Identification Number:
DI 81010 TN 26
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:FO Procedures - Electronic Process
Type:POMS Transmittals
Program:Title XVI (SSI)
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. 26, 10/11/2019

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

ODP revised this section to incorporate EDCS releases 32, 33, and 34 about the new Manual T16 Claim functionality. We also clarified the screens EDCS will display when technicians create disability cases for initial and appeal level cases.

 

Summary of Changes

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

In section A

We added a POMS reference redirecting the FO to DI 81010.150 for creating EDCS cases for Appeals Council requests.

We added information about the Manual T16 Claim functionality to the NOTE.

We changed the format and layout for steps 1 and 2. We also added specifics about what information the EDCS screens will display during case creation.

We moved the A.4 NOTE as text in section A.2.

In section B

We changed formatting to steps 1 and 2 to separate MCS exclusions based on Title and added MSSICS exclusions.

We added case creation procedures for the MSSICS exclusion utilizing the Manual T16 Claim functionality in EDCS.

We also added an IMPORTANT note that the Manual T16 Claim functionality should not be used for CDRs, and a NOTE that a Title XVI Age 18 redetermination is a CDR and to not process the case utilitizing the Manual T16 Claim functionality.

We added that a Manual T16 appeal level case can be established when the prior level case was not established in EDCS.

We added that a Manual T16 adjudicative level can be changed only on appeal level cases from appeal to escalated initial.

In section C

We removed the overview, changed layout, and clarified section by adding what information the EDCS screens will display when selecting disability reports for initial and appeal level cases.

In section D

We added the word prior before case to provide clarification to the FO user. This way the FO user knows that the appeal is for the prior case that at one time was closed out in EDCS, but is now pendingw due to medical reactivation or reopening, and not the new appeal level case the FO is trying to create in EDCS.

In section E

We added the word "prior" before "closed case" to provide clarification to the FO user. This way the FO user knows the closed case is referring to a prior case that was established in EDCS, and that explains to the FO user why he or she will see the Copy from Prior Button appear when creating a new case.

For section 1, we combined sections 1 and 2 since section 2 seemed redundant of section 1.

We added a new NOTE to section 1 to clarify that the FO user can key in new disability report or use the Copy from Prior button when creating a new EDCS case.

 

For section 2, we removed section 3, but incorporated the text into section 2. We revised the section to clarify the scenario and to elaborate the procedures that would essentially allow the FO to use the Copy from Prior button when creating a new EDCS case.

In section F

In the overview, we added Military Service Casualty Cases (MSCC) as a type of case that can be curtailed in EDCS. Throughout the F subsection we removed CAL before PM since it is the predictive model software that makes CAL as well as QDD determinations.

In section F.3, we revised the first bullet. An FO user can go back and curtail a 3368 after he or she initially answered "No" to the Curtail Form completion question on the Forms Selection page if he or she did not select the paper option for the 3369.

In section 4, we added i3368 to the subsection title since the content in the subsection references curtailment of an i3368. We also removed the overview to remove redundant information in the subsection.

We changed the title of subsection 4.a. We revised the content in the subsection, so the FO user can see when curtailment is automated or not automated at EDCS case creation. We revised the content to remove redundant information throughout the subsection. We removed the NOTE since the predictive model automatically runs initially in iClaim when the internet 3368 allegations are entered. We moved the information about when the predictive model runs at transfer to set CAL indicator to the end of this subsection.

We changed the title of subsection 4.b. We revised the content to reflect system changes to when the predictive model will run for non-internet claims, and that curtailment will no longer be automatic when the FO manually keys in a 3368 since disabling allegations are no longer collected in MCS nor MSSICS. Disabling allegations are now only collected on the 3368. EDCS currently uses a web service to call the predictive model that makes the CAL determination at the time of transfer to the DDS, and sets the CAL indicator. We removed the NOTE, but incorporated the part about the predictive model running when the user leaves the Medical Conditions page.

In section F.4. c, we made minor revisions. We removed the word CAL before PM as mentioned above throughout the section. We changed Select Form(s) page to the reflect the actual name of the page, which is Form(s) Selection page. We removed the NOTE, but instead incorporated in the paragraph that the Calculate CAL button remains on the 3820. We removed throughout the F section the references about the PM running at transfer to determine whether CAL applies, and moved it to the end of this section. We also added that at transfer, EDCS sends the CAL/QDD indicator to the DDS.

 

DI 81010.020 Creating Electronic Disability Collect System (EDCS) Cases

A. Establishing mainframe claim prior to creating EDCS case

Before the technician creates an EDCS case, he or she should use the Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS) to establish an:

  • Initial claim,

  • reconsideration request, or

  • hearing request.

For creating EDCS cases for Appeals Council (AC) requests, see DI 81010.150.A.3.

NOTE: For exceptions to establishing mainframe claim prior to creating an EDCS case, see DI 81010.020B in this section.

When establishing a case in EDCS:

  1. 1. 

    Always establish the case under the claimant’s own Social Security Number (SSN).

    1. a. 

      If there is no previously established case in EDCS for an SSN, EDCS displays a dialog box saying “NO EDCS CASE FOUND” on the Select Case Level screen.

    2. b. 

      If we previously established one or more cases in EDCS for an SSN, EDCS displays the:

      • Claimant’s name,

      • certified electronic folder (CEF) indicator,

      • date of birth,

      • date the case was established in EDCS,

      • claim or appeal level (initial, reconsideration, hearing, or Appeals Council),

      • claim type,

      • office code and type, and

      • status for each prior folder.

  2. 2. 

    EDCS cases are classified as either "initial" or "continuing disability review " (CDR) cases. Select the correct classification and the adjudicative level you want to establish. The adjudicative level must match the claim level established on the mainframe.

On the Select Case Level screen, the technician can select MCS exclusion claim, see DI 81010.020B.1 in this section. For MSSICS exclusions, if no mainframe claims are detected, then EDCS will allow the technician to manually create a TXVI claim, see DI 81010.020B.2 in this section.

The EDCS case is associated with the pending mainframe application. If you add a new subsequent application(s) to the mainframe or make changes on the mainframe to a claim after the case is transferred to another component, perform an Update After Transfer (UAT) using the EDCS UAT utility. For more information regarding the UAT utility, see DI 81010.095.

NOTE: For processing partially electronic cases, (e.g., case where one claim type can be established in EDCS, but a different claim type is an EDCS exclusion) refer to DI 81010.030C.

B. Exceptions to establishing a mainframe claim prior to creating an EDCS case

1. Title II MCS exclusion

The technician does not need to establish a new claim in MCS for the following Title II conversion claims:

  • Auxiliary child benefits (AUXCHD) to Childhood Disability Benefits (CDB) for continuing eligibility. For further instructions, see RS 00203.080.

  • Mother's or Father's benefits to Disabled Widow(er)’s Benefits (DWB). For further instructions, see DI 11015.005C.

  • WIB or Mother's or Father's benefits to DWB for Medicare purposes. For further instructions, see RS 00207.020.

Using the MCS Exclusion funtionality, you can establish the following claims in EDCS, as long as the claimant is on an existing Master Beneficiary Record (MBR) with a specific Ledger Account File (LAF) code:

  • CDB and DWB under age 60 - LAF

    • C

    • E

    • S6 - S9

    • D (any number)

    • AD

    • T4, or

    • T6

  • DWB over age 60 - LAF

    • C

    • S6 -S9, or

    • AD

NOTE: The technician must establish appeal level cases in EDCS using the MCS exclusion functionality for CDB or DWB claims if the MCS exclusion functionality was used for the associated prior level case.

2. Title XVI MSSICS exclusion

a. Technicians can manually establish an initial level Title XVI MSSICS exclusion or MSSICS limitation claim in EDCS.

b. EDCS also allows you to establish Manual Title XVI appeal level cases even if there is no prior Title XVI medical determination in the electronic folder. EDCS allows the technician to switch the adjudicative level from appeal to escalated initial on Manual Title XVI appeal level cases.

IMPORTANT: Do not use the Manual Title XVI functionality to establish CDR initial or CDR appeal cases. A Title XVI Age 18 redetermination is a CDR. Do not process these cases using the Manual Title XVI functionality in EDCS. For further processing instructions, see DI 81010.232.

Examples of possible MSSICS exclusions or limitations:

  • SSI Couples Case Processing Limitations

  • Locked MSSICS

  • Child filing and parent has no SSN

  • Terminated Supplemental Security Record (SSR)

c. To create a Manual Title XVI claim in EDCS:

  • On the Case Creation screen, select "yes" to the question, "Does this case have a T16 claim that cannot be brought into EDCS electronically and must be manually created?,"

  • Select the reason for manually creating the case from the drop down list. If you select "Other," you must provide a reason,

  • Select the claim type,

  • Add the protective filing date,

  • On the Manually Created T16 Information screen, provide the alien admission date (if applicable),

  • Presumptive disability onset date (if applicable), and

  • T16 Claims Representative unit code.

When you establish the case in EDCS, fax the paper Title XVI application and any other paper documents associated with the claim into the electronic folder.

C. Selecting disability reports in EDCS

After the technician selects the appropriate classification and adjudicative level (for example, initial claim, reconsideration, or hearing request) of the case, EDCS presents the Confirm Case Creation screen.

1. Initial claims

When creating an initial claim:

  • On the Confirm Case Creation screen, the FO technician selects the appropriate initial claim disability report. EDCS defaults to the report it determines is appropriate, but the technician can change the selection if a different report is appropriate, and

  • On the Form(s) Selection screen, the technician can:

    • key the SSA-3368 (Disability Report - Adult); or

    • submit paper forms.

IMPORTANT: Although the paper feature is currently an option, the only time you should use it for an initial claim is when the claimant or representative submits medical evidence and there is no disability report information. See DI 11018.005 for more information.

If you elect to complete an EDCS disability report that is different from the available Internet disability report, refer to DI 81007.035. If you are keying a subsequent initial case into EDCS and a prior closed electronic folder exists, consider copying information from the prior folder, see DI 81010.020E in this section.

In order to establish a CEF, you must establish all claims associated with the case in EDCS. If you are processing an EDCS case with an EDCS exclusion (i.e., partially electronic case), the official folder is paper. Although the official folder is paper, we can use EDCS to create an electronic record that the Disability Determination Services (DDS), Office of Hearings Operations (OHO), and other components can use for electronic case development.

2. Appeals

When creating an appeal:

  • On the Associate New Case screen, select "Yes" to associate appeal with prior case in EDCS,

  • On the Confirm Case Creation screen, the Appeal filing date is either propagated from the mainframe or the technician keys it in for MCS exclusion and Manual T16 appeal level cases, and

  • On the Form(s) Selection screen, the technician can:

    • key the SSA-3441 (Disability Report – Appeal) data into EDCS,

    • submit paper forms, or

    • select the 3441 Not Received option (only for incomplete appeal requests, see DI 12005.005).

If an i3441 is involved, see DI 81007.055.

For additional instructions regarding EDCS appeals see DI 81010.150.

D. Creating EDCS cases for appeals of less than fully favorable (LTFF) determinations or decisions

EDCS allows for the creation of an appeal for a claim that contains a less than fully favorable allowance. LTFF appeals occur when the claimant files an appeal based on one or more of the following:

  • Closed period (CP),

  • adverse onset date, or

  • medical diagnosis.

You cannot create the LTFF appeal in EDCS when the prior closed case that had a determination is now pending due to medical reactivation or reopening:

  • Notify the office of jurisdiction by uploading an SSA-5002 (Report of Contact) in the electronic folder, stating “Request for appeal received. Return case to FO,” and

  • contact the office of jurisdiction by telephone.

After notifying the office of jurisdiction of the request for appeal:

  • Check Claim Status in EDCS,

  • verify the case is no longer pending,

  • input the appeal in EDCS, and

  • transfer the appeal in EDCS.

E. Creating an EDCS case when a prior EDCS case exists

1. Using the Copy from Prior button in new EDCS case

The Copy from Prior button appears when you create a new EDCS case and a prior closed EDCS case exists. Once you select the Copy from Prior button, the Copy Prior Folder Information page appears. This page contains two summary boxes:

  1. a. 

    The top summary box displays information available for copying.

  2. b. 

    The bottom summary box displays information already collected.

After selecting information from the Available for Copying summary box, the information:

  • Propagates into the new EDCS case,

  • displays in the Already Collected summary box, and

  • can be changed, updated, or deleted in EDCS.

Review and update any information propagated from a prior EDCS case (e.g., verify the address and telephone number for each source copied from a prior case or update information such as the date the claimant last saw the source, the next appointment, the reason for seeing the source, etc.). The original information still exists in the prior EDCS case, remains available for copying, and is not deleted from the Available for Copying summary box.

NOTE: When the technician creates a new EDCS case, he or she has the option to key in all new disability report information or use the Copy from Prior utility in EDCS.

2. Prior EDCS case is erroneously pending

If a prior EDCS case is erroneously pending, though it was properly closed on the mainframe or downstream systems:

  • Verify the case is closed in other systems by reviewing mainframe queries (for example, MBR or SSR) and downstream case processing systems (for example, Case Processing and Management System (CPMS)), and

  • Close the old EDCS case using the Manual Clearance option.

This will allow the technician to create a new EDCS case, and use the Copy from Prior EDCS case functionality.

NOTE: For details on manual clearance, see DI 81010.105.

NOTE: It is never appropriate to use the UAT utility to add a new claim to an erroneously pending EDCS case when we establish a new MCS or MSSICS application(s).

F. Curtailing completion of the EDCS 3368, i3368 or EDCS 3820

EDCS allows curtailing disability data collection for some cases (i.e., Terminal Illness (TERI), Presumptive Disability (PD), Compassionate Allowance (CAL), and Military Service Casualty Cases (MSCC) cases). For details, see DI 11005.020.

1. Choosing the curtailment option on the Form(s) Selection page

If you choose the curtailment option on the Form(s) Selection page:

  • The EDCS 3369 (Work History Report) is grayed out,

  • EDCS does not allow you to select one of the associated radio buttons for form SSA-3369 (i.e., Key, Paper, or None), and

  • EDCS does not allow you to collect information about work history, education, or training.

2. Changing from curtailed to full development

To change from curtailed to full development:

  • Return to the Form(s) Selection page, and

  • change the answer on the Curtail Form Completion question to "No."

3. When you cannot curtail EDCS 3368 or EDCS 3820

You cannot curtail full development of an EDCS 3368 or EDCS 3820 if:

  • You selected the paper option for form 3369-BK Work History Report on the Form(s) Selection page, or

  • an Internet Disability Report has propagated into the EDCS case.

4. Curtailing the EDCS 3368 and i3368 for CAL cases

a. Allegations from an i3368

When the claimant completes the Conditions screen on the i3368, the Predictive Model (PM) runs to determine if one or more of the allegations entered are CAL conditions. If the PM determines there is a CAL condition, the i3368 curtails the job and education history sections.

When the curtailed i3368 propagates to EDCS, EDCS automatically curtails the 3368, and the Curtail Form Completion field on the Form(s) Selection page defaults to "yes."

If the i3368 is curtailed due to CAL, it remains curtailed in EDCS. The technician may add or modify conditions in the 3368, which could change the CAL indicator from "yes" to "no," but it will not uncurtail the 3368.

b. FO keys allegations in EDCS 3368

The FO technician may key in disabling allegations on the Medical Conditions and Physical and Mental Condition Information EDCS screens. After the technician leaves those screens, EDCS runs the PM and alerts the technician about the potential impact to curtailment. The technician can curtail the 3368 by changing the Curtail Form Completion to "yes" on the Form(s) Selection Page, unless one of the exceptions in DI 81010.020F.3 applies.

c. Curtailing the EDCS 3820

The PM does not run automatically when completing the EDCS 3820, so the Calculate CAL button remains on the 3820. However, you still have the ability to change curtailment at any point by changing the Curtail Form Completion answer on the Form(s) Selection page.

EDCS runs the PM at transfer to DDS to determine whether Quick Disability Determination (QDD) or CAL applies. EDCS sends the most recent CAL indicator to the DDS.

 


DI 81010 TN 26 - FO Procedures - Electronic Process - 10/11/2019