DI 81030.115 Disability Case Adjudication and Review System (DICARS) User Tools: Folder Indicators - Certified Electronic Folder (CEF)
A. Electronic Folder (EF) Indicator
The EF indicator icon is a DICARS user tool that appears as a computer icon in the Electronic Disability Folder (EDF) column on the DICARS picklists. The EF indicator is used by Federal quality reviewers and regional medical contractors/psychological contractors (MC/PCs) to determine if an Electronic Disability Collect System (EDCS) record exists for the corresponding case on the picklist. The EDCS record may or may not contain electronic medical or non-medical evidence. The EF indicator does not distinguish between cases containing only Field Office (FO) forms from those cases containing electronic medical/non-medical evidence.
B. Paper Folder Indicator
The paper folder indicator is a DICARS user tool that is displayed on the Federal quality reviewers and regional MC/PCs picklists. The paper folder indicator alerts the Federal quality reviewers and MC/PCs whether or not to expect a paper modular disability folder (MDF) from the disability determination services (DDS) for the corresponding case on the picklist, for a prior filing, or for a comparison point decision (CPD).
1. Paper Indicators on the DICARS Picklists
The paper indicator appears in the Paper column on the DICARS picklists and is defined as follows:
Y – Yes - Indicates there is a current paper folder associated with the claim.
N – No - Indicates there is no paper folder associated with the claim.
C – Current folder only is paper.
P – Prior or CPD folder only is paper.
B – Both the current and prior or CPD folders are paper
NOTE: The paper indicator value is derived from the current, prior and CPD eView folder indicators (refer to DI 81030.115B.2.).
2. Folder Indicators for Current and/or Prior or CPD Paper Folders
A checkmark displayed in the eView folder indicator checkbox indicates the presence of a paper folder. When no paper folder is involved, neither box will be checked.
The current and/or prior or CPD folder indicators are displayed:
a. DICARS Query Screen
The DICARS query screen may be used to determine whether there are paper folders for current, prior and/or CPD filings.
Access the DICARS Query Screen (i.e., by using the Query button located on the DICARS toolbar or by selecting Reports on the DICARS menu and then selecting “Query” in the drop-down menu).
Refer to the Workload Unit Summary on the DICARS Query Screen. The paper indicators for current, prior and/or CPD filings are reflected in two columns displayed to the far right on the Workload Unit Summary.
The checkboxes are labeled “Prior” for prior and CPD claims and “Curr” for current claims. The appropriate entries in the corresponding checkboxes are as follows:
—“Yes” indicates presence of a paper folder.
—“No” indicates no paper folder.
—“Yes” indicates presence of a paper folder.
—“No” indicates no paper folder.
—“UTL” indicates no CPD folder (unable to locate).
NOTE: The “prior” and “curr” entries are blank when the paper indicator is Y.
b. eView Case Status Screen
When the checkbox (es) for the current, prior and/or CPD folder(s) are completed by the FO on the EDCS Transfer Screen, the indicator(s) are enabled and displayed in eView on the “Case Status” screen. The current, prior and CPD folder indicators are completed by the FO when transferring a CEF to a receiving office (e.g., DDS). However, keep in mind that the checkbox (es) may have been modified using the eView Case Status Screen if the previous component with jurisdiction created or received a current, prior and/or CPD paper folder or corrected an incorrect FO entry.
Before performing a quality review, Federal quality reviewers and regional MC/PCs must review both the EDF and Paper columns on the DICARS picklists to determine in what form(s) the disability folder exists. If necessary, review the current, prior and CPD paper indicators (checkboxes) as described in DI 81030.115B.2. Federal reviewers evaluate the accuracy of the paper folder indicators and, if necessary, make required corrections.
1. Paper MDF Only
When the EF indicator is blank in the EDF column and the paper indicator is a “Y” in the Paper column (i.e., paper MDF only), the Federal quality reviewer processes the quality review according to existing instructions in the GN 04440.000.
2. Certified Electronic Folder (CEF) Only
Paper Column = N: When the EDF column shows a computer icon AND the paper indicator is an “N,” this indicates a CEF case.
Paper Column = P: When the EDF column shows a computer icon AND the paper indicator is a “P” (i.e., “prior or CPD paper folder only”), a current CEF exists along with a prior or CPD paper folder (i.e., the current filing is a CEF and a prior or CPD paper filing is being forwarded from the DDS). The prior paper filing may or may not have adjudicative significance to the current determination. The Federal quality review includes the review of the CEF and the prior or CPD paper folder.
3. DQB Guidelines – Current, Prior and CPD Paper Folders
a. Updating the Folder Indicators
Each processing office is responsible for updating the current and/or prior or CPD paper folder indicators. Updating the current, prior and/or CPD paper folder indicators ensures that downstream offices are properly notified of the type of case that will be received. Although each processing office can see the indicators, only the component with jurisdiction of the CEF can actually change the indicators.
Current, prior and CPD folder indicators continue to be error-prone. For example, in situations in which the FO set the indicators erroneously and DDS failed to change the indicators (or DDS incorrectly changed the indicators), it is the responsibility of the disability quality branch (DQB) to change/correct the folder indicator(s) values in eView. The “how to” instructions have been posted to QuickPlace (Folder Indicators).
b. Prior Paper Folder – General POMS References
DI 20505.010, Determining Need for Prior Folder;
DI 20505.015, DDS Actions in Obtaining Prior Folder; and
DI 20505.020, DDS Association of Prior and Current Folders.
c. Prior Folders
When documentation from a previously processed case has adjudicative significance to the evaluation and determination of a current case, specific documents that are stored in a prior paper folder must be incorporated into the current CEF.
Reopening Not Applicable - When the prior paper folder documentation is relevant, but a reopening is not applicable, ensure that copies of relevant documentation from the prior paper file are added to the CEF. Ensure that the prior paper folder indicator in the CEF is appropriately reflected.
Reopening Applicable – Until a component's case processing system has been upgraded to version 13.0, when the prior paper folder documentation is relevant and a reopening is applicable, the CEF must revert to paper processing. Relevant documentation from the prior paper file will not be added to the CEF. Refer to DI 81020.115, Processing Reopenings.
d. CEF and Prior Paper Folder (Prior Paper Folder Not Received by DQB)
When the CEF indicates there is a prior filing, but the prior paper folder is not received with the CEF:
Receipt the CEF and assign to a reviewer to verify if the prior paper folder is necessary to adjudicate the current determination.
When necessary, obtain the prior paper folder using established DQB guidelines.
When the prior paper folder is not received from the DDS within a two week timeframe, transfer the CEF to the DDS to obtain the prior folder.
When the DDS adjudicates a CEF without considering the prior paper folder, and DQB determines the prior paper folder is material to the current disability determination or the onset date, cite the appropriate deficiency and return jurisdiction to the DDS.
When a CEF contains no documentation to support the current determination (e.g., no medical evidence of record or SSA-831), the DQB determines there is a related paper folder (e.g., the determination is a reopening), and the paper indicator is “N,” correct the paper indicator and follow up for receipt of the paper folder using established DQB guidelines for obtaining the folder.
CEF Case and DQB Receives a Current Paper Folder
When a CEF (i.e., the paper indicator = “N”) is fully documented (i.e., when all claims for the current filing are part of the CEF) and the DQB unexpectedly receives a current paper folder, do not change the paper indicator. Send the paper folder back to the DDS for storage for the required retention period.
Lost Current and/or Prior Paper Folder
If the current and/or prior paper folder becomes lost en route from DDS to DQB, DQB should search for the paper folder using established DQB guidelines for obtaining folders.
f. CEF and CPD Paper Folder (CPD Paper Folder Not Received by DQB)
When the CEF indicates there is a CPD paper folder, but the CPD paper folder is not received with the CEF:
Receipt the CEF and assign to a reviewer to verify if the CPD paper folder is necessary to adjudicate the current CDR determination.
When necessary, obtain the CPD paper folder using established DQB guidelines.
When the CPD paper folder is not received from the DDS within a two week timeframe, transfer the CEF to the DDS to obtain the CPD folder.