Basic (09-06)

DI 39545.075 Management of the Consultative Examination (CE) Process

A. Policy

Each State agency is responsible for comprehensive oversight management of its CE process and for ensuring accuracy, integrity, and economy of the CE process. SSA regulations require the DDSs to:

  • Achieve and authorize appropriate rates of payment for purchased medical services consistent with Federal and State laws;

  • Monitor referrals and the purchase of CEs in accordance with SSA policies;

  • Determine rates of payment for medical or other services if the State (the DDS parent agency) does not set a fee schedule;

  • Authorize CEs;

  • Maintain good working relationships with the medical community in order to recruit sufficient physicians and other providers of medical services to ensure ready availability of CE providers.

B. Procedure

DDSs at a minimum must provide procedures for:

  • Monitoring referrals and purchasing of CEs to ensure only required examinations and tests are purchased;

  • Performing medical license verifications to ensure only qualified providers perform CEs for disability determination services;

  • Ensuring close attention is given to specific evaluation issues involved in each case;

  • CE scheduling intervals;

  • Ensuring timely completion and submission of CE reports;

  • Handling claimant complaints;

  • Reviewing CE reports;

  • Conducting annual onsite reviews of key providers;

  • Conducting ongoing recruitment, orientation and training for CE providers.

C. Definitions

1. Consultative Examination (CE)

CEs include physical and mental medical examinations, x-rays, laboratory tests and special diagnostic studies from qualified sources.

2. CE Panelist

A CE provider who has agreed to perform examinations and testing regularly for the DDS and who meets SSA’s qualifications to perform such services.

3. CE Provider

A qualified medical source that performs examinations, tests and other procedures at the request of the DDS and agrees to be compensated for these services based on the DDS’ fee schedule (including treating sources and laboratories). See DI 22510.010.

4. Medical Evidence of Record (MER)

MER includes, but is not limited to, medical history reports, medical opinions, treatment records, copies of laboratory reports, prescriptions, ancillary tests, x-rays, operative and pathology reports, consultative reports, and other technical information used to document disability claims.

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DI 39545.075 - Management of the Consultative Examination (CE) Process - 03/14/2014
Batch run: 03/14/2014