How to Enter or Update Grouped Claims in Mod Advisor

NCCI rating worksheets are the only worksheets that include grouped claims. Unlike standard claims, which list one claim per row, grouped claims combine multiple similar claims into a single entry. Mod Advisor fully supports this structure and handles grouped claims during worksheet imports, manual entry, and Excel import.

Understanding Grouped Claims

On an NCCI worksheet, grouped claims appear in the claim data columns where the claim number is replaced by the number of claims.

For example:

• NO. 7 indicates 7 grouped claims
• The worksheet shows a single total claim value representing all 7 claims combined

When Mod Advisor imports an NCCI worksheet, the system automatically recognizes these grouped entries and updates the claim count accordingly.

How Mod Advisor Identifies Grouped Claims

During import, Mod Advisor will:

1. Read the grouped claim count from the NCCI worksheet (e.g., NO. 7)
2. Set the claim_count field equal to that number (e.g., 7)
3. Map the grouped injury type to a grouped injury code

In the Claims tab, grouped claims are identified in the Injury Code column as:

• 5* – Temporary Total or Temporary Partial Disability (Grouped Claims)
• 6* – Medical Only (Grouped Claims)

These codes help you quickly identify which claims are grouped versus individual.

Editing Claim Count

Mod Advisor restricts when the claim count can be changed to maintain data integrity.

When You Can Edit Claim Count

• The claim count can be modified only when the selected Injury Code is a grouped claims code (5* or 6*).

When You Cannot Edit Claim Count

• If the Injury Code is not a grouped claims code, the claim count remains locked at 1.

The default value for all claims is 1, and users can only change this when a grouped claim Injury Code is selected.

Manual Claim Entry

When manually entering a claim in Mod Advisor, there are two ways to work with grouped claims.

Option 1 – Select a Grouped Injury Code

1. Select a grouped Injury Code (5* or 6*) on the claim form.
2. The Claim Count field will unlock.
3. Enter the total number of claims represented in the grouped entry (e.g., 7 for NO. 7).

Option 2 – Use the “NO. X” Format in Claim Number

Alternatively, you can drive the claim count from the claim number field:

• Enter the claim number in the format NO. X, where X is the number of claims.
• Examples: NO. 4, NO. 12
• Mod Advisor will automatically update the claim count to match the number after “NO.”

The default claim count is still 1, but it can be increased when a grouped Injury Code is selected or when the “NO. X” pattern is used with a grouped claim. 

Excel Import

When importing claims via Excel, the behavior for grouped claims mirrors what happens inside the application.

• If a grouped Injury Code (5* or 6*) is used, the claim count value can be greater than 1.
• If the claim number is provided in the format NO. X, Mod Advisor can use that to interpret the grouped claim count consistently with NCCI worksheets and manual entry.

This ensures that grouped claims behave consistently across:

• NCCI worksheet imports
• Manual claim entry in the application
• Excel-based claim imports