Identification Number:
DI 81010 TN 22
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:FO Procedures - Electronic Process
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 810 – Electronic Disability Guide (eDG) Procedures for the Electronic Process
Subchapter 10 – FO Procedures - Electronic Process
Transmittal No. 22, 07/10/2019

Audience

PSC: CA, CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, ERE, FCR, FDE, FDEC, RECONE, RECONR, RECOVR;
DQB: DE, PA, PE, TL;
OCO-ODO: BET, BTE, CR, CTE, CTE TEDE, DEC, DS, PAS, PETE, PETL, RCOVTA, RECONE, RECONR, RECOVR;
ODD-DDS: ADJ, DHU;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: HQ;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Programs (ODP) revised this subchapter to update information regarding CEF exclusions and limitations, and to remove policy outdated due to enhancements in the Electronic Disability Collect System (EDCS) that allow more cases to be processed electronically. We also consolidated the two POMS sections, so that all EDCS exclusion procedures are maintained in one section. We incorporated EM-16021 EDCS/eView/EFI Print Documents Policy Instructions Will Follow Shortly into this Transmittal though this Transmittal update is revising the print policy for partially electronic cases.

Summary of Changes

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

In section A.1, we removed MSSICS exclusion since we have created manual functionality in the electronic folder for initial claims that cannot be processed in MSSICS.

In section A.5, we removed the note since the SDW workload has long-since been completed.

In Section A, we added number 7 subsection to add that Statutorily Blind Determinations are EDCS exclusions, and that the FO should reference DI 13010.135 for paper processing procedures.

We removed overview in section B since we verified with electronic folder systems staff that the only two limitations in EDCS are Title II and Title XVI abbreviated applications.

We updated section C to clarify processing procedures when there is an EDCS case with an EDCS exclusion. We incorporated new print policy for storing most documents in eView for partially electronic cases. There is no longer a requirement to print all documents from eView at case closure to associate with paper folder. The only printing requirement is for documents that solely pertain to excluded claim. We also added a note to incorporate the update after transfer scenario in DI 81010.032 for when there is a second claim being filed, but the first claim has already been electronically transferred out of the Field Office (FO). We do not think it is necessary to repeat the same steps listed in section C. We added DI 81010.085 as a PFI reference. We added the hearing business process for when the hearing office receives a partially electronic case.

In section D, we removed instructions - Processing Reconsideration Cases where an Initial Level Claim was denied by the FO as a Technical or Substantial Gainful Activity (SGA) Denial since the technical reactivation processing instructions are found in DI 81010.110. The FO can also process medical reactivations found in DI 81010.143.The FO can reactivate claims in EDCS or eView. The reactivation functionality is also now at the claim level regardless if it is a technical or medical denial and as long as the claim is in the most recent case in the folder. We plan to update DI 81010.110 and DI 81010.143 in the future to reflect those reactivation functionality changes.

We moved up section E to section D. We clarified that the scenario presented is for Multiple Pending Cases (an Initial Classification folder and a Continuing Disability Review folder). We also added information about a new paper folder indicator in EDCS when a paper CDR case is being processed with an electronic initial claim and vice versa (MPC) to notify downstream components.

We removed section F since all the DDSs legacy systems have the electronic reopening functionality in their software.

We removed section G since the FOs can perform medical reactivations in EDCS or eView. Medical reactivation processing instructions can be found in DI 81010.143. The reactivation functionality is now at the claim level regardless if it is a technical or medical denial as long as the claim is in the most recent case in the folder. We plan to update DI 81010.110 and DI 81010.143 in the future to reflect the reactivation functionality changes.

We removed section H since all the DDSs legacy systems have the electronic reopening functionality in their software.

We removed section I since the FOs can manually add T16 claims at any appeal level though the case was processed as paper at prior adjudicative levels. In addition, OHO has created a business process for processing EDCS exclusions while taking advantage of electronic processing when at least one claim is processed in EDCS.

 

DI 81010.032 Sending an Electronic Disability Collect System (EDCS) Exclusion to the Disability Determination Services (DDS) after a Certified Electronic Folder (CEF) Has Been Established and Transferred

This section is being obsoleted and instead being incorporated as a note in DI 81010.030.

Conversion Table
Old POMS ReferenceNew POMS Reference
DI 81010.030DI 81010.030
DI 81010.032DI 81010.030

DI 81010.030 Certified Electronic Folder (CEF) Exclusions and Limitations

If any Electronic Disability Collect System (EDCS) exclusions are present for any claim associated with a case:

  • Establish a paper folder on the EDCS exclusion; and

  • Use EDCS to enter information on the non-exclusion claim, if applicable.

For details on distinguishing between claims, cases, and filings, see Electronic Disability (eDib) Glossary - DI 81001.010B.1.

If an individual has applied for benefits on multiple titles or Social Security Numbers (SSNs) and one or more of the claims is an EDCS exclusion, the Field Office (FO) must create a paper Modular Disability Folder (MDF) even though one of the claims is in EDCS. The paper folder then becomes the official folder. At case closure, the adjudicating office converts the electronic folder to paper and files the document in the appropriate sections of the MDF. However, data keyed into EDCS for the non-exclusion claim remains electronic and displays in eView.

A. EDCS Exclusions

1. Modernized Claim Systems (MCS) Exclusions

Any claim that is an MCS exclusion cannot be created in EDCS. For a listing of MCS exclusions, see MCS Exclusions - MSOM MCS 004.002.

NOTE: Several types of stand-alone conversion actions that do not require applications can be established in EDCS utilizing the MCS Exclusion Information functionality. For more information on these, see DI 81010.020.

As updates for EDCS are released, situations that were EDCS exclusions in the past will be able to be established in EDCS.

2. Federal Witness Protection Program and Changed-Identity Cases

SSA has jurisdiction of any Title II or Title XVI disability claim filed by, or on behalf of, an individual who changed their identity under the guidance of the Department of Justice (e.g., witness protection program) or due to harassment (e.g., spousal abuse). The DDS does not have jurisdiction over “Witness Protection” or “Changed-Identity Cases.” Normally these cases are not filed in the FO. Due to their sensitive nature, never enter these cases into EDCS. You must complete a paper application and paper disability reports. For more information regarding Witness Protection Program and Changed-Identity Cases see, Title XVI Changed-Identity Claims - DI 11055.115.

3. Celebrity Cases

For SSA purposes, a celebrity is defined as a person of extraordinary national prominence.

  • SSA systems will identify these cases and alert the interviewer an exclusion applies.

  • FO employees must not make the decision to exclude a case based on celebrity status.

  • FO employees must complete paper disability reports in situations involving celebrities.

  • FO should follow normal case procedures.

4. Expedited Reinstatement (EXR) Cases

Although EDCS supports electronic continuing disability reviews (eCDRs), EXRs remain EDCS exclusions. Software changes and an updated business process are required before EXR cases can be correctly processed using EDCS in the eCDR process.

5. Cases with Multiple Periods of Entitlement

EDCS does not support cases that involve multiple periods of entitlement.

6. End Stage Renal Disease (ESRD) Only Cases

Stand-alone claims for ESRD benefits are EDCS exclusions. Process ESRD cases in accordance with HI Based on End Stage Renal Disease - HI 00801.186 through Form SSA-892-U2 (ESRD Medical Determination) - HI 00801.308, and End-Stage Renal Disease (ESRD) Entitlement Provisions - DI 45001.001 through Medicare Disallowances - DI 45001.340.

For information on processing ESRD claims with a CEF, see Processing End Stage Renal Disease (ESRD) Cases - DI 81010.144.

7. Statutorily Blind Determination Cases

During a work CDR, a beneficiary may allege having a visual impairment. These statutorily blind determination cases are EDCS exclusions. Though these cases are processed as CDRs, the DDS must make an initial statutorily blind determination. Software changes are needed to process these cases in EDCS. For paper processing procedures, see DI 13010.135.

B. EDCS Limitations

Title II and Title XVI abbreviated applications (ABAPs) are two EDCS limitations. EDCS does not recognize them as valid claims and will not allow the FO to create a case .

The FO technician may initially establish an ABAP to process a technical denial. If the FO technician determines a technical denial is not appropriate, and the case will require a medical determination, the FO should follow the instructions below.

1. Title II

In order to create a case in EDCS for Title II claims with an ABAP:

  • Change or delete the abbreviated application coding on MCS; and

  • Process the claim as a full application.

Once the full claim is established:

  • The issue DDSDEC appears on the DW01; and

  • EDCS will allow case creation.

2. Title XVI

In order to create a case in EDCS for Title XVI claims with an ABAP, follow your office policy and either:

  • Change the ABAP to a full claim and enter the issue of “Application” on the Modernized Supplemental Security Income Claims System (MSSICS) DW01; or

  • Change the ABAP to a deferred claim and enter the issue of “DEFER APP” on the MSSICS DW01.

C. Processing Multiple Claims When At Least One of the Claims is an EDCS Exclusion

When multiple claims are filed at the same time and at least one of the claims is an EDCS exclusion, the official folder is paper. Use EDCS to enter information on the non-exclusion claim(s), and file documentation that pertains solely to the excluded claim in the paper MDF.

The FO will take the following actions to document both the electronic and paper folders properly:

  • Establish non-exclusion claim(s) in EDCS;

  • Create a paper MDF for EDCS exclusion claim(s);

  • File the documents that pertain solely to the excluded claim in the MDF. In eView, upload any documents that apply to both the electronic and the paper claim;

  • Add a message to the EDCS case indicating that a related paper claim exists. Provide the current claim level, type, and Social Security Number (SSN) for the paper claim, conversion, or appeal along with the reason for the exclusion;

  • Update paper folder indicator (PFI) in EDCS stating that a paper folder has been created for this filing, see DI 81010.085;

  • Transfer case in EDCS;

  • Print an EDCS routing form for the MDF and annotate the form to show that an EDCS Exclusion is associated with the case with the following: “EDCS exclusion-associate with EDCS case transferred on MM/DD/YYYY."; and

  • Mail the paper MDF to the adjudicating office.

NOTE: If there is an EDCS case for a claim that has already been transferred out of the FO, and there is a subsequent claim filed that is an EDCS exclusion, follow the steps for creating the paper MDF in DI 81010.030.C in this section. Utilize the Update After Transfer functionality when creating the message to the EDCS case stating that a paper claim exists, and inform the DDS that it is necessary to update the PFI in eView.

The DDS will:

  • electronically process the electronic portion of the claim;

  • only print documentation that pertains solely to the excluded claim, and associate these items in the MDF for FO adjudication after making a determination; and

  • Return the electronic and paper portions of the case to the FO after adjudication.

The hearing office (HO) will:

  • fax or scan documentation for the excluded paper claim into the electronic folder. This ensures all folder documentation is stored in the electronic folder at the hearing level. Documentation includes the application, development, notices, and decision;

  • Add a message in eView that all documents from the paper claim have been added to the electronic portion of the case. The message indicates all documents for the excluded claim are now stored in the electronic folder; and

  • Print and mail or fax a copy of the hearing decision for the excluded claim to alert the FO or PSC to process the decision.

IMPORTANT: When all claims in a case convert to paper, all documents must be printed. For example, when the DDS closes a case without a determination and the "No Determination" reason is to "Stop Electronic Processing," all documents must be printed and added to the paper folder.

D. Processing an Initial Claim with a Continuing Disability Review (CDR)

Multiple Pending Cases (MPC) are both an initial claim and a CDR for the same individual that are pending at the same time. For example, a Title XVI Age 18 Redetermination and a Title II DIB or CDB. EDCS cannot process MPC, unless one of the MPC scenarios below applies. The FO technician can process MPC by establishing one case in EDCS, and the second case as paper. Though one of the cases can be worked electronically, these cases are still official paper folders. Adjudicating components (for example, DDS) must print all documents at case closure and file in the paper folder.

If an individual files an initial claim and has a pending CDR at the same time:

  • Enter the initial claim in EDCS and complete the disability forms;

    • NOTE: Certain Childhood Disability Beneficiary (CDB) and Disabled Widow Beneficiary (DWB) cases do not require establishment of an MCS claim prior to creating an EDCS case. Supplemental Security Income (SSI) cases that cannot be established in MSSICS can be established in EDCS utilizing the Manual TXI creation functionality. For more information on conversion cases, see Childhood Disability Benefits (CDB) General - RS 00203.080 and DI 81010.020B.

  • Transfer the initial claim in EDCS. On the EDCS Transfer screen, check the paper folder indicator “A paper CDR is being processed together with this case” ;

  • Complete CDR forms and associate them with the Comparison Point Decision (CPD) folder or create a paper MDF;

  • Print the EDCS routing form to attach to the paper MDF. Annotate the EDCS routing form with the following to show that an EDCS Exclusion is associated with the case: “EDCS exclusion-associate paper CDR with EDCS initial case transferred on MM/DD/YYYY"; and

  • Mail the paper MDF to the adjudicating office.

The FO technician can establish MPC for the following scenarios in EDCS:

  • CDR Appeals Council (AC) or Federal Court (FC) level case, if a non-CDR case exists at the Initial (IN), Reconsideration (RC), or Hearing (HR) level;

  • A non-CDR case at the IN, RC, or HR level, if a pending CDR case exists at AC or FC level;

  • A non-CDR case for the AC or FC level case, if a pending CDR case exists at the IN, RC, or HR level;

  • CDR case for the IN, RC, or HR levels if a non-CDR case exists at the AC or FC level.


DI 81010 TN 22 - FO Procedures - Electronic Process - 7/10/2019