Tuesday, April 05, 2016

#ONCPDW #PDWorkshop Social Security and Provider Directories

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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