How Florida Leverages Use of Regulatory Data

In this session at WCI’s 2017 Workers’ Compensation Educational Conference, Brittany O’Neil, Senior Policy Coordinator of the Florida Division of Workers’ Compensation, shared how the Division is leveraging electronic claims, medical, and policy data reported to the Division as required by statute (69L-7.730, F.A.C. and section 440.185, F.S.).

By accessing and providing this data in different ways, such as new applications, reports, and data-applied methodologies, the Division is providing unique services to carriers, employers, and other claims-handling entities to identify where they can increase their regulatory and business performance.

There are three buckets of data utilized – policy data, medical data and claims data.

Policy Data:

• 9,000 policies a year
• 100,000 notice of election to be exempt
• 30,000 investigations per year to verify coverage in place and appropriate
• 10,000 people/45,000 policies in a construction policy tracking database

A coverage assistance program was established for those who say they can’t find coverage in Florida. People can now search by class code or description to show companies with active policies. This is a piece of data that an employer can show their agent for further investigation as to why the employer can not find a policy.

They are also piloting an Investor Observations for Underwriting (I.O.U) program available for underwriters to find ways to find employer information.

Claims Data:

• 480,000 lost-time and denied claims and the associated transactions
• 5,000-6,000 files per year for onsite audited
• 50,000-60,000 first payment transactions

The Division created an Insurer Regulatory Report of industry comparisons, listing premium dollars, EDI data – comparing industries, historical audit and current industry figures.

Medical Data:

• 4,000,000 medical bills per year
• CPS evaluates monthly batches for timeliness and accuracy
• Reimbursement manuals
• Annual Accomplishments Report

The Division has begun analyzing charge data to try to find ways to drill down to facilities and find patterns to see why discrepancies are there. They are also looking for the providers who are most engaged in workers’ compensation. They can then use this data to properly communicate to them based on their high- or low-level system knowledge.