DI 52165.001 Using the Interactive Computations Facility (ICF) to Compute Workers' Compensation (WC) Public Disability Benefit (PDB) Offset and ICF Terms
Most actions for WC/PDB inputs are done using the ICF WC/PDB functions in the Title II/Interactive Computations area. The Title II/Interactive Computations is located under option #7 on the Main Menu in Personal Communications (PCOM).
The WC/PDB ICF functions are used to make post-entitlement (PE) inputs and when a claim cannot be properly computed in the Modernized Claims System (MCS) Earnings Computation (EC).
ICF functions #31, #32, and #34 are the primary functions used to compute and input WC/PDB offset.
ICF function #33 is used to query or print WC/PDB data.
ICF functions #9 and #28 are sometimes used for computations, but due to system limitations, are used cautiously.
A. Definitions - ICF terms
1. Pre-adjudicate record
The pre-adjudicate function in ICF does not allow the user to process an action to completion. It performs calculations and shows the effects of different WC data without affecting the beneficiary record. ICF #31 is always in pre-adjudicate format. ICF #32 and #34 give the option to save a record in a pre-adjudicate format. Only one pre-adjudicate record is housed in the system at any one time and will remain available for 18 months.
2. Adjudicate record
An adjudicate record in ICF allows you to process an action to completion. You can use ICF #32 or #34 to process adjudicate records. ICF #34 OREO requires referral to a Benefit Authorizer (BA)/Benefit Technical Examiner (BTE) in the processing center (PC) for processing.
Propagation is the process that ICF programs allow you to use data from prior records. You can save data in ICF #31, #32, or #34 as a pre-adjudicate record and later pull this data in for use in an adjudicate record for final processing. All three functions allow you to propagate from prior pre-adjudicate, adjudicate, and shared data records.
B. When to use ICF
Use ICF when:
You need to make an input to add to, change, or delete the existing WC/PDB information on the MBR; or
You are processing an A101 or EF101, WC/PDB involved, and the MCS EC offset computation cannot be used.
C. ICF functions and what they do
ICF #31 performs offset calculations without affecting the record. To process to completion, the data must be propagated into #32 or #34. The record can only be saved as pre-adjudicate.
ICF #32 performs offset calculations and posts the information to the MBR through T2R or creates a record to use with an A101 or EF101. You have the option to adjudicate the record or save the record in a pre-adjudicate format similar to #31.
NOTE: When processing actions in ICF, T2R does not use ICF computations when posting the information to the MBR. The ICF input data is sent to T2R. T2R is a data-driven system that performs its own computations using MBR and T2 Shared data. If you use fictitious data or manipulate the ICF inputs to arrive at the desired ICF results, the resulting T2R WC/PDB offset computation may differ from your ICF results.
ICF #33 allows you to view data from prior pre-adjudicate and adjudicate records. All adjudicated datasheets are stored in the Online Retrieval System (ORS) once the data has been either transmitted to T2R or propagated into MADCAP Direct Data Entry (MACADE). Only the most recent pre-adjudicate data are stored in ICF since the data is periodically purged after 18 months.
ICF #34 does not perform any offset calculations or directly posts the information to the MBR through T2R. The calculations must be done manually. Data from a previously saved #31 or #32 record can be propagated into OREO and overkeyed as necessary. A processing center (PC) benefit authorizer/benefit technical examiner (BA/BTE) effectuates the changes using a MACADE action.
D. How to determine which ICF function to use
If you start to process an action in ICF #31 or #32, that same information can later be propagated into #32 or #34, if necessary.
ICF #31 - Use #31 to run sample calculations or when you do not want to immediately process the action.
ICF #32 - Use #32 to adjudicate your decision and post the WC/PDB data to the MBR in Post Entitlement issues or save the computation for use in an A101 or EF101 in claims situations.
ICF #34 - Use #34 when you need to adjudicate your action and a processing limitation or policy requirement will not allow you to use #32. For limitations, see MSOM ICFT2 031.001D. Also see the Interactive Computational Facility (ICF) Resource Page for WC/PDB Offset Computations See ICF Resource Page. Consider using e2455+ calculator – Click here.
E. Interactive computational facility (ICF) resource page for WC/PDB offset computations
The PCs use a national website, Interactive Computational Facility (ICF) Resource Page for WC/PDB Offset Computations See ICF Resource Page for information about ICF limitations and workarounds. This site also provides helpful hints and processing instructions for more complicated ICF cases.
DI 52165.010 - How to Complete ICF WC/PDB Screens
DI 52165.020 - Situations that require use of #34 (OREO) due to policy requirements
DI 52170.000 - Manual calculations
MSOM ICFT2 031.001D - Processing limitations/exceptions