DATA SHARING PROJECT

9.1    Submission and Reporting Schedule
9.2    Which Files are Eligible for Submission?

9.3    Methods of Submission
9.4    Prescreening of Files and Error Corrections
       9.4.1    Corrections or Updating Previous Submissions
9.5    Edits for Submission
       9.5.1    General Edits
9.6    Format Instructions for Diskettes
9.7    Record Layout for Data Files
        9.7.1    Formatting Files on Corporations

        9.7.2    Magnetic Media Submission Edits

9.1 Submission and Reporting Schedule

There are two reporting cycles per year:

Phase	Cycle 1	Cycle 2
Data Collection	JAN 1 - JUN 30	JUL 1 - DEC 31
Companies submit data to PIAA	JUL 1 - AUG 31	JAN 1 - FEB 28
Error correction, data processing and report generation	SEP 1 - SEP 30	MAR 1 - MAR 31
Table 9-A

9.2 Which Files are Eligible for Submission?

Files will be submitted on physicians, paraprofessional and corporations, which fit into the criteria described:

Closed claims and suits. A "claim" is defined as a file in which a demand for compensation has been made but no legal papers have been filed with the court. A "suit" is a file in which formal litigation has been instituted. Closed claims and suite are submitted in the cycle in which they close (e.g. a suit closed on march 1, 1995 is included in the first cycle of 1995).

Suits that have been open for one year. This means that open suits are submitted one year after they are declared suits. For example, a suit opened on February 1, 1997 would be submitted in the first cycle of 1998. Suits are also resubmitted at the time of closure, thus capturing any additional information available or that have changed since the initial report.

Corporation files which fit into one of the above criteria.

Files NOT to be included in the submission:

Files involving premises or general liability.

Files in which an incident or event has been reported but no claim for compensation has been made.

Open files in which the misadventure, care rendered, or actual condition fields are unknown. These claims should be monitored and included in an upcoming submission cycle when this information becomes available.

9.3 Methods of Submission

The PIAA will accept three types of submission:

Electronic

Floppy Disks created by an IBM compatible personal computer

Data Forms

9.4 Prescreening of Files and Error Corrections

Records submitted to the PIAA will be checked in accordance with the system editing rules. General edits are found on Introduction section and field-specific edits begin Claims Administration.

The PIAA will provide each reporting company a light version of the data sharing program which will perform the following operations:

Import File Format Check

Import File Content Type Check

Import File Error Corrections

We require you to run this program to check your file format and content type before submitting your data to PIAA. This program can also help you correct those invalid entries after PIAA screens the submissions and return to you. You will need a Microsoft .NET framework 1.1 to run this program. A copy of the .NET framework 1.1 can be downloaded from the download section of this site and also included in the software CD in cases you don't have it on your system.

9.4.1 Corrections or Updating Previous Submissions

When you want to make changes to records submitted on tape or floppy disk, you must resubmit the ENTIRE record. The system will overwrite the old record with the new record.

When previously reported open files close, take care to review the submission and update information.

9.5 Edits for Submission

Below are the required edits for submitting your company's data via magnetic media. In addition to the edits below, there are field-specific edits which appear at the end of this section and will assist you in putting together an edit package that can check your records for compatibility before submission.

9.5.1 General Edits

Make sure that all required field are completed.

Required fields having table references must always contain a valid table value.

Optional fields having table references must always contain a valid table value.

All codes you entered must be valid. Make sure that the Data Manager has the specialty codes for your company and that they are updated regularly.

The number you are reporting for each file must add up to what you report on your Transmittal Form (total records submitted, total indemnity, total ALAE).

9.6 Format Instructions for Diskettes

For submission of 3.5 diskette or electronic submission, the file must be a delimited ASCII text file with the choice of your preferred delimiter (such as "|", "#", "~", etc) or a Microsoft Excel Comma Separated Values Files (known as CSV) containing the following format. Sample files can be found from the download section or the software CD.

A header which consists of (1) your three-digit company ID number (found in the Claims Administration section); (2) your company name; and (3) a three-digit submission period in the form YYC, where YY is the year (i.e. 99, 00, 01, etc) and C is the cycle in which you are submitting (1 or 2).

Data records that are 50 fields apiece. These are your data files, one file per record, which meet the criteria as described in the Introduction. The layout for each record is described in detail under "Record Layout for data Files Heading".

For all submissions - header, data files, and trailer - these rules by be applied:

All fields with no entry in them must NOT have space inserted. Leave the field as a NULL. This does not pertain to REQUIRED fields that MUST have an entry.

All money fields must be rounded to the nearest dollar. For example, the correct way to enter $125,788.67 would be 125789.

All information must be in the order presented in this manual. These rules are in addition to the instructions already stated under "Prescreening of Files" above.

9.7 Record Layout for Data Files

Found on the following pages is the format and description of the fields to be included in each data file. Field specific edits are also contained in this section.

Several data fields reported require codification. The table of code values can be found in the Table section of this manual. Also included in this manual is an augmentation to the ICD-9 Procedures and Codes Manual which can be found in section 12.

Data processing personnel must pay particular attention to the fields containing ICD-9 codes, as the placement of a decimal point is required for submission.

Note: No PAD spaces in this new data submission format.

Field No	Field Name	Entry	Description
1	Company ID	Required	Enter your company ID code from the company table.

2	Incident Number	Required	Enter the claim ID number utilized by your company. This number identifies the general claim or incident.

3	Insured Number	Required	Enter the number assigned to the insured involved in the claim as listed above. If there are other insureds involved in the claim, list them each on separate data files.

4	Accident Date	Required	Enter the date (YYYY/MM/DD) the accident or incident occurred. EDIT - Cannot be later than report date.

5	Report Date	Required	Enter the date (YYYY/MM/DD) your company received first notice of the incident. EDIT - Cannot be later than claim/suit date.

6	Closed Date	Required	Required if closed. Enter the date (YYYY/MM/DD) the file was closed by your company.

7	Status	Required	Enter a "c" if the file is a claim (demand for compensation; no litigation) or "s" if it is a suit (formal litigation instituted). See the Status Table.

8	Coverage Type	Required	Enter the code for type of coverage the insured has from the Coverage Table.

All information regarding the claimant should be the claimant's status at the time of the incident.

Field No	Field Name	Entry	Description
9	Age	Required	Required if the file is closed with an indemnity payment. Enter claimant's age. If a newborn or infant is involved, enter "nb" for newborn or "00" for a baby less than a year old when the allegations are not directed to the birth. If claimant is over 100, enter "99".


10	Sex	Required	Required if the file is closed with an indemnity payment. Enter "m" for male, "f" for female or "u" for unknown. See Table.

11	Collateral Source	Optional	Enter the code for other claimant compensation benefits from the Collateral Source table.

All information regarding the insured should be the insured's status at the time of the incident.

Field No	Field Name	Entry	Description
12	Specialty	Required	Enter the primary medical specialty in which the defendant is rated. Use the code utilized by your company. Make sure that you send your list of codes to the PIAA. EDIT - A code of less than five characters must by right justified and padded to the left with zeros.

13	Board Certified	Optional	Enter either "c" for certified or "n" for not certified for the primary specialty in which the insured is rated. See the Board Status table.

14	Limits	Required	Enter the code for the insured's limits of liability from the Policy Limits table in section 4. Use the limits that appear on your policy declaration page.

15	Type Practice	Required	Enter the code for the insured's type of practice from the Practice Type table.

16	Medial School	Required	Enter "05999" for a US medical school; "99998" for a medical school outside of the US; or "99999" for a medical school not in the AMA listing. See the Medical School table.

17	Full Time /Part Time	Required	Enter "f" for a full-time physician or "p" for a part-time physician. See the Full/Part Time table.

18	Age	Required	Enter the age of the insured.

19	Sex	Required	Enter "m" for male; "f" for female; or "u" for unknown. See Table.

20	Type of Institution	Required	Enter the code for the type of institution. Use the Type of Institution table. EDIT - Codes of "01" or "05" must have an incident location not equal to "99". EDIT - Codes of "01" or "02" must have an entry in the Hospital Type field.

21	Incident Location	Optional	Enter the code for the location where the incident occurred from the Incident Location table.

22	Type of Hospital	Required	Required if the location was a hospital. Enter "n" for non-teaching hospital or "t" for teaching hospital. See the Hospital Type table.

23	State	Required	Enter a code for the state in which the loss occurred from the State table.

24	Total Indemnity Paid	Required	Enter the amount of the indemnity paid on behalf of the defendant. For files having no indemnity payment, enter zero. EDIT - Entry in Lump Sum/Structured Settlement field is required if indemnity paid > 0.

25	Non-economic portion of total payment	Required if a verdict	Enter the amount of the non-economic damages portion of the verdict paid on behalf of the defendant.

26	ALAE Defense Counsel	Optional	Enter expense payments made to defense counsel. Round to the nearest dollar,, omit commas and dollar signs.

27	ALAE Expert Witness	Optional	Enter expense payments for expert witnesses in this field.

28	ALAE Other Reasons	Optional	Enter expense payments for other reasons in this field.

29	Total ALAE	Required	Enter the total expense paid on this file (defendant). For files having no expense payments, enter zero.

30	Lump Sum or Structured Settlement	Required	Required if file is closed. Enter "s" for structured settlements; "l" for lump sum; or "n" for no payment. If only part of the award was structured, enter "s".

Loss Causation and Description - remember to include the decimal point for all ICD-9 codes.

Field No.	Field Name	Entry	Description
31	Severity	Required	Enter the code which best describes the result of the incident from the Severity Index table.

32	Actual Condition	Required	Using the ICD-9 codes, enter the actual condition (NOT a misdiagnosis) of the patient. If there is more than one, select the condition that is most involved in the generation of the claim. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

33	Misdiagnosis	Optional	Enter the incorrect diagnosis from the ICD-9 manual. The field is ONLY used if the misadventure is "01", Diagnosis Error, and the physician actually identified the disease incorrectly. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

34	Care Rendered	Required	Enter the ICD-9 code for the treatment rendered to the patient. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

35	Procedure - Anesthesia	Optional	Enter the ICD-9 code for the procedure for which anesthesia was administered. EDIT - This field is REQUIRED if the care rendered is in the 200's, regardless of whether or not the defendant is an anesthesiologist. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

36	Misadventure	Required	Enter the code for the error that was the MOST CASUALLY RELATED TO THE RESULT. EDIT - If misadventure > 1, misdiagnosis field is blank. EDIT - Insured must be an anesthesiologist or paraprofessional for misadventure to be in the 50's.

37	Treatment Delay / Not Performed	Required	Required if misadventure is coded Delay in Performance (07) or Not Performed (08) and blank otherwise. Enter the ICD-9 code for the procedure associated with the misadventure. EDIT - Use ONLY if there was a delay of the procedure or it was not performed. Your code in the misadventure field must be "7" or "8".

38,39	Iatrogenic Injury 1, 2	Optional	Enter the ICD-9 code for the injury DIRECTLY caused by the acts of the physician. This does NOT mean general resulting injuries. NOTE - Enter codes found in the Iatrogenic Injury section of section 12. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

40	Outcome	Required	Enter ICD-9 code for resulting adverse outcome to claimant as a result of treatment. EDIT - Please remember to fill in with zeros if the decimal are less than 4 digits (ex: 699.9 should be coded as 699.9000)

41,42,43	Associated Issue 1, 2, 3	Required	ONLY Associated Issue 1 is required if misadventure is No Medical Misadventure ("99"), other two are optional. Enter the code for any associated issues that have impact on the claim from the Associated Issues table.

44,45,46	Associated Personnel 1, 2, 3	Optional	Enter codes from the Associated Personnel table that indicates other persons who had involvement in the claims (e.g. a nurse or ER physician).

47	Disposition Code	Required	Required if case is closed. If case is open, do not enter. Enter the final disposition from the Disposition Code table. EDIT - Field is required if close date is filled in.

48	Disposition Time	Required	Required if case is closed. If case is open, do not enter. Enter the final disposition from the Disposition Time table. EDIT - Field is required if close date is filled in.

49	Company Liability Decision	Optional	Enter the code from the Review Panel, Arbitration Panel, and Company Liability table.

50	Previous Claims Experience	Optional	Has the insured had prior claims or suits with your company. Enter "y" for Yes or "n" for No.

9.7.1 Formatting Files on Corporations

Corporation files are those in which the insured is a corporation, partnership, institution or like entity, rather than an individual physician.
Corporate files will be accepted using the same criteria for submission as an individual. Although there is not a much data required for corporation submittals, the record must still have the full 50 fields per file. See the record layout below (fields must be in the order)

Field No	Field Name	Entry	Description
1	Company ID	Required	Enter your company ID code from the company table.

2	Incident Number	Required	Enter the claim ID number utilized by your company. This number identifies the general claim or incident.

3	Insured Number	Required	Enter the number assigned to the insured involved in the claim as listed above. If there are other insureds involved in the claim, list them each on separate data files.

4	Accident Date	Required	Enter the date (YYYY/MM/DD) the accident or incident occurred. EDIT - Cannot be later than report date.

5	Report Date	Required	Enter the date (YYYY/MM/DD) your company received first notice of the incident. EDIT - Cannot be later than claim/suit date.

6	Closed Date	Required	Required if closed. Enter the date (YYYY/MM/DD) the file was closed by your company.

7	Status	Required	Enter a "c" if the file is a claim (demand for compensation; no litigation) or "s" if it is a suit (formal litigation instituted). See the Status Table.

8	Coverage Type	Required	Enter the code for type of coverage the insured has from the Coverage Table.

9	Age	Required	Required if the file is closed with an indemnity payment. Enter claimant's age. If a newborn or infant is involved, enter "nb" for newborn or "00" for a baby less than a year old when the allegations are not directed to the birth. If claimant is over 100, enter "99".

10	Sex	Required	Required if the file is closed with an indemnity payment. Enter "m" for male, "f" for female or "u" for unknown. See Table.

11	Collateral Source	Optional	Enter the code for other claimant compensation benefits from the Collateral Source table.

12	Specialty	Required	Enter the primary medical specialty in which the defendant is rated. Use the code utilized by your company. Make sure that you send your list of codes to the PIAA. EDIT - A code of less than five characters must by right justified and padded to the left with zeros.

14	Limits	Required	Enter the code for the insured's limits of liability from the Policy Limits table in section 4. Use the limits that appear on your policy declaration page.

23	State	Required	Enter a code for the state in which the loss occurred from the State table.

24	Total Indemnity Paid	Required	Enter the amount of the indemnity paid on behalf of the defendant. For files having no indemnity payment, enter zero. EDIT - Entry in Lump Sum/Structured Settlement field is required if indemnity paid > 0.

25	Non-economic portion of total payment	Required if a verdict	Enter the amount of the non-economic damages portion of the verdict paid on behalf of the defendant.

26	ALAE Defense Counsel	Optional	Enter expense payments made to defense counsel. Round to the nearest dollar, omit commas and dollar signs.

27	ALAE Expert Witness	Optional	Enter expense payments for expert witnesses in this field.

28	ALAE Other Reasons	Optional	Enter expense payments for other reasons in this field.

29	Total ALAE	Required	Enter the total expense paid on this file (defendant). For files having no expense payments, enter zero.

30	Lump Sum or Structured Settlement	Required	Required if file is closed. Enter "s" for structured settlements; "l" for lump sum; or "n" for no payment. If only part of the award was structured, enter "s".


49	Company Liability Decision	Optional	Enter the code from the Review Panel, Arbitration Panel, and Company Liability table.

50	Previous Claims Experience	Optional	Has the insured had prior claims or suits with your company. Enter "y" for Yes or "n" for No.

9.7.2 Magnetic Media and Electronic Submission Edits

Field with no enter must NOT be filled with spaces.
The reporting date in the header record must be correct for the period being processed.
All date field are of the form YYYY/MM/DD (e.g. 1999/12/31). The month must be less than 13 and all dates must be earlier or the same as the process date.
The accumulated amounts of indemnity and expenses being reported must equal the amounts declared in the trailer record.
All records, including updates to previously submitted records, must be complete. If you submit an update to a record, the system overwrites the old record with the new record.
All money fields should be rounded to the nearest dollar and reported in whole dollars. Omit dollar signs, commas, and decimal points (e.g. an indemnity payment of $152,619.53 is reported in the format 152620).