Experience Rating (ER) Split Data Reporting Template

Posted Date: November 22, 2017

Benefit from using the ER Split Data reporting template for submitting data for former professional employer organization (PEO) clients or ownership changes.

The template provides a convenient way for you to enter the audited exposure and loss information for these types of employers and then have an electronic file automatically created for submission to NCCI using Data Transfer via the Internet.

Download the ER Split Data Reporting Template (Excel).

Keep these points in mind when using the template:

  • State applicability and required data elements are defined in the Experience Rating (ER) Split Data Reporting Guide.
  • The first tab is for data input, and the second tab provides entry instructions.
  • Each file you create can contain up to five separate ER Split Data reports. Each report can contain up to 100 rows for exposure and loss data.
  • The created file includes the record layouts as defined in the Experience Rating (ER) Split Data Reporting Guide.
  • Before initial submission, access to submit data files must be granted by NCCI’s Customer Service Department.

Report ER Split Data when:

  • Clients terminate their agreements with a PEO and were covered under the PEO master policy
  • Employers sell a portion of their operations, or a subset of locations, and an ERM-14 Form was submitted to NCCI

For more information, contact our Customer Service Center at 800-NCCI-123 (800-622-4123).