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Find answers to frequently asked questions.

Question:
Is it necessary to have a psychiatrist conduct the Mental Status Exam (MSE) on an applicant or will a licensed social worker suffice?

The Mental Status Exam must be performed by an "Acceptable Medical Source" (AMS) in order to establish a "medically determinable physical or mental impairment."

Acceptable Medical Sources include physicians, psychologists, advanced practice nurse practitioners (APRN), or physician assistants (PA).  Further, the APRN category includes: Certified Nurse Midwife, Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. Audiologists are also acceptable medical sources for hearing-related disorders.

Licensed Clinical Social Workers (LCSWs) are not included.

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Question:
When requesting medical records, what type of records are specifically needed? I requested ALL records for a client, and received over 500 pages from the hospital. In the future, can I make a more specific request for efficiency purposes?

Great question! While we do typically advise to collect all records, 500 pages is understandably a lot! Not all applicants will have this many, but if you are seeing that certain hospitals/providers tend to send significant amounts (particularly if they aren't helpful for the application), you could ask for: Inpatient hospitalization records, discharge summaries, outpatient/emergency records, and psychiatric examinations/mental status exams. Those are all pretty key for the application. When you submit the records to DDS, I'd recommend adding a note that these were all that you requested, so that it doesn't look like you just weren't sending everything you have.

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Question:
Are medical providers required to respond to your request for medical records once you provide a copy of the SSA 827 to them? Is eliciting cooperation from them generally an issue for case managers?

Generally speaking, medical providers are not legally bound to provide records to a third party. They are not required to provide records to DDS, either. However, HIPAA regulations require healthcare providers to provide individuals copies of their own records: 

"The Privacy Rule generally requires HIPAA covered entities (health plans and most health care providers) to provide individuals, upon request, with access to the protected health information (PHI) about them in one or more “designated record sets” maintained by or for the covered entity.

We hear from most SOAR providers that they are able to get medical records from most sources. Some states have special laws that cover access to records for disability applications. We also do our best to build relationships with commonly used providers and the medical records departments to try to improve those relationships, and clarify and expedite processes.

 

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Question:
Should I file a SSI/SSDI claim when there are no medical records available?

Yes, you should file a SOAR-assisted application because even if you don’t have access to the medical evidence, DDS will request directly from prior treating sources and/or schedule appropriate Consultative Examinations (CE) to obtain diagnoses. Remember, SSA needs a diagnosis to make a disability determination. Remember, to write in the “Remarks Section” on SSA forms, about your efforts to obtain medical information so that DDS will know what they need to do to medically develop the claim.

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Question:
How long does a medical provider have to provide information to a patient? Is it a federal mandate or do individual states have a different timeline?

HIPAA requires medical providers to release the patient's records within 30 days after the request is received (https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/ind…). Some states have laws that require the release of medical records in fewer than 30 days.

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Question:
What is the rate of approval for applicants who do not use SOAR? The statistics appear positive but would be more useful if shown in comparison to the overall population of those applying and/or those who do not use SOAR.

Great question! Check out our most up-to-date National Outcomes to see how SOAR-assisted applications compare to those without SOAR assistance.

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Question:
Is the SOAR Online Application Tracking (OAT) Program HIPAA Compliant?

Yes, the SOAR Online Application Tracking (OAT) program is fully HIPAA compliant. The system does not collect any personally identifying information about applicants during any part of the process. When users add a new applicant to the database, they create a unique applicant ID. The use of this ID avoids the need for personally identifiable information and helps prevent case duplication.

The ID is a 10-digit alphanumeric in the following format: xx00xx0000 (2 letters/2numbers/2 letters/4 numbers). It can be any letters and numbers you choose - just be sure to note it in your hard copy records.

Additional demographic information collected about an applicant is limited to age (without birthdate) and gender.

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