Electronic Disability Claims Processing:

SSA Needs to Address Risks Associated with Its Accelerated Systems Development Strategy

GAO-04-466: Published: Mar 26, 2004. Publicly Released: Mar 26, 2004.

Additional Materials:

Contact:

Linda D. Koontz
(202) 512-7487
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

The Social Security Administration's (SSA) AeDib initiative is designed to provide SSA with a more efficient, paperless system that will enable its disability components to electronically view and share claims data and process claims electronically. Yet previous GAO reviews found that SSA's accelerated strategy to develop AeDib involved risks that could threaten a complete and successful transition to this capability. At the Subcommittee's request, GAO reviewed AeDib to assess (1) SSA's progress and strategy, (2) the adequacy of measures taken to avoid software development problems similar to those encountered in SSA's previous efforts, (3) the adequacy of cost/benefit analyses, and (4) SSA's consultation with stakeholders.

SSA is continuing its work on the AeDib initiative and is in various stages of completing its electronic disability system; however, its accelerated strategy continues to involve risks. Specifically, GAO found that the agency is relying on limited pilot testing to help guide business and technical decisions and ensure that technology supporting the electronic disability system will work as intended. Further, it is beginning its national rollout without ensuring that all critical problems identified in the pilot testing have been resolved and without conducting testing adequate to evaluate the performance of all system components collectively. Without resolution of critical problems and full testing, SSA cannot be assured that interrelated components will work together successfully. While SSA has procedures to guide its software development, it could provide no evidence that it was consistently applying them in this case. In addition, while SSA has identified AeDib system and security risks, it has not finalized mitigation strategies. Without these measures being in place, SSA stands at greater vulnerability to circumstances that could impede project success. The agency also has not validated its analysis to ensure the reasonableness of estimated AeDib costs and benefits. While indicating that it would use pilot test results to validate cost-benefit estimates, officials have not indicated when this will be accomplished. This leaves SSA without a validated cost-benefit analysis, and the assurance that its AeDib cost estimates are reliable and that anticipated benefits will therefore be realized. Finally, SSA reports that it has increased its communications with AeDib stakeholders and users; however, state officials dealing with disability determinations have varying perspectives. A national organization representing these state officials continues to voice concerns about SSA's approach. And while the Commissioner states that SSA is consulting with stakeholders and the medical community, the agency has not articulated a comprehensive plan for ensuring that the concerns of this population are addressed.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should validate all AeDib cost and benefit estimates.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: SSA conducted quarterly evaluations to assess the AeDib (electronic disability system's) performance, costs, and processing times. These evaluations should help the agency ensure the reasonableness of estimated AeDib costs and the anticipated benefits that will be realized.

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should implement a communications plan that clearly and comprehensively conveys SSA's approach for effectively addressing disability stakeholders' and users' concerns and ensuring their full involvement in the AeDib initiative.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: In fiscal year 2007, SSA reported that it had implemented its electronic disability system in all 50 state Disability Determination Services (DDSs) and certified all DDSs as ready to use the system's electronic claims folders as the official claims record. Further, the agency stated that it continually reassesses how it communicates with its electronic disability system stakeholders. However, as of September 2008, SSA had not implemented a communications plan that clearly and comprehensively conveyed the agency's approach for effectively addressing disability stakeholder and users' concerns; moreover, the agency stated that it planned to take no further action on implementing this recommendation. Without a clear and comprehensive plan for communicating with and addressing concerns of its stakeholders, SSA places at risk vital end-user acceptance and support of the electronic disability system that is crucial to its service delivery and to achieving anticipated benefits.

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should establish a revised time frame for and expedite actions toward finalizing AeDib risk mitigation strategies.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: In its comments on our report, SSA stated that it believed the success of its AeDib (electronic disability system) over the preceding 26 months had attested to the agency's diligent and ongoing efforts to mitigate risks. In fiscal year 2007, the agency reported that it had implemented the system in all 50 Disability Determination Services (DDS) and certified all state DDSs as ready to use the system's electronic claims folders as the official claims record. However, as of September 2008, the agency has not provided any evidence that risk mitigation strategies have been completed for the AeDib program, and stated that it plans to take no further action on implementing this recommendation. In our view, risk mitigation strategies continue to be needed to help prevent circumstances that could impede successful AeDib program outcomes.

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should ensure that users have approved the software developed and that systems have been certified for production.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: In proceeding with the implementation of the electronic disability system, SSA took measures to ensure that users approve new software and that it certifies its systems for production. For example, we reviewed agency documentation reflecting disability system users' approval of new software and SSA's certification of over 50 cases where software was put into production during the time frame from February 2004 (shortly after the national rollout of the electronic disability system began) through October 2004).

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should ensure that all critical problems identified in pilot testing of the electronic disability system components are resolved and that end-to-end testing of the interrelated systems is performed.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: SSA did not agree with our recommendation. Thus, the agency did not take steps to resolve all of the critical problems that had been identified during its pilot testing of the Document Management Architecture--a key component of its electronic disability system. SSA also did not conduct end-to-end testing of the interrelated electronic disability system components before continuing with the national rollout of this system. Resolving all critical problems and conducting end-to-end testing of the interrelated system components prior to their rollout could have limited the problems that SSA and the DDSs encountered with the electronic disability system's operation during its nationwide implementation.

    Recommendation: To reduce the risks associated with SSA's strategy to develop an electronic disability claims processing system, the Commissioner of Social Security, before continuing with the AeDib national rollout, should validate all AeDib cost and benefit estimates.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: SSA conducted quarterly evaluations to assess the AeDib (electronic disability system's) performance, costs, and processing times. These evaluations should help the agency ensure the reasonableness of estimated AeDib costs and the anticipated benefits that will be realized.

    Jun 10, 2014

    May 22, 2014

    May 12, 2014

    May 8, 2014

    May 7, 2014

    Apr 2, 2014

    Feb 26, 2014

    Feb 12, 2014

    Looking for more? Browse all our products here