TN 6 (07-10)
DI 81020.020 Electronic Case Development
A. General case development information
For Certified Electronic Folder (CEF) cases, follow current policies and procedures when:
Developing disability cases;
Developing and requesting Medical Evidence of Record (MER); and
Obtaining Consultative Examinations (CE) (see Consultative Examinations (CE) - DI 81020.070).
B. Modifications to case development correspondence
Case development letters used to request evidence for CEF cases, when appropriate, must include:
A Document Management Architecture (DMA) barcode with appropriate indexing information (see Document Management Architecture (DMA) Barcodes and Document Indexing - DI 81020.035);
The Disability Determination Services’ (DDS) P.O. Box of the contract scanner as the return address (see Contract Scanning Procedures – DI 81020.045A.); and
At the discretion of the DDS, the DMA fax number so that medical providers can fax documents directly to the CEF.
C. Requesting work history from the claimant
Information entered into the Work History section of the Electronic Disability Collect System (EDCS) SSA-3368 (Disability Report – Adult) propagates into the EDCS SSA-3369 (Work History Report).
When printed from eView, the SSA-3369 includes:
To prevent unnecessary development of the SSA-3369, the Disability Examiner (DE) must review the CEF for the presence of the SSA-3369 before developing the case.
To locate the SSA-3369:
Select the Case Documents tab in eView;
Select Section E. Disability Related Development (Blue); and
Select the Work History Report (SSA-3369), if present.
Select the Case Data tab in eView;
Select Forms from the navigation tree on the left side of the screen;
Select the appropriate claim level; and
Select the SSA-3369 to view.
If the SSA-3369 is in the CEF, review the document for completeness and accuracy. If the SSA-3369 does not contain all relevant vocational experience and descriptions, obtain such evidence following normal case development per DI 22515.030 Use of Form SSA-3369-BK (Work History Report).
Send the partially completed form to the claimant for completion. If the claimant lists more past relevant jobs than can be documented on one SSA-3369 form, send sufficient additional forms to document that work history.
In lieu of sending the claimant additional SSA-3369 forms for supplemental evidence, DDS may obtain this information by telephone and document findings on an SSA-5002 (Report of Contact) or on the DDS case development worksheet. Annotate eView in the “Note” section of the existing SSA-3369 to reference the SSA-5002 or worksheet (see Use of Form SSA-3369-BK (Work History Report) - DI 22515.030).
D. Appointed representative data
If the DDS receives a Title XVI-only case with an appointed representative and the appointed representative data is not included in the Electronic Folder Interface (EFI) download:
Check EDCS for a “Representative Involved” flag and an Appointment of Representative Form SSA-1696; and
Key the appointed representative data (name, address, telephone number, fax number) into the case processing system to ensure that copies of letters and notices are sent to the representative.
REMINDER: The FO receives an alert that appears on the EDCS Action Page. The action item appears as, “Request FO to add Client Contact”.
NOTE: EDCS/eView/EFI no longer distinguishes between attorney and non-attorney representatives. An appointed representative is always referred to as “Appointed Representative”.
DI 81010.100 – Electronic Disability Collect System (EDCS) Action Page
E. Health Information Technology (health IT)
If the DDS receives a claim with a health information technology (HIT) flag:
View the “HIT Analysis Alert” message, when present (for more information regarding viewing messages, see Certified Electronic Folder (CEF) Messages DI 81020.090C);
Review the SSA-3367 (Disability Report – Field Office), SSA-3368 (Disability Report – Adult), or SSA-3820 (Disability Report – Child), and any medical evidence submitted by the applicant; and
Review the health IT documents: HIT MER located in the back yellow section of the EF and other health IT documents, such as HIT Request, HIT Response, HIT Extract, etc., located in the blue section of the EF.
The health IT documents appear on the DDS case processing worksheet the same as any medical evidence received.
NOTE: Health IT actions are annotated as “HIT” in the EF instead of health IT.
If, after reviewing the file, the medical evidence is not sufficient for a fully favorable determination:
Continue normal case development;
Send medical records requests to all appropriate sources reported by the applicant and use health IT documents to target development, if appropriate.
If a HIT Response document is in the EF, determine if a traditional medical records request to the health IT participating source(s) is appropriate.
If the HIT MER does not cover the relevant time period alleged by the claimant or if it provides clues that additional medical records may be available (e.g., in paper form or in another system), determine if a call to the health IT participating source(s) or to the claimant is necessary to ensure that the alleged period of treatment is addressed. Initiate a traditional medical records request to the health IT participating source(s), as needed.
Follow current procedures to obtain a consultative exam (CE), as needed (see Consultative Examinations (CE) – DI 81020.070). Attach HIT MER as background evidence, if appropriate.