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.
- Multiple Directories (Vendor Files)
- Information about language and Transportation
- 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
— Consultant exams mean they have to keep information current to be able to refer claimants for exams
Challenges moving forward
- Operational (Sources of Truth, Resources)
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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