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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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Highlights

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.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration 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.
Closed – Not Implemented
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.
Social Security Administration 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.
Closed – Not Implemented
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.

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Topics

Claims processingDisability benefitsElectronic data processingFederal social security programsstate relationsState-administered programsStrategic planningSystems analysisSystems designSystems evaluationProgram implementation