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DI 11010.285: Change in Processing Centers (PCs) for Special Disability Workload (SDW) Initial Claims, Appeals and Amended Awards

changes
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  • Effective Dates: 04/06/2018 - Present
  • Effective Dates: 04/11/2018 - Present
  • TN 49 (08-08)
  • DI 11010.285 Change in Processing Centers (PCs) for Special Disability Workload (SDW) Initial Claims, Appeals and Amended Awards
  • A. Background
  • This section provides guidance on PC jurisdiction and processing SDW initial claims, appeals and amended awards, effective 10/01/03. Field Office (FO), Disability Determination Services (DDS) and PC personnel started processing SDW cases in 07/2001. The regions suspended processing these cases in 11/2001 and resumed in May and early 06/2002. A majority of these cases are the Office of Disability Operations (OD) jurisdiction. The remainder of the SDW cases are the jurisdiction of Processing Centers (PCs) 1-6 and the Office of International Operations (OIO).
  • The PC jurisdictional breakdowns for all non-SDW disability cases are as follows:
  • * Cases involving Number Holders (NHs) under age 54 and residing in the United States are ODO jurisdiction.
  • * Cases involving NHs age 54 and over and residing in the United States are PC 1-6 jurisdiction, based on SSN distribution.
  • * Cases involving beneficiaries outside the United States, any age, are OIO jurisdiction.
  • * Process SDW initial claims (awards and denials) and appeals adjudicated by cadre/Field Office (FO) prior 10/01/03, in accordance with the PC jurisdictional breakdown previously mentioned in this chapter.
  • Effective 10/01/03, the following breakdown applies:
  • * Process all SDW initial claims (awards and denials), and appeals involving beneficiaries residing in the U.S., requiring manual processing, any age, adjudicated by the cadre on 10/01/03 or later by PC, based on SSN jurisdiction.
  • * Process all SDW initial claims (awards and denials) and appeals requiring manual processing, any age, involving beneficiaries outside the U.S. by OIO.
  • * Process all SDW cases forwarded by the cadre for amended awards according to the two breakdowns immediately above.
  • NOTE: This does not change the basic PC jurisdictional breakdown. It only changes which component processes the SDW initial claims, appeals and amended awards. The windfall offset and folder jurisdiction follows normal PC jurisdictional breakdown. Processing all other disability claims (non-SDW claims) are still based on the PC jurisdictional breakdown and age of the living NH or if the NH is deceased.
  • These instructions do not modify the basic rule for processing misrouted claims - if a claim is sent to the incorrect processing center, that office processes the claim.
  • B. Processing instructions for SDW initial claims, appeals and SDW amended awards
  • Cadre actions effective 10/01/03 follow the processing preference priorities – Modernized Claims Systems Earnings Computation (MCS EC), Automation Determination of Award (A101), and EF101. SDW cases are not excluded from electronic processing unless the case meets one of the exclusions in Certified Electronic Folder (CEF) Exclusions and Limitations - DI 81010.030A.6.
  • NOTE: These instructions do not change processing claims and amended awards for beneficiaries living outside of the United States. These actions continue to be the jurisdiction of OIO.
  • NOTE: Processing jurisdiction for denials is the same for awards. The Manual Adjustment, Credit and Award Process (MADCAP) Manual Adjustment Credit and Award Data Entry (MACADE) System (Item 10 on SSA Main Menu) provides FO technicians with direct data entry capability for MCS exclusions. Enter MCS disallowance exclusions directly into MADCAP using MACADE Function 5. See Overview of MACADE Disallowance Function SM 00380.500 for more information. Continue to follow special SDW processing instructions located in the SDW Handbook: Continue to follow special SDW processing instructions located in the SDW Handbook here.
  • NOTE: Processing jurisdiction for denials is the same for awards. The Manual Adjustment, Credit and Award Process (MADCAP) Manual Adjustment Credit and Award Data Entry (MACADE) System (Item 10 on SSA Main Menu) provides FO technicians with direct data entry capability for MCS exclusions. Enter MCS disallowance exclusions directly into MADCAP using MACADE Function 5. See Overview of MACADE Disallowance Function SM 00380.500 for more information. Continue to follow special SDW processing instructions located in the SDW Handbook here.
  • 1. MCS EC
  • Use this procedure in the usual manner.
  • 2. A101/EF101
  • For processing A101/EF101 use the following procedures:
  • * A101 - Enter the correct processing center (PC) code based on the 10/01/03 processing jurisdiction breakdown on the DECI screen before transmitting the A101 to the PC. Document the claim electronically if a CEF or EF is involved. If a copy of the document is required fax it into the CEF or EF. If the case is paper forward the claims material/claims file to the processing center of folder maintenance. For example, if the NH is under age 54, send the claims material/claims file to ODO, even though the A101 stub record is sent to a PC for the paperless process.
  • * EF101/Initial, Appeals and Amended Awards procedures:
  • * EF101 - Forward the claims material/claims file to the PC based on the 10/01/03 jurisdictional breakdown. If the NH is under 54 years of age, annotate the route sheet (in addition to SDW remarks) “UNDER AGE 54 CASE.” This alerts the PC that the final folder jurisdiction is ODO.
  • * Amended Awards - Forward the claims material to the PC based on the 10/01/03 jurisdictional breakdown. If the NH is under 54 years of age, annotate the route sheet (in addition to SDW remarks) “UNDER AGE 54 CASE.” (See Electronic Form 101 Process-T2PE 009.001 for instructions on amended award preparation.)
  • NOTE: After the PC processes the award, the cadre may note problems with the award effectuation, e.g., erroneous release of benefits or incorrect rates. If the cadre believes immediate remedial action is needed, the cadre contacts the PC SDW coordinator, through the SDW Project Manager or Regional Office (RO) SDW coordinator, to determine the best means of correction.
  • C. Process – Program Service Center (PSC) actions
  • Effective 10/01/03, the six PSCs receives all SDW initial claims, appeals and amended awards for beneficiaries residing in the United States. If the beneficiary is under age 54, ODO completes all post-adjudicative actions, including windfall offset. Alert PC of all claims, which are the final jurisdiction of ODO, as it affects Action Control Record (ACR) preparation, MACADE coding, and disposition of the material/folder.
  • To assist the PSCs in identifying these cases, the cadre enters the remark “UNDER AGE 54 CASE” (in addition to the SDW remark) in the remarks portion of the A101/SSA-3601 (Claims Routing Form).
  • 1. A101 processing
  • Process the A101 according to current SDW procedures and relevant local instructions. The Type of Event Levels (TOELs) for these awards is CLAIM SPECDIB. The Benefit Authorizer (BA) should always check the A101 remarks to determine if additional information is contained on the RPOC screen(s). If the number holder is under age 54, add MADCAP paragraph B38 to the award notice.
  • If a problem with processing the claim cannot be resolved by remarks on the A101 or RPOC screens, refer the issue according to local procedure for contact with the cadre that forwarded the case.
  • 2. EF 101 and amended awards
  • Use the following procedure:
  • * NH Age 54or Older - Process according to current procedures, PC has final folder jurisdiction. The TOELs are CLAIM DIBTRNS.
  • * NH Under Age 54 - The route sheet contains the remark, “Under Age 54 Case.” Receipt the claim in PCACS under Selection 03, with a Type of Receipt 4 - DIB TRNS on the RCLM screen. The TOELs are CLAIM DIBTRNS.
  • * If the action is an initial claim, do not prepare an original folder. Process the action as an ACR.
  • * The original folder is prepared in ODO. After all processing has been completed, FIN the action and forward the material to ODO. If the action was an initial claim, alert ODO to establish an original folder on PCACS.
  • 3. Windfall offset processing
  • The office that has permanent jurisdiction processes the windfall offset, as well as any other post-adjudicative action. For example, if the SDW award for a claimant under age 54 is processed in Mid-America Program Service Center (MAMPSC), ODO processes the offset action on that case. In most situations, the HST screen and WOD coding on the MACADE action is sufficient to produce an automated computation or exception in the jurisdictional office. There are a limited number of situations when processing an award requires a request to the FO for a manual computation, e.g., amended awards and certain dual entitlement situations. Refer to Processing Amended Awards - SM 00815.200 and Processing Multiple Entitlement Awards - SM 00815.300 for a description of these situations and the required MACADE coding.
  • When making a request for a manual offset computation in connection with processing the award, and the NH is under age 54, process as follows:
  • * Request a manual computation from the FO via the e4345 application. If the e4345 cannot be used, follow local procedures, e.g., fax, PCACS Request for Assistance.
  • * Identify the case as an SDW case and indicate to the FO to return the response to the appropriate module in PC 7
  • * Obtain the module of jurisdiction from DOORS - Function 20 on the SSA MENU.
  • To establish the control in ODO, change the SITE to PC7 on the DIAR screen when establishing a diary, e.g., for e4345 or on the RQF1 screen for Requests for Assistance if the e4345 cannot be used. Enter the ODO jurisdictional module for the COMPONENT and enter BA as the FUNCTION. The TOELs are OFFSET WINDFALL. In the text, explain the reason for requesting the manual computation, and if a diary is prepared to control the action, e.g., fax request, include the code of the FO.
  • 4. Other post-adjudicative actions
  • If the PSC needs to initiate any other development for Number Holders under age 54, follow the PCACS development guidelines using the appropriate functions and TOELs.
  • D. Process – field office actions effective 10/01/03
  • The FOs receive requests from the PSCs on these SDW cases, primarily involving windfall offset, with an instruction to reply to PC 7. Be alert to which office to send the response.
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