27.

Q: What are your future plans for the use of the
ADP system?

A:

Implementation of the ADP system has been planned as follows:

a.

Immediate effort Level I. Use the equipment
available, automate current discrete but
independent functions, institute uniformity
and build an enriched "machine-readable"
data base.

Level II. Identify and specify (document) in detail a complete system "as This effort addresses:

b.

Long Range

it should be."

Management Reports (including transaction processing costs and delays)

The Level I System has been planned for development and implementation in three stages as follows:

Stage 1, comprising the Case Management File
(46 data elements) and the Claimant Name
Index File. This stage provides automated index
capability, case tracking and status capability,
and limited management information reports.

This package started installation in March 1977. Installation was completed in October 1977. The system response time in district offices with large data bases was unacceptable. The entire package was re-written by the equipment vendor. The re-write package has been installed and is fully operational.

33-532 O 79 (Pt. 2) - 25

27. Continued

Stage 2, comprising the Claimant Address File,
the Supplemental Name (i.e., Supervisor, third-
party, dependents, etc.) File, the Priority
correspondence file, automating the CAS00
(case summary sheet), the Post-card reply
system will begin pilot testing in Dallas in
November 1978. Full implementation is planned
for December 1978.

This stage of the system will be used to
automatically "cue" a claims examiner when a
"call-up" event takes place. Adjudication
is delayed when a claims examiner is forced
to request additional information from a claimant,
his doctor, his agency, etc.

Stage 3 has been developed in two parts, the
Bill Pay system and the Compensation - CPI system.
The Bill Pay system was fully implemented in
June 1978. Presently, approximately 80% of all
bills paid are processed through the automated
system. Of those bills paid during July through
the automated system 50-60% are processed in 28
days or less. Once the manual adjudication (i.e.,
Bill review and approval) process is completed
and entered into the ADP system, a check is issued
within ten calendar days (i.e., a weekly cycle).
The Compensation CPI system is in development
and will complete pilot-testing by December 1978.
Following the completion of pilot-testing this
system will begin field implementation. This
system will provide for the centralized, disburse-
ment of supplemental and periodic roll payments,
automatic calculation of CPI, the generation of
various statistical reports, the automation of
the chargeback function, automatic notification
to claimant and agency regarding receipt of claims,
the increased gathering of data to support the
various office functions, especially the claims
examiner functions, and the production of the
1099- MED Statement for Recipients of Medical and
Health Care Payments.

27. Continued

Late spring 1979 the present Level I system effort will be reviewed in terms of the Level II system design process. The purpose of this review is primarily intended to identify and define the Level I "freeze point" and the best method of conversion to the Level II system.

The Level II system development effort has been
directed to focus on the entire FEC process. This
total review and/or analysis effort has been delegated
to a Federally Funded Research and Development
Center (FFRDC), the Mitre Corporation. MITRE has
been tasked to develop a total systems specification
covering both the manual and the automated processing
of claims. This specification will be used as the
basis of a competitive procurement. This procurement
is scheduled for completion in summer 1980.

Until the MITRE developed specification is complete the applicability of the present equipment and/or software systems cannot be determined. This determination must take place after the Level II Specification is complete and before the competitive procurement is initiated.

With the availability of the ADP system, how
can you explain the very slow payment of approved
claims?

A:

The term "slow payment" of "approved claims" is
taken to mean "placed on a compensation roll"
(i.e., daily or periodic) for claims that have
been "adjudicated." The payment of approved
claims, except for medical payments, is still
a manual action. Because of the third-party
review, namely the Bill-pay software, some of the
district offices initially were more careful and
thorough before submitting their medical bills
for processing. A review of the actual history
of the medical bill paying system shows that this
processing is in fact improving as the district
office personnel conform to a uniform process
and learn the system. (Refer to the response to
question 5.)

The ADP system for compensation will complete
pilot testing in December 1978. Bills, once
presented to the system will be paid within
ten working days.

Level 1 of the ADP system, which is designed to
automate clerical functions, and is divided into
3 stages, seems to be suffering from poor implemen-
tation. For example, in stage 1 is it true that
the case status component is not in uniform use,
and that it is undecided as to which codes are
to be used? Is it true that the claimant name
index component of stage 1 is so slow that personnel
find it faster to do name searches by using the
old index cards? In stage 2, have the statistics
to be used been decided upon? Has the correspondence
control component been set up by only one district
office without the creation of a national format?
Is it also true that the bill pay component of stage
3 can only be used in a very limited number of cases
because 1) of the lack of required data, 2) it has
failed to create the charge back record as yet, and
3) it removes the substantive and probative evidence
from the claim file.

A:

A set of case status codes were initially included.
A new more complete set of codes has been developed
and is to be implemented shortly.

The question on "Name searches" has been answered
above. The Level I Stage 1 rewrite now in use
corrected this problem. Such searches responses
are now on the order of two (2) seconds or less.

Presently all Stage 2 (CA88) statistics have been
agreed upon. Priority correspondence control is
an integral part of the Stage 2 system. The Stage
2 system has not been placed into any district office.
The San Francisco district office on the other hand
has made an attempt to independently automate a very
limited correspondence control capability using
equipment that is not compatible with the Four Phase
Systems Inc. equipment now used at all district
offices. We are gaining valuable experience from
the San Francisco effort but that is not the
correspondence control component in the Stage 2

system.

The Bill-Pay component of Stage 3 is in fact in
use in every district office except Honolulu.*
Each district office presently reports in excess
of 75% of the bills received are paid through the
ADP system. It does not create a chargeback record

29. Continued

as all required data will not be available until
after Stage 2 has been implemented and was not
intended to produce a chargeback record until
the automated compensation system is in place.
It does, however, collect financial information
for chargeback. The complete chargeback records
can not be built until the Compensation CPI
System is installed and in use in Spring 1979.

The bill pay system provides an automated means of: • checking for possible duplicates;

The statement that the Bill-Pay system "removes
the substantive and probative evidence from the
claim file" is incorrect. Bills are processed
in batches, avoiding the delays caused by finding
the case folder and filing the bills. The Bills
are then filed as a batch to insure a clean audit-
trail and follow-up capability. A small subset
of the Bills are Doctor bills containing comments
or opinions on Doctor bills submitted on CA16 forms.
This small subset is duplicated and the copy is
filed in the case folder.

continued transmission difficulties preclude

its use in Honolulu.