Medical costs account for a significant portion of workers’ compensation claims, making Medical Data Call (MDC) reporting a critical component of regulatory compliance and industry analytics. While MDC reporting has traditionally applied to larger carriers, upcoming changes will soon require more insurers to participate.
At the National Council on Compensation Insurance’s (NCCI) recent Data Now Program 2025 (DNP), industry leaders emphasized the expansion of Medical Data Call reporting and the challenges insurers face in collecting, validating, and submitting accurate medical transaction data. As requirements evolve, insurers must assess their reporting readiness, data accuracy, and technology infrastructure to stay compliant and avoid penalties.
This article explores why Medical Data Call reporting is expanding, what challenges insurers must prepare for, and how they can streamline compliance.
What Is Medical Data Call Reporting?
Medical Data Call (MDC) reporting requires insurers to submit detailed medical transaction records, including payments to healthcare providers, treatment types, and prescription drug costs. Regulators and rating bureaus use this data to:
- Analyze medical cost trends and their impact on workers’ compensation premiums
- Monitor provider billing practices to detect anomalies and potential fraud
- Evaluate the effectiveness of cost-containment measures such as fee schedules and utilization reviews
With medical costs continuing to rise, regulators are expanding reporting requirements to include more carriers and more granular data submissions.
Why Medical Data Call Reporting Is Expanding
The NCCI DNP 2025 highlighted several drivers behind the expansion of MDC reporting:
- Lower Reporting Thresholds: More carriers will be required to submit MDC data based on revised premium eligibility criteria.
- Rising Medical Costs: Increased claims costs necessitate better data insights to refine medical pricing models.
- Regulatory and Legislative Demand: State regulators are relying more on MDC data to guide workers’ compensation policy decisions.
- Focus on Provider Transparency: More granular reporting helps detect excessive medical billing and treatment inefficiencies.
As these changes take effect, insurers must prepare their systems, processes, and compliance strategies to ensure seamless MDC submissions.
Challenges Insurers Face with Medical Data Call Reporting
1. Data Collection and Integration Issues
- Medical transaction data often resides in multiple systems, including claims management, bill review platforms, and third-party vendors.
- Data formatting inconsistencies create challenges in standardizing reports for regulatory submission.
2. Accuracy and Validation Concerns
- Missing or incorrect medical procedure codes, provider details, and payment data can lead to rejected reports and compliance fines.
- Ensuring alignment between medical and indemnity claim data is critical for accurate reporting.
3. Increased Reporting Volume & Complexity
- MDC requires insurers to submit detailed, transaction-level data rather than summary-level information.
- Expanding reporting thresholds mean more insurers must handle complex submission requirements.
4. Compliance & Regulatory Risks
- Failure to comply with MDC reporting standards can result in penalties, audits, and increased regulatory scrutiny.
- Inconsistent or incomplete data submissions can impact state-level rate filings and future compliance evaluations.
How Insurers Can Prepare for Medical Data Call Reporting
1. Assess Data Readiness and System Capabilities
- Conduct an internal audit to determine if your existing claims and medical payment systems can capture all required MDC fields.
- Ensure seamless integration between claims systems, medical bill review platforms, and regulatory reporting tools.
2. Strengthen Data Accuracy and Validation Processes
- Implement automated data validation tools to detect missing or inaccurate medical billing details before submission.
- Establish cross-departmental review processes to align medical claim data with indemnity payment records.
How True Helps
TrueClaims™ provides built-in validation checks to ensure MDC submissions meet regulatory requirements and prevent reporting errors.
3. Optimize Reporting Automation and Submission Workflows
- Reduce manual workload by leveraging automation for MDC data extraction and formatting.
- Implement real-time compliance tracking dashboards to monitor reporting deadlines and data quality.
How True Helps
TrueClaims centralizes compliance tracking, ensuring medical reporting stays on schedule and meets evolving standards.
4. Stay Proactive with Regulatory Updates
- Monitor NCCI and state regulatory announcements for changes to MDC thresholds and reporting criteria.
- Engage with regulatory working groups and industry discussions to stay informed about best practices.
Turning Medical Data Reporting into a Competitive Advantage
Medical Data Call reporting is no longer just a requirement for select insurers—it’s becoming a standard across the industry. Carriers that proactively enhance their data accuracy, automation, and compliance strategies will gain a competitive edge in:
- Reducing compliance risks and submission errors
- Gaining better insights into medical cost drivers and provider trends
- Strengthening claims management and underwriting precision
Are You Ready for the Expansion of Medical Data Call Reporting?
By focusing on data integration, automation, and compliance monitoring, insurers can successfully adapt to evolving MDC requirements while improving medical claims cost management.
Next Steps: Preparing Your Organization for MDC Compliance
- Review internal MDC data capabilities to identify gaps in reporting readiness.
- Implement automated reporting solutions to streamline data collection and submission.
- Engage with compliance experts to ensure alignment with new regulatory requirements.
By taking these steps, insurers can transition smoothly into expanded MDC reporting and leverage medical claims data to improve operational and financial outcomes.
For more insights on the hottest topics in the insurance industry and to stay updated on the latest trends, join the True Community, or contact Ryan Smith at ryan@experiencetrue.com to discuss how True solutions can help you stay ahead of reporting and compliance changes.
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