Workers’ compensation EDI

Read the acknowledgement before you send the filing.

Xmitly checks a FROI or SROI against the jurisdiction ruleset in force on its effective date — while the transaction is still in your claims system, and still cheap to fix.

4,595,276
CA acks, 2024
90%
Accepted
7%
Accepted w/ error
3%
Rejected
The same transaction, two ways
Day 4 — jurisdiction responseTR
MTC 00 First Report Claim DEMO-CO-1001 Ack TRANSACTION REJECTED × Employer FEIN missing × Date of injury after date reported × Nature of injury not in code list Re-file required. Timeliness clock did not stop.
Day 0 — Xmitly, before transmissionPRE-CHECK
POST /v1/claims/validate filing_required true ruleset CO / effective-dated errors 3 × employer.fein required × injury.date > reported_date × injury.nature invalid code Fix now. Nothing has been sent.

Illustrative. Synthetic claim, synthetic errors — no transaction shown here was ever transmitted to a jurisdiction.

One filing in ten arrives imperfect.

California logged 4.6 million acknowledgement records in 2024. Across FROI and SROI, three percent came back rejected and a further seven percent were accepted with errors — roughly 450,000 defective transactions, in one state, in one year.

3% rejected 7% accepted with errors 90% clean

Source: California DWC, WCIS Report Table 8. Each square is one percent.

The loop runs backwards

Transmission was never the hard part.

Getting a file to a jurisdiction is solved, and has been for years. What isn’t solved is knowing, at the moment you build the transaction, whether it will survive that jurisdiction’s edit rules — which are versioned, effective-dated, and different in every state.

So you transmit, wait, read an acknowledgement, work out which rule you broke, fix it, re-file. Every cycle costs days. On a late filing, days cost money, and the clock never stopped running.

  1. 01
    Post a claim

    Jurisdiction-neutral JSON. One shape, whatever state you file in.

  2. 02
    Xmitly decides whether a filing is required

    And says so explicitly when it cannot determine that from what you sent, instead of guessing.

  3. 03
    It validates against the ruleset in force

    The version effective on the filing’s own date — not today’s version, when those differ.

  4. 04
    You see the errors first

    Field level, each one carrying the rule that produced it.

Built in the open, by one person

An honest ledger, not a roadmap.

Anything marked as verified against a regulator would need a regulator’s evidence. There isn’t any yet, so nothing claims it.

ComponentState
Canonical claim model, jurisdiction abstractionBuilt
Versioned, effective-dated rules engineBuilt
Sandbox with simulated acknowledgementsBuilt
Colorado requirement tables loadedNot yet
IAIABC XML serialisation and batchingNot yet
Verified against a Colorado test acknowledgementNot yet
Production transmissionDisabled

Read this before you assume anything

Xmitly is not approved, certified, endorsed by, affiliated with, or authorised by the Colorado Division of Workers’ Compensation, the IAIABC, or any other regulator. Colorado EDI vendor testing has not begun.

No transaction from Xmitly has ever been sent to a jurisdiction. Production transmission is disabled in code and cannot be reached with a sandbox key. Every acknowledgement in the sandbox is generated locally and labelled SIMULATED SANDBOX ACKNOWLEDGEMENT.

Where a requirement has not been implemented from authoritative source material, the engine returns AWAITING_AUTHORITATIVE_RULESET rather than a guess. A validator that guesses is worse than no validator, because it lets you believe an unreviewed filing was compliant.

What I want right now

To be told I’m wrong about the problem.

I’m looking for claims software vendors, TPAs and carriers who file FROI and SROI and have an opinion about what actually goes wrong — particularly anyone working through Colorado’s R3.1 cutover, and what your acknowledgement traffic looks like since July.

There is nothing to buy. I’m trying to find out whether the problem I think exists is the problem you have.

Johnw@xmitly.com