Identification Number:
DI 81010 TN 31
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:FO 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 10 – FO Procedures - Electronic Process
Transmittal No. 31, 11/25/2019

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 Policy is revising POMS to incorporate the instructions related to MINE and MINE-equivalent cases contained in Emergency Message (EM)-16034 SEN. This transmittal updates the instructions in POMS section DI 81010.230, Creating an EDCS Record for an Electronic Continuing Disability Review (eCDR).

 

Summary of Changes

DI 81010.230 Creating an EDCS Record for an Electronic Continuing Disability Review (eCDR)

Subsection A clarifies procedures and add instructions for EDCS case creation for a MINE or MINE-equivalent case

Subsection A1 - We added more detailed instructions.

Subsection A2 - We added eCDR Appeal procedures to reflect UMC functionality from release 39.

Subsection A3 - This section is new and adds steps to create an EDCS case for a MINE or MINE-equivalent case

Subsection B2 - We removed EXR from CDR types as EXR's are processed as paper cases

Section D - We changed the note in this section to describe the Updates After Transfer functionality that now applies to eCDRs.

DI 81010.230 Creating an EDCS Record for an Electronic Continuing Disability Review (eCDR)

EDCS includes screens to collect and display information for processing electronic CDRs (eCDRs). The EDCS files created are similar to the abbreviated records currently created for cases excluded from the Modernized Claim System (MCS). Data is propagated from the Master Beneficiary Record (MBR) and Supplemental Security Record (SSR) to the eCDR in EDCS.

A. EDCS case creation for adult or child CDR

Review the CDR forms upon receipt. Prior to creating the eCDR, ensure that you know the date of the most recent favorable medical decision, known as the Comparison Point Decision (CPD) date, see DI 81010.215A and DI 28010.105. If the CPD folder is a paper Modular Disability Folder (MDF), obtain or thoroughly search for the CPD folder.

1. Creating the initial eCDR

Take the following actions to create an eCDR:

  • Enter the client’s (beneficiary/recipient) SSN or First and Last Name on the Disability Case Selection page and select “Search;”

  • Select the radio button for the closed CDR case for which the eCDR will be established and select “Create Case;”

  • On the Select Case Level page, select "CDR initial"

  • On the Confirm Case Creation page:

    • Select the type of disability report for the case (for example, Adult (454);

    • Enter the Comparison Point Decision (CPD) date;

    • Answer the question, “Have you worked since the CPD date?” with a Yes or No;

    • Answer the question, “Are you using a Ticket to Work?” with a Yes or No;

    • Click on “Create Case” button

NOTE: See related instructions for Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability Collect System (EDCS) DI 81010.232.

 

2. Creating an eCDR Appeal

Verify entitlement before loading a CDR into EDCS and double-check that there has been a determination before loading the appeal. Also, verify that the cessation has posted to the DCF before loading the appeal. These actions will help avoid unnecessary complications.

For Title II CDR appeals, the FO technician enters the appeal directly into EDCS. EDCS collects appeal and Statutory Benefit Continuation (SBC) information. In an effort to prevent improper payments, EDCS automatically updates the Disability Control File (DCF) with case status movement, and medical determination. This information also updates the MBR with appeal data and sets the appropriate payment status.

For Title XVI CDR appeals, the FO technician first enters the appeal through MSSICS in order for MSSICS appeal data to propagate in EDCS. EDCS will automatically update the DCF with case status movement, and medical determination information. If the FO technician is unable to establish the appeal in MSSICS, then the technician enters the appeal via Direct SSR Update. This will result in an EDCS exclusion, and the technician will have to process the appeal as a paper case because the Manual T16 Case Creation functionality in EDCS should not be used for CDR level claims.

For concurrent CDR appeals, the FO technician should first establish Title XVI appeal in MSSICS, and then enter Title II appeal information in EDCS. Processing the Titles in this order will ensure appeal information is captured for Title II and Title XVI in EDCS, and EDCS will then simultaneously send updates about case movement and medical determination to the DCF, and other mainframe systems. However, as stated above, if the FO technician is unable to establish the appeal in MSSICS, the technician enters the appeal via Direct SSR Update, which will result in an EDCS exclusion, and the technician will have to process the concurrent appeal as a paper case.

NOTE: If either title is an EDCS exclusion, please follow paper processing procedures. Do not use the Manual T16 Case Creation functionality in EDCS for CDR initial or appeal level cases.

Take the following actions to create an eCDR appeal case:

  • Enter the client’s (beneficiary/recipient) SSN or First and Last Name on the Disability Case Selection page and select “Search;”

  • Select the radio button for the closed CDR case for which the eCDR appeal will be established and select “Create Case;”

  • On the Select Case Level, select CDR appeal adjudicative level (for example, CDR Reconsideration);

  • On the Associate New Case, EDCS will ask, Would you like your new case to be associated with the prior case listed above?,” select “yes;” and

  • Click “OK” button to create appeal.

3. Creating EDCS case for a Medical Improvement Not Expected (MINE) or MINE-equivalent case

MINE or MINE-equivalent CDR cases do not require completion of a Continuing Disability Review Report (SSA-454)

Take the following actions to create a MINE or MINE-equivalent eCDR:

  • Review the case to determine if MINE or MINE - equivalent processing applies following instructions in DI 13005.022.C.1 through C.3.

  • Enter the Client's (beneficiary/recipient) SSN or First and Last Name on the Disability Case Selection page in EDCS and select “Search.”

  • Select the radio button for the closed case for which you intend to establish the eCDR and select “Create Case.”

  • Select “CDR Initial” from the “Select Case Level” screen.

  • Go to the “Form(s) Selection” screen, following “Form SSA-454-BK Continuing Disability Review Report,” select “Paper."

  • Link the appropriate Comparison Point Decision (CPD) folder (if electronic), see DI 81010.235.

  • Enter the CPD date on the “Confirm Case Creation” screen.

  • Complete the CDR information and EDCS SSA-3367 (Disability Report-Field Office) on the “Form(s) Selection” screen.

  • Add the form SSA-5002 (Report of Contact) to explain the basis for the FO's conclusion to process the case under MINE procedures.

  • Enter the remark, “MINE or MINE-equivalent CDR case process per DI 28040.000” on the Routing Form Remarks section of the EDCS Transfer page.

  • Transfer the case in EDCS to the appropriate DDS. Enter the following responses to the question: Is there a paper folder containing medical evidence for the last favorable determination?:

    1. a. 

      Select “No” if the CPD is electronic.

    2. b. 

      Select “Yes” if the CPD is paper. Mail paper CPD to the DDS.

    3. c. 

      Select "Unable to Locate" if the FO cannot locate the CPD folder, for more information see DI 81010.242.

NOTE: MINE or MINE-equivalent processing does not apply if the FO is unable to locate the CPD folder.

B. CDR information screen

This screen contains basic information about the beneficiary, CDR type, and FO controlling the input. The CDR Information folder contains the following data elements:

1. Client identification

Review the screens to ensure that the correct mailing address has propagated from the MBR/SSR. If the data is incorrect, update the information in EDCS as well as the MBR/SSR.

NOTE: If there is a representative payee, enter the claimant’s residence address on the Client Identification screen.

2. Case information

  • Identify and input the type of CDR from the following chart:

    CDR Types

    Periodic Review Due - 3 year diary/MIP

    T16 Age 18 Redet

    Periodic Review Due - 1 year diary/Low Birth Weight/MIE diary

    CDR Mailer – “DO CDR”

    Periodic Review Due – 5 or 7 year diary/MINE

    SGA Cessation-EPE Medical Review (Sec 111 Protection N/A)

    Miscellaneous (includes T16 1619)

    Named Litigant/court case

    NOTE: Review the Disability Control File (DCF) (ECDR, QCDR, and QMID screens) to ensure that EDCS is picking up all the entitlements (e.g., Claim types) and correct CDR type. If DCF reflects information for more than one CDR (i.e., a prior CDR(s) was done), use the CDR Type for the current CDR being established in EDCS.

  • Input the CPD date (See the Comparison Point Decision (CPD) Date and Folder - DI 81010.215A.).

  • For lost folder cases, enter a CPD date that is 12 months prior to the date of the interview.

  • For Age 18 Disability Redeterminations, EDCS propagates the CPD field as 12 months prior to the case creation date.

  • Enter the appropriate response concerning the need for DDS capability development.

  • Add a "Potential 301 Case Flag" in EDCS if the SSA-454 (Continuing Disability Review Report) indicates the claimant is participating in a Vocational Rehabilitation (VR) Program.

3. Title II or Title XVI FO contact information

Enter the unit code of the FO component controlling the eCDR. The remaining contact information propagates from the mainframe. Correct if necessary.

C. CDR claims screen

The CDR Claims screen displays a summary table containing all claims applicable to the CDR. All of the information is propagated from the mainframe for all claims (Title II and Title XVI). Select the claim to view the CDR claim information.

NOTE: For each entitlement listed in the summary table, review the MBR or SSR to ensure entitlement has not been terminated and that screen out criteria does not apply (See DI 13005.020)

1. Claim information screen

Information for this screen is propagated from MBR/SSR.

2. Representative payee information

To access this screen, select the name hypertext link in the summary table under the Representative Payee Information header of the CDR Representatives page.

NOTE: If the claimant does not have a representative payee, this screen is not utilized.

EDCS collects only one representative payee per CDR case. This screen also indicates whether the payee is the individual’s legal guardian. The representative payee information on this screen is propagated from the mainframe via the MBR/SSR or entered by the user. If there is no representative payee information propagating from the mainframe, the user can enter a representative payee using this screen when appropriate.

NOTE: Under no circumstances should a beneficiary have multiple representative payees listed. Ensure that only one representative payee name and address is captured. If more than one is listed, delete all except the correct payee prior to transfer. If there are multiple representative payees for Title II and Title XVI, make appropriate corrections in the mainframe.

3. Appointed representative information

EDCS no longer distinguishes between Attorney and Non-Attorney contact types. All contacts are now referred to as Appointed Representative. The appointed representative information displayed on this screen is entered in EDCS by the user.

The Appointed Representative screen is accessed from the:

  • Appointed Rep folder of the Navigation Tree;

  • 3367 Capability/Remark page (when there is no 3369 (Work History Report ) folder present);

  • 3369 Remarks page; or

  • Flags page.

For initial, reconsideration, and hearing level eCDR cases, the sources of data for the appointed representative are Registration, Appointment Services for Representatives (RASR), the SSR and any active Modernized Claim System (MCS) Check/Notice 2 (NOT2) screen. EDCS collects one appointed representative per case level (i.e. initial, reconsideration, and hearing).

For appeal level cases, EDCS displays the appointed representative data collected in the prior level. For example, if an appointed representative was entered at the initial level, EDCS displays the initial level information in the appropriate fields of the reconsideration level. If the information is incorrect, change the information in the appropriate system then repropagate the case in EDCS.

When the user enters the Case Selection page for the first time to establish a case, the question, “Does this person have an appointed representative?” is pre-filled with “yes” if appointed representative data propagates from the RASR or the mainframe.

If no appointed representative data propagates and the user answers “yes” to the question, “Does this person have an appointed representative?” complete the additional fields including the name, and contact information, for the appointed representative.

EDCS automatically sets the “Representative Involved” flag when appointed representative data exists or is added on the Appointed Representative screen. EDCS automatically removes the “Representative Involved” flag if appointed representative data is deleted by changing the appointed representative question radio button from [Yes] to [No].

NOTE: Users are able to set the Representative Involved flag manually. As indicated, certain conditions will trigger EDCS to set or remove the flag automatically.

Once an electronic record is created, the FO faxes the SSA-1696 (Appointment of Representative) form to the electronic folder (EF) using current faxing procedures.

4. Legal guardian information

Legal guardian information is collected on the CDR Representative Payee Information page to indicate if the representative payee is also the legal guardian. The field displays a “Yes” or “No” answer when the representative payee information displayed on the screen is propagated from the mainframe. Otherwise, the field must be completed.

D. EDCS 3367

There is no change in the procedure for completing the EDCS 3367.

NOTE: The Update after Transfer (UAT) functionality is limited for eCDRs. Once an eCDR record has been established in EDCS and transferred to the DDS, changes to address, telephone number, etc., must be keyed into the CDR Information or CDR Representative page and sent to the DDS as a UAT. This information does not repropagate from the MBR or SSR. In addition, the FO cannot add a new CDR claim to a CDR classification folder. If a CDR is needed for a new entitlement, the FO must send a paper folder to the DDS to be associated with the pending eCDR.


DI 81010 TN 31 - FO Procedures - Electronic Process - 11/25/2019