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Case
Management Modules - iSeries Platform
Case Tracking System (CT)
This system provides capability for tracking Social Security Disability
claims and generating management information, examiner performance data
and case processing information. It tracks disability determination cases
from receipt to disposition, stores case history on-line for reference
when adding new cases, and prepares reports and statistical analysis on
the case information entered into the system.
Automatic Case Assignment (ACA)
This module allows the system to automatically assign cases to examiners
as cases are received or in batch mode. It functions interactively with
the Case Master File in our Case Tracking system as cases are initially
received and entered, thus eliminating the need for operators to manually
assign cases to an examiner before they can be entered into the system.
Cases are assigned to examiners based on case type, case level, examiner
daily and weekly maximums, and case priority.
Consultative Exam/Fiscal System (CE)
This system provides comprehensive functionality for the consultative
exam process from exam scheduling to payment authorization and fiscal
reporting.
It provides the user with the capability to automatically
order and schedule an exam, and contains automated follow-up functions,
reminder letters, CE and MER budget reports, and vendor performance reports.
Medical Evidence
of Record Letter System (MER)
The MER module creates letters to be sent to medical providers and other
sources requesting medical evidence of record, by combining stored boilerplate
formats and paragraphs with claimant data from the Case Master and operator
keyed text. User-definable menus exist for selecting prototype letters
from a list of available letter types. This system is also used to generate
claimant and third party letters.
Automated Closure Process (ACP)
This system allows for the entry of 831, 832 and 833 information, prints
the appropriate forms, and uses this stored information to automate the
creation of the internal case closure screen and the NDDSS closure mask.
Decisional Notices Module (DNM)
This module automates the printing of decisional notices. By storing standard
decisional notice text and only prompting the operator for variable information,
the amount of information to be completed for a decisional notice is significantly
reduced. This module is designed for use with the Automated Closure Process
(ACP) subsystem or as a stand-alone application.
Electronic
Worksheet System (EWS)
This electronic worksheet system is designed to provide all case information
to the examiner through the workstation. The examiner is initially presented
with a summary of his/her pending caseload by various parameters as set
by the system administrator. The examiner can select a category and display
the cases in that category sorted in several ways, including alphabetic,
SSN, and case age.
When an individual
case is selected, the electronic worksheet for that case is displayed
with general information about the case, case issues, a listing of actions
taken, and follow-up actions to be taken. Each of these areas can be expanded
to display more detailed information. From this screen the examiner can
create a MER letter, order a CE, fill out a closure form, or write a PDN.
Additional entries
can be made for phone contacts or case notes. Both case and fiscal inquires
are accessible. Each worksheet entry can be accompanied by a detailed
notes screen that includes a keyword search function. The worksheet can
be viewed by any user who is given access to this function.
Total integration
with all other functions of the system automatically updates the worksheet
in real time to avoid the examiner having to perform redundant data entry.
At any time during the process the worksheet may be printed in detail
format, which includes all notes associated with the worksheet, or in
summary format without the notes.
MER/FAX
The MER/FAX module is a PC-based product that allows MER letters stored
on the DDS host processor to be merged with a scanned image of the 827
Medical Release Form, and automatically faxed to participating vendors.
Upon receipt of the SSA827 at the DDS, it is scanned, indexed, and stored
on a PC. When the MER/FAX software detects a related MER letter on the
host, it automatically retrieves the letter and faxes it along with the
827 to the appropriate vendor. This process is truly invisible to the
user working with the host DDS system. Examiners and other staff can fax
these documents without adding any steps to their current process and
without any training related to PCs, LANs, or fax tools.
CE/FAX
The CE/FAX module is An extension of the MER/FAX module, and can use the
same hardware. It is based on the premise that DDSs sometimes send copies
of medical evidence gathered through MER to doctors who will perform CEs.
Electronic Medical Evidence System (EME)
The Electronic Medical Evidence System (EME) by I. Levy & Associates,
Inc. is a totally integrated solution to electronically send requests
to providers, electronically receive medical evidence from providers,
and manage the original MER letter, the 827, the invoice, and the medical
evidence in a paperless fashion using electronic delivery and workflow
technologies.
Disability Hearings Unit (DHU)
This system provides for the tracking of information related to DHU cases.
It allows for the scheduling of hearing appointments and hearing sites.
It also tracks hearing officers, locations, processing times between major
events in the hearing process, and appointment status.
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