Identification Number:
DI 81020 TN 24
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:DDS Procedures - Electronic Process
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 810 – Electronic Disability Guide (eDG) Procedures for the Electronic Process
Subchapter 20 – DDS Procedures - Electronic Process
Transmittal No. 24, 09/10/2021

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

This is a Quick Action Transmittal. The revisions to this section do not change or introduce new policy or procedure.

Summary of Changes

DI 81020.020 Electronic Case Development

E. Health Information Technology (health IT) - The list of health IT documents was updated. A list of the HIT MER included and excluded from the HIT Standard Document was added. In addition, DI 22505.006C.1.c was added as a reference.

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:

  • The information provided by the claimant during the disability interview; and

  • Three extra spaces for additional jobs.

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:

  1. 1. 

    Select the Case Documents tab in eView;

  2. 2. 

    Select Section E. Disability Related Development (Blue); and

  3. 3. 

    Select the Work History Report (SSA-3369), if present.

Or

  1. 1. 

    Select the Case Data tab in eView;

  2. 2. 

    Select Forms from the navigation tree on the left side of the screen;

  3. 3. 

    Select the appropriate claim level; and

  4. 4. 

    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”.

See Also:

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 No Request, HIT Response, HIT Extract, and HIT SSA-827 Issue located in the blue section of the EF.

  • HIT MER is presented in a HIT Standard Document. HIT Standard Documents include narrative reports for the following:

    • Audiometry/Audiology Reports

    • Angiograms

    • Cardiac Catheterizations

    • Doppler Tests

    • Electrocardiographs, Electrocardiograms (ECG)

    • Echocardiograms

    • Stress Testing (exercise, pharma)

    • Holter Monitoring

    • Electroencephalograms (EEG)

    • Electromyography (EMG)/Nerve Conduction Studies

    • Genetic Testing

    • Visual Acuity

    • Visual Fields

    • Mental Status Evaluations

    • Neuropsychological Testing

    • Psychological Testing

    • Computed Tomography (CT) Reports

    • Magnetic Resonance Imaging (MRI) Reports

    • Positron Emission Tomography (PET) Reports

    • X-Ray Reports

    • Myelograms

    • Defusion Capacity for Carbon Monoxide (DLCO) Studies

    • Pulmonary Function Tests (PFT)

    • Bone Marrow Biopsy/Aspiration

    • Colonoscopy Reports

    • Endoscopy Reports

    • Ultrasound (excluding Dopplers)

    • Laboratory Results

    • Pathology Results

    • Admission Summaries/History and Physicals

    • Emergency Room (ER) Notes

    • Discharge Summaries

    • Consults (Inpatient and/or Outpatient)

    • Neonatal Reports

    • Operative Reports

    • Office Notes

    • Clinic Notes

    • Mental/Behavioral Health Notes

    • Progress Notes

    • Physical /Occupational Therapy Notes

    • Antineoplastic Therapy Notes

    • Blood Transfusion Records

    • Dialysis Records

  • HIT Standard Documents exclude graphical evidence or images for the following:

    • Audiograms

    • Tracing Images

    • Visual Fields

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:

  1. 1. 

    Continue normal case development;

  2. 2. 

    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. For more information on when a traditional request is needed, see DI 22505.006C.1.c.

If the HIT MER does not cover the relevant time period alleged by the claimant or if it provides clues that additional medical records 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.

If there is Health Information Technology (HIT) medical evidence in the yellow folder, prior to utilizing traditional means to request follow-up medical evidence, utilize electronic means for following up for medical records, such as a HIT User Trigger. Also, use Electronic Records Express (ERE), if available.

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.


DI 81020 TN 24 - DDS Procedures - Electronic Process - 9/10/2021