Update on Health IT at SSA

SSA’s HIT initiative is an electronic records transmission program that allows SSA to request and obtain medical records from participating providers instantaneously at no cost to the claimant or representative. While only agency staff can currently utilize HIT directly, NOSSCR is working on getting HIT expanded to representatives and ensuring that HIT is utilized whenever possible to obtain records, which saves times, reduces costs to claimants and representatives, and ensures the record is complete. For these reasons, this is a top priority for NOSSCR.

As a direct result of our efforts, we’ve convinced OHO to add a functionality so that HIT requests are automated at the hearing level (i.e. when a request for hearing is filed, HIT requests are made automatically like they are at the DDS level). This automated HIT trigger was implemented in February 2023 for every new case received at OHO. We have also confirmed with SSA and OHO leadership that OHO staff should be making updated HIT requests during case workup in all cases, regardless of whether the claimant is represented or unrepresented, and that the automated HIT trigger does not preclude use of the manner trigger to generate subsequent HIT requests. 

We hope this will ensure HIT is being utilized more consistently while we continue to advocate for the expansion of HIT to the representative community.

A list of participating HIT providers can be viewed here.  Below is a factsheet on HIT provided by SSA.

Health IT (HIT) at SSA

Overview

• Medical Evidence Gathering & Analysis through Health IT (MEGAHIT) is the system that provides an automated approach to request, pay, and process electronic medical evidence from participating Health IT (HIT) partners for all adjudicative levels with the presence of a valid authorization to disclose information to the Social Security Administration (SSA-827).
• We have 228 HIT partners in 50 states, DC, and five U.S. territories representing more than 35,300 provider facilities.
• When a case with a participating HIT provider is transmitted from the field office to the Disability Determination Service (DDS) or Hearing Office, an automated request reaches the medical provider and if evidence is available, it is in the case by the time it reaches the DDS.
• Additionally, users at all adjudicative levels can initiate a user-triggered request for records via HIT for additional, updated medical records.
• Adjudicators receive decision support through business rules mapping specific diagnostic and procedure codes to SSA’s medical listing of impairments.
• MEGAHIT’s automated fiscal process (Pay4HIT) pays providers the national rate of $15 for every response generating HIT MER received via HIT.  We automatically generate invoices for SSA’s financial offices, the Department of Treasury (DOT), and provider statements.  This enables DOT to make more timely payments to providers who respond to our request for medical records through HIT. 

Benefits

• HIT provides SSA adjudicators a standardized format and display of medical evidence.
• HIT provides structured data to aid decision support and quality assurance to examiners through intelligent analysis via business rules.
• Faster records receipt and a standardized display of records leads to more efficient case processing:
  • On average, cases with HIT Medical Evidence of Record (MER) processed 9.9% faster than those without.
  • Cases with only HIT MER processed 43.7% faster.
  • Records are received in seconds to minutes, instead of days to weeks such as when requesting via traditional methods of fax or mail.
• Less burdensome for medical providers to respond to SSA requests as compared to channels that require manual actions