Reporting temporary total disability to temporary partial disability benefit changes

Sept. 29, 2026

When an employee returns to work at reduced hours or wages, the claim administrator must report the change in one of two scenarios. The first is a one-time electronic data interchange (EDI) transaction, while the second is a two-step EDI transaction process. 

One-step transaction process 

The process for changing benefits from temporary total disability (TTD) to temporary partial disability (TPD), with no stoppage of benefits in between, is done by reporting the Change in Benefit Type (CB) transaction. The CB transaction reports a change from one weekly paid periodic benefit to another. The CB transaction works best when the amount of the first TPD benefit payment is known at the time the benefits change, or within two weeks of the employee's actual return-to-work date. 

The CB transaction must include an "actual" return-to-work (RTW Type Code) with the return-to-work restrictions and the "Anticipated Wage Loss Indicator” both set to "yes. " This will ensure a document is generated from the CB transaction. 

Two-step transaction process 

In contrast to the CB transaction process, if the amount of the first TPD payment is unknown at the time benefits change, or within 14 days of the employee's actual return-to-work date, then the sender should submit a Full Suspension (SX) transaction to stop payment of the TTD benefits. The sender must then start the TPD benefits with a Reinstatement of Benefits (RB) transaction after the employee's wages are known and the claim administrator can make the TPD payment.  

Like the CB transaction process, the sender must include an “actual” RTW Type Code within the SX filing, with the return-to-work restrictions and the "Anticipated Wage Loss Indicator" both set to "yes." This will ensure a document is properly generated from the SX transaction. 

Summary 

EDI allows flexible options for reporting a change in the employee's benefits from TTD to TPD. Depending on the specific claim facts, the claim administrator may want to report the change quickly through a CB transaction or may have to wait for the employee's wages information and then report an SX transaction and an RB transaction. Both scenarios are valid reporting tools used by EDI senders.