Before the technician creates an EDCS case, the Modernized Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS)/Consolidated Claims Experience (CCE) should be used to establish an:

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  Initial claim,

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  reconsideration request, or

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  hearing request.

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

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 one or more cases have previously been established in EDCS for an SSN, EDCS displays the:

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        Claimant’s name,

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        certified electronic folder (CEF) indicator,

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        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/CCE 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 subsequent application(s) to the mainframe are added or changes are made 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.

1. Title II MCS exclusion

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

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

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

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

Using the MCS Exclusion functionality, 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:

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  CDB and DWB under age 60 - LAF

  • –

    C

  • –

    E

  • –

    S6 - S9

  • –

    D (any number)

  • –

    AD

  • –

    T4, or

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    T6

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  DWB over age 60 - LAF

  • –

    C

  • –

    S6 -S9, or

  • –

    AD

2. Title XVI MSSICS/CCE exclusion

a. Technicians can manually establish an initial level Title XVI MSSICS/CCE exclusion or MSSICS/CCE 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.

c. Technicians should manually establish a MSSICS/CCE exclusion claim in EDCS for aged individuals, 65 years and older, requiring a medical determination to qualify for the pooled trust exception. See SI 01120.203D for more information on pooled trust exceptions.

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/CCE exclusions or limitations:

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  SSI Couples Case Processing Limitations

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  Locked MSSICS/CCE

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  Child filing and parent has no SSN

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  Terminated Supplemental Security Record (SSR)

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

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  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?,"

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

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  Select the claim type,

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  Add the protective filing date,

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

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  Presumptive disability onset date (if applicable), and

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  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.

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.

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:

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  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,

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  verify the case is no longer pending,

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  input the appeal in EDCS, and

• •

  transfer the appeal in EDCS.

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.