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Changes to Workers' Compensation Division audits - wcd oregon

Changes to Workers' Compensation Division audits - wcd oregon 2025

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The Workers' Compensation Division (WCD) is implementing a new audit methodology for claims processing performance, shifting from a rigid, one-size-fits-all approach to a more flexible, risk-based system. This change aims to enhance compliance, identify industry issues, reward high performers, and increase accountability among underperformers. Starting in late 2009, WCD will conduct annual audits focusing on timeliness of benefit payments and specific performance areas, replacing existing audit programs. The division seeks industry feedback on these changes and will hold information sessions to discuss the new approach.

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What triggers a workers comp audit?

The work needed during the year may be more than expected, or unforeseen circumstances might reduce your actual payroll compared to the estimate. Therefore, most state regulators require an annual audit so that appropriate adjustments to the initial premium can be made.

What is an NCCI classification inspection?

A classification inspection is a review of a policyholders current business operations to determine the proper classification code(s).

What is the goal for the NCCI?

With over 100 years of experience, NCCI serves as the nations most comprehensive source for workers compensation data, insights, and solutions. NCCIs mission is to foster a healthy workers compensation system through its role as a licensed rating, advisory, and statistical organization.

What is a test audit for workers compensation?

A WCIRB field representative conducts a test audit at the employers place of business or at the location where the employers records are maintained by reviewing all relevant payroll records and reports, including but not limited to payroll registers, payroll journals, individual earning reports, time cards, job

What is a NCCi audit?

NCCI performs test audits in several states. A test audit is an examination, of the carrier audit. The test auditor reviews the original records of the insured, compares those results to the carriers results, identifies and explains any differences, and reports the results back to the carrier.

What is NCCI and what is its purpose?

The National Correct Coding Initiative (NCCI) The Centers for Medicare Medicaid Services (CMS) National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding, with the overall goal of reducing improper payments of Medicare Part B and Medicaid claims.

What is the 90 day rule for workers comp in Oregon?

Oregons Workers Compensation Act is no different. If you suffer an industrial injury, statute provides that notice of an accident resulting in an injury or death shall be given immediately by the worker or beneficiary of the worker to the employer, but not later than 90 days after the accident. ORS 656.265(1)(a).