Introduction

The information contained in this Medical Data Call Manual contains the reporting guidelines for the Call.  This Medical Data Call Manual replaces all previously released Medical Data Call Implementation Guides and Manuals.  The current web-based manual located on the PCRB’s website at www.pcrb.com.

The Medical Data Call Manual applies to data submitted to PCRB.   Data providers are required to comply with the instructions and guidelines contained in this manual in conjunction with PCRB’s Statistical Plan.  Each data provider should develop its own internal methods for how to apply the information contained in these manuals.  However, the end result must meet PCRB’s criteria.

This manual is your source for PCRB’s Medical Data Call reporting rules and requirements, as well as additional information and examples to assist you in meeting your reporting requirements.

During its July 30, 2008 meeting, the Pennsylvania Compensation Rating Bureau’s Governing Board voted unanimously to authorize the PCRB to begin collecting detailed medical data.  That vote was taken after careful consideration of the potential importance and utility of detailed medical data, as well as available methods for accomplishing the collection of such information.  Factors addressed in the Board’s discussion included the following points:

• Medical losses represented over 55 percent of loss costs in Pennsylvania
• Medical detail could enhance PCRB’s ability to explain filings
• Medical cost containment issues are potentially important public policy matters
  • Fee Schedule – Relationships to Medicare, overall richness of reimbursements
  • Charge Master System
  • Treatment Protocols
• Medical detail would be imperative for PCRB to be able to opine with authority on a variety of possible proposals to change the payment system for workers compensation in Pennsylvania
• The ability to compare data with other jurisdictions will emerge with the common collection of this data elsewhere

The National Council on Compensation Insurance, Inc. (NCCI) has, through an extended and rigorous process, established a construct for the reporting and collection of medical detail information.  That process has been accepted by carriers for use by NCCI states and has been implemented in those states.   The NCCI refers to the collection of this medical detail as the Medical Data Call.  The NCCI has shared the formats, timelines and related collateral for the Medical Data Call with all independent bureaus and has advised those bureaus that they are at liberty to adopt and use any portion(s) of that intellectual property as they may see fit.

The PCRB believes, and the Governing Board has specifically concurred, that using and conforming as much as possible to the NCCI standards for the collection of medical detail information will be the most beneficial and effective means of expanding our information base to include medical detail information.

If you have any questions about the Medical Data Call, please contact the PCRB via one of the following: