ExamWorks Clinical Solutions Will Implement New File Specifications

Thursday, February 12, 2015

Over the last year, the Centers for Medicare & Medicaid Services (CMS) has issued three key Alerts related to Mandatory Insurer Reporting.

  • November 25, 2014 - Reporting Partial Social Security Numbers.
  • November 10, 2014 - Submitting Recovery Agent Information for MSP Recovery.
  • May 13, 2014 - ICD-10 code implementation was delayed until October 1, 2015.

To accommodate the changes made by CMS and to improve the services offered by ExamWorks Clinical Solutions (ECS), we are implementing a new file specification titled, "ECS MIR Customer File Spec v4." The following list of changes should be reviewed in great detail.

New File Specification Implementation Time Line:

  • April 1, 2015 - Clients can begin submitting the New ECS File Specification in the Test Environment.
  • July 1, 2015 - Clients can begin submitting the New ECS File Specification in the Production Environment.
  • December 31, 2015 -Support for Existing File Specification titled (GL MIR Customer File Spec 05152013) will no longer be supported; ECS recommends submitting the New ECS File Specification prior to 10/1/2015.

New Fields:

  • ICD-10 Alleged Cause of Injury Code
  • ICD-10 Code fields
  • User Defined Fields
  • Adjuster Fields
  • Recovery Agent Fields

Existing Field Modification:

  • Added Claim Number to Customer Eligibility Input file
  • Added "D" to the list of values for Medicare Eligibility
  • Updated definition of MIR Reportable
  • Removed CPR Indicator field and replaced with Reserved for Future Use

Important Note Regarding ICD-10:

CMS requires ICD-10 codes for claims with a date of injury on or after October 1, 2015. You can report ICD-10 codes on claims with a date of injury prior to 10/1/2015. Please note if you submit both ICD-9 and CD-10 codes, we will only validate and submit the ICD-10 codes.

Please contact your MMSEA Compliance Manager with any questions at or 866-672-3453 x 1122.

Download As Document