted in house; and the total cost per claim if reported by a vendor. The costs and expenses shall be itemized to reflect costs and expenses related to reporting the data elements listed in subdivision (e) only.
(3) The variance period for reporting data elements under subdivisions (a)(1)(A) and (B) shall not be extended. The variance period for reporting data elements under subdivision (a)(1)(C) may be extended for additional twelve month periods if the claims administrator resubmits a written request for a variance. A claims administrator granted a variance shall submit to the WCIS all data elements that were required to be submitted under subdivision (e) during the variance period except for data elements that were not known to the claims administrator, the claims administrator's agents, or not captured on the claims administrator's electronic data systems. The data shall be submitted in an electronic format acceptable to the Division.
(b) Each claims administrator shall submit to the WCIS on each claim, within five (5) business days of knowledge of the claim, each of the following data elements known to the claims administrator:
Data Element Name DN
ACCIDENT DESCRIPTION /CAUSE 38
CAUSE OF INJURY CODE 37
CLAIM ADMINISTRATOR ADDRESS LINE 2 11
CLAIM ADMINISTRATOR ADDRESS LINE 1 10
CLAIM ADMINISTRATOR CITY 12
CLAIM ADMINISTRATOR CLAIM NUMBER 15
CLAIM ADMINISTRATOR POSTAL CODE 14
CLAIM ADMINISTRATOR STATE 13
CLASS CODE (3) 59
DATE DISABILITY BEGAN 56
DATE LAST DAY WORKED 65
DATE OF HIRE (1) 61
DATE OF INJURY 31
DATE OF RETURN TO WORK 68
DATE REPORTED TO CLAIM ADMINISTRATOR 41
DATE REPORTED TO EMPLOYER 40
EMPLOYEE ADDRESS LINE 1 (1) 46
EMPLOYEE ADDRESS LINE 2 (1) 47
EMPLOYEE CITY (1) 48
EMPLOYEE DATE OF BIRTH 52
EMPLOYEE DATE OF DEATH 57
EMPLOYEE FIRST NAME 44
EMPLOYEE LAST NAME 43
EMPLOYEE MIDDLE INITIAL (1) 45
EMPLOYEE PHONE (1) 51
EMPLOYEE POSTAL CODE (1) 50
EMPLOYEE STATE (1) 49
EMPLOYER ADDRESS LINE 1 19
EMPLOYER ADDRESS LINE 2 20
EMPLOYER CITY 21
EMPLOYER FEIN 16
EMPLOYER NAME 18
EMPLOYER POSTAL CODE 23
EMPLOYER STATE 22
EMPLOYMENT STATUS CODE (1) 58
GENDER CODE 53
INDUSTRY CODE 25
INSURER FEIN 6
INSURER NAME 7
JURISDICTION 4
MAINTENANCE TYPE CODE 2
MAINTENANCE TYPE CODE DATE 3
MARITAL STATUS CODE (2) 54
NATURE OF INJURY CODE 35
NUMBER OF DEPENDENTS (2) 55
OCCUPATION DESCRIPTION 60
PART OF BODY INJURED CODE 36
POSTAL CODE OF INJURY SITE 33
SALARY CONTINUED INDICATOR 67
SELF INSURED INDICATOR 24
SOCIAL SECURITY NUMBER (1) 42
THIRD PARTY ADMINISTRATOR FEIN 8
THIRD PARTY ADMINISTRATOR NAME 9
WAGE (1) 62
WAGE PERIOD (1) 63
______________
(1) Required only when provided to the claims administrator.
(2) Death Cases Only.
(3) Required for insured claims only; optional for self-insured claims.
Data elements omitted under this subsection because they were not known by the claims administrator shall be submitted within sixty (60) days from the date of the first report under this subsection.
(c) Each transmission of data elements listed under (b), (d), (e), (f), or (g) of this section shall also include the following elements for data linkage:
Data Element Name DN
CLAIM ADMINISTRATOR CLAIM NUMBER (2) (3) (4) 15
DATE OF INJURY (2) 31
INSURER FEIN (4) 6
JURISDICTION CLAIM NUMBER (2) (3) (4) 5
MAINTENANCE TYPE CODE (1) 2
MAINTENANCE TYPE CODE DATE (1) 3
SOCIAL SECURITY NUMBER (2) (3) 42
THIRD PARTY ADMINISTRATOR FEIN (4) 8
______________
(1) Maintenance Type Code (DN 2) and Maintenance Type Code Date (DN 3) are required for transmissions under Subsections (b), (d), (f), and (g).
(2) This number will be provided by WCIS upon receipt of the first report. The Jurisdiction Claim Number (DN 5) is required when changing a Claim Administrator Claim Number (DN 15); it is optional for other transmissions under this subsection.
(3) The Date of Injury (DN 31), Employee SSN (DN 42), and Claim Administrator Claim Number (DN 15) need not be submitted if the Jurisdiction Claim Number (DN 5) accompanies the transmission, except for transmissions required under Subsection (f).
(4) If the Jurisdiction Claim Number (DN 5) is not provided, trading partners must provide the Claim Administrator Claim Number (DN 15) and the Third Party Administrator FEIN (DN 8), or, if there is no third party administrator, the Insurer FEIN (DN 6).
(d) Each claims administrator shall submit to the WCIS within fifteen (15) business days the following data elements, whenever indemnity benefits of a particular type and amount are started, changed, suspended, restarted, stopped, delayed, or denied, or when a claim is closed or reopened, or when the claims administrator is notified of a change in employee representation. Submissions under this subsection are required only for claims with a date of injury on or after July 1, 2000, and shall not include data on routine payments made during the course of an uninterrupted period of indemnity benefits.
Data Element Name DN
CLAIM STATUS 73
DATE DISABILITY BEGAN 56
DATE OF MAXIMUM MEDICAL IMPROVEMENT 70
DATE OF REPRESENTATION 76
DATE OF RETURN TO WORK 68
DATE OF RETURN TO WORK/RELEASE TO WORK 72
EMPLOYMENT STATUS CODE 58
LATE REASON CODE 77
PAID TO DATE/ REDUCED EARNINGS/RECOVERIES
AMOUNT 96
PAID TO DATE/ REDUCED EARNINGS/RECOVERIES
CODE 95
PAYMENT/ADJUSTMENT CODE 85
PAYMENT/ADJUSTMENT DAYS PAID 91
PAYMENT/ADJUSTMENT END DATE 89
PAYMENT/ADJUSTMENT PAIDTO DATE 86
PAYMENT/ADJUSTMENT START DATE 88
PAYMENT/ADJUSTMENT WEEKLY AMOUNT 87
PAYMENT/ADJUSTMENT WEEKS PAID 90
PERMANENT IMPAIRMENT BODY PART CODE (1) (2) 83
PERMANENT IMPAIRMENT PERCENTAGE (2) 84
WAGE 62
WAGE PERIOD 63
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(1) May use Code 90 (Multiple Body Parts) to reflect combined rating for any/all impairments.
(2) Use actual permanent disability rating at the time of initial payment of permanent disability benefits. For compromise and release cases and stipulated settlements, use permanent disability estimate as reported to the appropriate rating organization established under Insurance Code s 11750, et seq.
(e) On and after September 22, 2006, claims administrators handling one hundred and fifty (150) or more total claims per year shall submit to the WCIS on each claim with a date of service on or after September 22, 2006, the following data elements for all medical services for which the claims administrator has received a billing or other report of provided medical services. The California EDI Implementation Guide for Medical Bill Payment Records sets forth the specific California reporting requirements. The data elements required in this subdivision are taken from California EDI Implementation Guide for Medical Bill Payment Records and the IAIABC EDI Implementation Guide for Medical Bill Payment Records. The claims administrator shall submit the data within ninety (90) calendar days of the medical bill payment. Each claims administrator shall transmit the data elements by electronic data interchange in the manner set forth in the California EDI Implementation Guide for Medical Bill Payment Records.
Data Element Name DN
ACKNOWLEDGMENT TRANSACTION SET ID 110
ADMISSION DATE 513
ADMITTING DIAGNOSIS CODE 535
APPLICATION ACKNOWLEDGMENT CODE 111
BASIS OF COST DETERMINATION CODE 564
BATCH CONTROL NUMBER 532
BILL ADJUSTMENT AMOUNT 545
BILL ADJUSTMENT GROUP CODE (5) 543
BILL ADJUSTMENT REASON CODE 544
BILL ADJUSTMENT UNITS 546
BILL SUBMISSION REASON CODE 508
BILLING FORMAT CODE 503
BILLING PROVIDER FEIN 629
BILLING PROVIDER LAST/GROUP NAME 528
BILLING PROVIDER POSTAL CODE 542
BILLING PROVIDER PRIMARY SPECIALTY CODE (4) 537
BILLING PROVIDER STATE LICENSE NUMBER (4) 630
BILLING PROVIDER UNIQUE BILL IDENTIFICATION
NUMBER 523
BILLING TYPE CODE 502
CLAIM ADMINISTRATOR CLAIM NUMBER 15
CLAIM ADMINISTRATOR FEIN 187
CLAIM ADMINISTRATOR NAME 188
CONTRACT TYPE CODE 515
DATE INSURER PAID BILL 512
DATE INSURER RECEIVED BILL 511
DATE OF BILL 510
DATE OF INJURY 31
DATE PROCESSED 108
DATE TRANSMISSION SENT 100
DAYS/UNITS BILLED 554
DAYS/UNITS CODE 553
DIAGNOSIS POINTER 557
DISCHARGE DATE 514
DISPENSE AS WRITTEN CODE 562
DME BILLING FREQUENCY CODE 567
DRG CODE 518
DRUG NAME 563
DRUGS/SUPPLIES BILLED AMOUNT 572
DRUGS/SUPPLIES DISPENSING FEE 579
DRUGS/SUPPLIES NUMBER OF DAYS 571
DRUGS/SUPPLIES QUANTITY DISPENSED 570
ELEMENT ERROR NUMBER 116
ELEMENT NUMBER 115
EMPLOYEE FIRST NAME 44
EMPLOYEE LAST NAME 43
EMPLOYEE MIDDLE NAME/INITIAL 45
EMPLOYEE EMPLOYMENT VISA 152
EMPLOYEE GREEN CARD 153
EMPLOYEE PASSPORT NUMBER 156
EMPLOYEE SOCIAL SECURITY NUMBER 42
FACILITY CODE 504
FACILITY FEIN 679
FACILITY MEDICARE NUMBER 681
FACILITY NAME 678
FACILITY POSTAL CODE 688
FACILITY STATE LICENSE NUMBER 680
HCPCS BILL PROCEDURE CODE 737
HCPCS LINE PROCEDURE BILLED CODE 714
HCPCS LINE PROCEDURE PAID CODE 726
HCPCS MODIFIER BILLED CODE 717
HCPCS MODIFIER PAID CODE 727
HCPCS PRINCIPLE PROCEDURE BILLED CODE 626
ICD-9 CM DIAGNOSIS CODE 522
ICD-9 CM PRINCIPAL PROCEDURE CODE 525
ICD-9 CM PROCEDURE CODE 736
INSURER FEIN 6
INSURER NAME 7
INTERCHANGE VERSION ID 105
JURISDICTION CLAIM NUMBER 5
JURISDICTION MODIFIER BILLED CODE (8)(10) 718
JURISDICTION MODIFIER PAID CODE (8) 730
JURISDICTION PROCEDURE BILLED CODE (8) 715
JURISDICTION PROCEDURE PAID CODE (8)(9) 729
LINE NUMBER 547
MANAGED CARE ORGANIZATION FEIN (1) 704
MANAGED CARE ORGANIZATION IDENTIFICATION
NUMBER 208
MANAGED CARE ORGANIZATION NAME 209
MANAGED CARE ORGANIZATION POSTAL CODE 712
NDC BILLED CODE 721
NDC PAID CODE 728
ORIGINAL TRANSMISSION DATE 102
ORIGINAL TRANSMISSION TIME 103
PLACE OF SERVICE BILL CODE 555
PLACE OF SERVICE LINE CODE 600
PRESCRIPTION BILL DATE 527
PRESCRIPTION LINE DATE 604
PRESCRIPTION LINE NUMBER 561
PRINCIPLE DIAGNOSIS CODE 521
PRINCIPLE PROCEDURE DATE 550
PROCEDURE DATE 524
PROVIDER AGREEMENT CODE (3) 507
RECEIVER ID 99
RELEASE OF INFORMATION CODE 526
RENDERING BILL PROVIDER FEIN 642
RENDERING BILL PROVIDER LAST/GROUP NAME 638
RENDERING BILL PROVIDER POSTAL CODE 656
RENDERING BILL PROVIDER PRIMARY SPECIALTY CODE 651
RENDERING BILL PROVIDER SPECIALTY LICENSE
NUMBER 649
RENDERING BILL PROVIDER STATE LICENSE NUMBER 643
RENDERING LINE PROVIDER NATIONAL ID (7) 592
RENDERING LINE PROVIDER FEIN 586
RENDERING LINE PROVIDER LAST/GROUP NAME (6) 589
RENDERING LINE PROVIDER POSTAL CODE 593
RENDERING LINE PROVIDER PRIMARY SPECIALTY
CODE (6) 595
RENDERING LINE PROVIDER STATE LICENSE NUMBER (6) 599
REPORTING PERIOD 615
REVENUE BILLED CODE 559
REVENUE PAID CODE 576
SENDER ID 98
SERVICE ADJUSTMENT AMOUNT 733
SERVICE ADJUSTMENT GROUP CODE (5) 731
SERVICE ADJUSTMENT REASON CODE (5) 732
SERVICE BILL DATE(S) RANGE 509
SERVICE LINE DATE(S) RANGE 605
TEST/PRODUCTION INDICATOR 104
TIME PROCESSED 109
TIME TRANSMISSION SENT 101
TOTAL AMOUNT PAID PER BILL (2) 516
TOTAL AMOUNT PAID PER LINE (2) 574
TOTAL CHARGE PER BILL 501
TOTAL CHARGE PER LINE - PURCHASE 566
TOTAL CHARGE PER LINE - RENTAL 565
TOTAL CHARGE PER LINE 552
TRANSACTION TRACKING NUMBER 266
UNIQUE BILL ID NUMBER 500
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(1) For HCO claims use the FEIN of the sponsoring organization in DN 704.
(2) Not required on non-denied bills if amount paid equals amount charged.
(3) For MPN claims use code P "Participation Agreement"
(4) Does not apply if billing provider is an organization.
(5) Required if charged and paid amounts differ.
(6) Optional if rendering provider equals billing provider.
(7) To be provided following the assignment of a National Provider Identifier by the United States Department of Health and Human Services, Centers for Medicare & Medicaid Services ( "CMS").
(8) The codes for this data element are the codes that are set forth in the California Official Medical Fee Schedule, a publication of the State of California, Department of Industrial Relations (adopted pursuant to Labor Code s 5307.1 and Title 8, California Code of Regulations s 9790 et seq.).
(9) Optional if procedure billed equals procedure paid.
(10) Use when a modifier has been provided.
(f) Notwithstanding the requirement in Subsection (b) to submit data elements omitted from the first report within 60 days from the date of transmission of the first report, when a claims administrator becomes aware of an error or need to update data elements previously transmitted, or learns of information that was previously omitted, the claims administrator shall transmit the corrected, updated or omitted data to WCIS no later than the next submission of data for the affected claim.
(g) No later than January 31 of every year, commencing in 2001, claims administrators shall, for each claim with a date of injury on or after July 1, 2000 and with any payment in any benefit category in the previous calendar year, report the total paid in each payment category through the previous calendar year by submitting the following data elements: (continued)