Case Worksheet (CWS)

The Case Worksheet is the main interface and point of interaction between the case worker and pending cases. All activity regarding the claimant is initiated through the CWS. It is here the case worker finds all pending items-case receipts, letters to be sent requesting medical evidence (MER), Consultative Exam (CE) follow-ups, etc.

 

Through the worksheet, the case worker can create a MER letter, order a CE, fill out a closure form, or write a decisional case notice. Additional entries can be made for phone contacts or case notes. Each worksheet entry can be accompanied by a detailed notes screen that includes a keyword search function.

 

Integration with all DCM modules provides automatic updates of the CWS in real time avoiding redundant data entry. CWS is an aid to the case worker in the development and collection of evidence related to the claim, generation of timely follow-ups and notification of third parties with legitimate interests in the claimant's case. At any time during the process, the CWS detail may be printed.

Case Receipt

Cases are generally received through electronic processes from external systems. An Electronic Folder is created and DCM provides an Electronic Folder Interface which allows access to all documents for the case.

 

Consultative Exam (CE)

CE provides the capability to automatically order and schedule medical, psychological and secondary (laboratory, x-ray) evaluations of the claimant. It contains automated follow-up functions, reminder letters, CE budget reports and vendor performance reports. It integrates with the fiscal system to authorize payments to vendors and claimants. It supports multi-language letters.

CE Outbound Fax

This module is an extension of the MER Outbound Fax. Often government agencies may send copies of medical evidence gathered through MER to doctors who will perform consultative exams. CE Outbound Fax allows CE request letters, medical release forms and medical evidence to be automatically faxed to participating vendors. For nonparticipating vendors, the system prints the letters, forms and medical evidence for mailing.

eForms

This application allows the case worker to select web-based forms and complete them electronically. The system allows the form to be populated with selected case information. The forms can be saved in the EF, modified and printed at the case worker's discretion.

Closure Forms Processing (CFP)

CFP automates the final processing of cases which includes creation of the case closure screen, printing of determination forms, and updating the Electronic Folder. Decision codes, standard decisional notice text and claimant explanation letters are provided for efficient case closure.

Disability Hearings Unit (DHU)

The DHU module provides the capability to schedule and track hearings requested by claimants. Schedules are maintained for the officers at multiple offices throughout the state. It contains automated follow-up functions, reminder letters, travel expense re-imbursement... It integrates with the fiscal system to authorize payments to vendors and claimants. It supports multi-language letters.

Medical Consultant Referrals (MCR)

This module supports the referral of cases to in-house medical staff for review. Their expertise is invaluable to the adjudicative staff in making accurate claimant disability evaluations. MCR tracks actions taken by the medical staff in support of the case development. Payment of the staff can be configured by action, by review, fixed salary, etc. The actual checks are produced from an outside source.

Automatic Case Assignment (ACA)

ACA automatically assigns cases to case workers based on user-definable parameters. These include new cases as well as backlog cases. Any cases not assigned are stored in the backlog for the next case assignment process.

Medical Evidence of Record (MER)

The MER application automates the collection of medical evidence received from health care professionals. Letters are created from stored formats and paragraphs, claimant data, and case worker keyed text. The case worker may select prototype letters from a list of user defined letter types. This module can optionally be used to generate claimant and third-party letters. MER supports multi-language letters.

Electronic Folder (EF)

EFI is a totally integrated solution to electronically receive medical evidence and CE Reports from providers and manage them along with the original MER letters, CE requests, and invoices in a paperless fashion using electronic delivery and workflow technologies. When the CWS screen alerts the case worker that medical evidence or a CE report has been received, it can be delivered directly to the case worker's workstation to view and process the case in a paperless manner. The evidence can be electronically viewed, highlighted, annotated, mailed, faxed, printed, saved, etc. EF supports multiple formats including eForms, manually scanned images, imported documents, etc.

MER Outbound Fax

This module allows MER letters created by the case worker, to be merged with a Medical Release Form, and automatically faxed to participating vendors. For nonparticipating vendors, the system prints the letters and forms for mailing.

Quality Assurance (QA)

QA is an automated process to select cases for review. User-specified selection and sampling criteria are used to create a Sample Profile. A QA case record is created for each case that meets the Sample Profile. The reviewer can record and classify errors. A large text area is featured to provide the case worker with reviewer feedback. A variety of QA management reports are provided. Both In-Line and End-of Line QA processes are available.

System Architecture

The Case Management System currently operates on the IBM iSeries™ family. The system fully supports reading and writing of data in XML format for interoperation with other systems. IBM’s DB2 database is uniquely suited to support many different development environments through adherence to existing and emerging open standards. DCM's adoption of an electronic folder and a paperless environment is facilitated by IBM’s Content Manager. Content Manager for iSeries provides document imaging, integration, and workflow from entry to enterprise level. IBM WebSphere Message Queue (WMQ) allows interchange of data from statewide or nationwide locations to a central data repository. It offers comprehensive security options and assures reliable delivery of data transactions.

To Do Lists (To Do)

This module can be configured to summarize the case workers daily workload in an intuitive prioritized tickler list. For example, the tickler list can be configured to show Active Cases, New Cases Assigned, case worker designated follow-ups (reminders), aged outstanding cases, cases with completed MC Referrals, cases with newly available supporting medical evidence ... To Do Lists are available not only for adjudicative staff but also for case supervisors, QA personnel, Medical Consultants; anyone supporting the adjudicative development. From the To Do List you can seamlessly access the Case Worksheet to perform development. These functions help ensure that the agency makes efficient use of their limited resources.