Electronic Disability Claims Processing:

SSA Is Proceeding with Its Accelerated Systems Initiative but Needs to Address Operational Issues

GAO-05-97: Published: Sep 23, 2005. Publicly Released: Oct 24, 2005.

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Through an initiative known as AeDib, the Social Security Administration (SSA) is implementing a system in which medical images and other documents that have traditionally been kept in paper folders will be stored in electronic folders, enabling disability offices--including SSA's 144 Office of Hearings and Appeals sites and 54 state disability determination services--to process disability claims electronically. This initiative supports a program that, in 2004, made payments of approximately $113 billion to more than 14 million beneficiaries and their families. In March 2004, GAO recommended that SSA take steps to ensure the successful implementation of the electronic disability system. GAO was asked to assess SSA's status in implementing AeDib and the actions the agency has taken in response to GAO's prior recommendations on this initiative.

Since January 2004, SSA has been implementing its electronic disability system at 53 state disability determination services and 85 Office of Hearings and Appeals sites. It plans to complete implementation in all state sites by October 2005 and all hearings and appeals sites by November 2005. Nonetheless, considerable work is needed before these entities will be ready to process all initial claims electronically. SSA's effort to certify all state offices to electronically process claims and maintain the electronic folder as an official claims record is not expected to be completed until January 2007. In addition, state disability officials expressed concerns about the system's operations and reliability and about limitations in their electronic processing capabilities. Accordingly, a number of the offices reported varying levels of system usage, and their officials said that processing claims electronically generally took longer and consumed more resources than the previous method. Further, SSA and the state disability determination services lacked continuity of operations plans for ensuring that states could continue to process disability claims during emergencies. As SSA has implemented its system, it has taken actions that supported three of GAO's five prior recommendations. It has initiated studies that could help validate AeDib planning assumptions, costs, and benefits. It has also approved new software and certified its systems for production. In addition, according to state disability officials, the agency had improved its communications with them. However, SSA did not demonstrate action on two recommendations calling for thorough testing of its interrelated system components before implementation and completion of risk mitigation strategies for the projects supporting the initiative. Thorough testing and risk mitigation strategies could have helped limit problems with the system's operation and other circumstances that could impede the project's success.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: SSA reported that it has implemented the system in all 50 DDSs and has certified all state DDSs as ready to use the system's electronic claims folders as the official claims record. In FY 2008, the agency stated that it had addressed issues concerning its electronic disability system's electronic forms and had provided the state Disability Determination Services (DDS) with the necessary software capabilities to fully process initial claims in the electronic processing environment. Concerning its monitors, SSA stated that it has provided all disability examiners and medical consultants with dual monitors as well as many other personnel involved in case processing related activities in order to allow employees to view two electronic files simultaneously and improve case processing times. However, the agency has not provided evidence that corroborates their statements. Specifically, SSA has not provided a documented strategy that articulates milestones, resources, and priorities for resolving problems with the electronic disability system's operations.

    Recommendation: To further reduce the risks to SSA's progress in successfully achieving its electronic disability claims processing capability, the Commissioner of Social Security should develop and implement a strategy that articulates milestones, resources, and priorities for efficiently and effectively resolving problems with the electronic disability system's operations, including (1) identifying and implementing a solution to improve the use of electronic forms, (2) identifying and implementing a solution to address concerns with existing computer monitors, and (3) ensuring that the DDSs have the necessary software capabilities to fully and efficiently process initial claims in the electronic processing environment.

    Agency Affected: Social Security Administration

  2. Status: Closed - Not Implemented

    Comments: In fiscal year 2008, SSA reported that state Disability Determination Services (DDS) had developed continuity of operations plans for short-term work disruptions of up to 8 hours. However, the agency could not provide documented evidence that it had ensured the completion and implementation of these plans or that the DDS' planning efforts complemented SSA's contingency plans. In the absence of continuity of operations plans, SSA will lack assurance that it is positioned to successfully sustain the essential delivery of disability benefits during unforeseen circumstances.

    Recommendation: To further reduce the risks to SSA's progress in successfully achieving its electronic disability claims processing capability, the Commissioner of Social Security should ensure that the state DDSs develop and implement continuity of operations plans that complement SSA's plans for continuing essential disability claims processing functions in any emergency or other situation that may disrupt normal operations.

    Agency Affected: Social Security Administration

 

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