SSA has requirements to check for information with Providers.

Social Security Disability Insurance – SSDI
Supplemental Security Income – SSI

An approval of disability leads to Financial payments and Medicaid/Medicare coverage.

Claimants make a claim. SSA/DDS request evidence from Providers. Providers submit medical evidence. SSA/DDS then sends a claim determination to the Claimant

The Medical record is the evidence.

Situation Today

Multiple Directories (Vendor Files)
Information about language and Transportation
Four Territories
Location information (Billing and Record locations information)

3.2M entries in Vendor files

Information Source is from claimants identifying where they have been treated.

Historical information is needed. eg. Applications come in using names that were used 20 years ago. – Maintain request preferences. eg. Paper, fax
Profile Information
— Consultant exams mean they have to keep information current to be able to refer claimants for exams

Challenges moving forward

Governance
Operational (Sources of Truth, Resources)
Sustainability

Interoperability opens up possibility for dramatic improvements in turn around. From 90 days to 45 for paper + Electronic to 48 hours for fully Electronic.

Presenter: Marty Prahl, Office of Disability Systems, SSA

The Challenge with Direct is the missing Workflow layer.

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