Data certification is the required process where the data provider submits test data to NCCI for review prior to the data provider being approved to submit data into NCCI’s production systems. NCCI will review the test data and files for proper format, file structure, and system connections. Once certified, the data provider is approved to submit data to NCCI for production processing. The data certification process only applies to: Policy, Unit, Indemnity Data Call, and Medical Data Call.
Data Certification Requirements
Before submitting data to NCCI, data providers must complete and pass the data certification process to ensure quality data is used in NCCI’s products and services. This requirement helps to eliminate possible errors and minimize data quality issues before production processing. Data providers that choose to use a service provider to submit their data must ensure that the service provider completes the certification process as well.
Data providers are also required to notify NCCI and repeat the data certification process when they have relevant system changes in connection with the reporting of their data. This recertification process ensures that quality data continues to be used in NCCI’s products and services.
Getting Started With Data Certification
To start the certification process, data providers must first complete the
Data Provider Profile (DPP) form and submit the form to NCCI. Details of the certification process for applicable data types and DPP form instructions are outlined in the
Electronic Transmission User’s Guide (ETUG). For Medical and Indemnity data, this form may be completed by a service provider.
Who Should Complete Data Certification?
- Carriers, state funds, self-insured groups, or other insurers submitting Policy, Unit, Indemnity, and/or Medical data to NCCI for the first time
- Service providers (third party administrators (TPAs), managing general agents (MGAs), bill review/pharmacy vendors) reporting on behalf of a carrier
- Any data provider with relevant system changes or change in data reporter
Examples of Relevant System Changes for Data Recertification
- Replatforming or significant restructuring of reporting systems, which may cause material changes to the reported data, including supporting systems, claims systems, etc.
- Using a new service provider to report data on the data provider’s behalf
- Reporting a new transaction type or data type
Data Certification Resources by Data Type*
* Financial Calls and Pool Data do not have a formal certification process. Detailed Claim Information (DCI) program requirements are not included in this list as DCI has been retired for all states except Texas, but can be found in the
Electronic Transmission User’s Guide (ETUG).
