BASIC (01-08)

DI 81020.015 Electronic Claim Receipt Process

To receipt electronic Continuing Disability Review (eCDR) claims, see Receipting an eCDR - DI 81020.205.

A. General

The Disability Determination Services (DDS) may receive electronic claims transferred from any SSA office or another DDS office. For Electronic Disability Collect System (EDCS) claims, the DDS is alerted to the electronic claim transfer via the Electronic Folder Interface (EFI) download and when they receive the EDCS Routing Form (see EDCS Routing Form - DI 81001.045). Depending on the situation, attachments to the EDCS Routing Form may include:

  • For Certified Electronic Folders (CEF), signed SSA-827s (Authorization to Disclose Information to the Social Security Administration [SSA]), other paper document(s) not faxed or scanned (e.g., medical records submitted to the Field Office (FO) by the claimant), and any available prior paper folders if being sent to the DDS; or

  • For paper folders, a Modular Disability Folder (MDF).

NOTE: In situations where a claim is added via the Update - After - Transfer (UAT) utility, the DDS receives an EFI download for the added claim but does not receive any paper documents (i.e., EDCS Routing Form). It is the responsibility of the DDS to ensure the claim has been receipted and assigned.

B. Receipting Electronic Claims

For FO actions when transferring an electronic claim to DDS, see Transferring Cases in EDCS - DI 81010.085.

To receipt electronic claims, the DDS:

  1. Accepts jurisdiction if the claim was received by the appropriate office. Do not accept jurisdiction if the EFI download indicates a current paper folder exists for the claim and the paper folder has not been received.

  2. Rejects jurisdiction of the claim for the following reasons and examples:

    REJECT REASONSEXAMPLES OF WHEN TO USE

    “Fld/Paper Not Recd in 30 days”

    The paper documents associated with the Certified Electronic Folder (CEF) (e.g., EDCS Routing Form) or the current paper folder is not received within 30 days.

    “Incorrect Jurisdiction”

    The claim was sent to an incorrect office. The DDS adds a message to the CEF if further explanation is needed.

    “Incorrect Claim Type”

    The claim type is incorrect (e.g., CDB-R should have been CDB-D).

    “Incorrect Claim Level”

    The FO denies an initial level claim because a claimant failed to complete and return SSA-827s. The claimant later completes and returns the SSA-827s and the FO sends a reconsideration level claim to the DDS when an initial medical decision is needed.

    “827 Invalid or Not Recd”

    The DDS does not receive any complete paper SSA-827s or there is not an image of a complete SSA-827 in the CEF.

    “Incomplete File”

    Something that is necessary to adjudicate the claim is missing from the CEF (e.g., no SSA-3368 [Disability Report - Adult]). The DDS adds a message to the CEF to indicate what is needed.

    “Requested by FO”

    The FO requests the claim back prior to case receipt.

    “FO Action Needed”

    FO action is necessary before the DDS can process the claim. The DDS adds a message to the CEF to explain what action is needed.

    To reject jurisdiction, the DDS:

    • Enters one of the reject reasons;

    • Adds a message to the CEF to explain the reason for the rejection; and

    • Forwards any documents and paper folders to the appropriate office.

      NOTE: Do not reject jurisdiction of an electronic reconsideration claim if the SSA-3441 (Disability Report – Appeal) is not included in the CEF. These cases are identified by an alert on the Alerts and Message tab in eView titled “5002: 3441 not received” along with the description, “See Case Documents tab for detailed information”. Under the Case Documents tab there is a SSA-5002 documenting the reason for appeal and the FO attempt(s) to obtain the 3441. (See Processing Electronic Reconsideration Cases - DI 81020.025A.).

  3. Processes the EFI Download. EDCS creates an EFI download for each claim established. All claims that have an EDCS Routing Form should also have an EFI Download. If no EFI Download is available, see Electronic Folder Interface (EFI) Download - DI 81020.005. NOTE: Paper folders can have EFI downloads if one claim was entered in EDCS but one claim is an EDCS exclusion.

  4. Do NOT change the claim type. The only time it is acceptable to change the claim type is when making a DI into a BI, a DC into a BC, or a DS into a BS.

  5. Reviews eView and the DDS case processing system for any flags and messages to determine if priority handling is required.

  6. Ensures the Paper Folder Indicators (PFI) are correct (see Paper Folder Indicators (PFI) - DI 81020.010).

  7. Receipts and assigns the claim.

  8. Processes the claim following current procedures.

C. Receipting Paper Folders Associated with an Electronic Claim

Occasionally, a system limitation may prevent the FO from entering a new claim into EDCS when a related claim was previously entered on EDCS. In these situations, the new claim is an EDCS exclusion and the paper folder becomes the official record for the entire case. For a list of EDCS exclusion claims, see DI 81010.030 - Certified Electronic Folder (CEF) Exclusions. Any associated CEF must be converted to paper.

NOTE: If a paper folder is received with no paper SSA-3368 (Disability Report - Adult), SSA-3441 (Disability Report - Appeal), or SSA-3820 (Disability Report - Child) and there is no corresponding EFI download, do not assume that the case is an EDCS exclusion. Check case status using eView and follow procedures in Electronic Folder Interface (EFI) Download DI 81020.005A.

If a CEF claim is pending at the DDS when the FO begins an EDCS exclusion claim, then the following applies:

1. FO Actions

  • Create a paper MDF;

  • Print sections A through D of the CEF and file the documentation in the paper folder;

  • Annotate the SSA-408 Route Slip attached to the MDF “EDCS exclusion-associate with claim transferred on MM/DD/YYYY”; and

  • Mail the paper MDF to the DDS.

2. DDS Actions

  • Manually receipt the paper folder.

  • Assign the EDCS exclusion claim and the pending CEF to the same disability examiner (DE). If the CEF has already been assigned, assign the EDCS exclusion claim to the same DE.

  • Prepare and upload to the CEF an SSA-5002 (Report of Contact) to document that the claim(s) is being processed as a paper folder.

  • Add a message without an expiration date to the CEF to indicate that the official folder is now paper.

  • Update the current PFI for the CEF to show a current paper folder has been created (see Paper Folder Indicator (PFI) - DI 81020.010).

  • Print sections E and F of the CEF and file in the paper folder.

  • Process the case following current paper procedures. All documentation must be maintained in the paper folder.

NOTE: If the EDCS exclusion claim is created before the CEF claim is transferred to the DDS, follow current procedures for processing paper folders.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0481020015
DI 81020.015 - Electronic Claim Receipt Process - 09/27/2013
Batch run: 09/27/2013
Rev:09/27/2013