Meet Carol Heitland, Disability Benefits Expert
Carol Heitland is a recognized expert in disability benefits determination, particularly Social Security disability case management. She has over 30 years of experience leading the design, delivery, and support of complex enterprise-wide case management systems in the public sector market.
How did you acquire your expertise in benefits administration, particularly involving Social Security and other disability programs?
Out of technical school, I went to work as a programmer for I Levy and Associates, which had been developing disability determination software for about five years. Every U.S. state and territory has a Disability Determinations Services agency, or DDS, that adjudicates the Social Security disability claims for their state or territory. At that time, however, very few DDS’s even had a computer, and disability software was in its infancy. As we gained more DDS customers, the software features expanded. I was involved in requirement gathering, testing, training, and support. We wore a lot of hats in those days.
How did you come to work for MicroPact?
You could say I never really left my first job. By 2000, 47 of the nation’s 54 DDS’s were using software built by one of two companies, either I Levy or VERSA, to manage their caseloads. In 2015, both companies’ products became part of MicroPact’s broader portfolio of case management software. The two applications are solid workhorses that have been enhanced over the years to keep current with all state and federal regulations. For nearly four decades, we’ve delivered on time and on budget.
Today MicroPact’s solutions process more than 3.8 million disability claims each year, including Medicaid disability claims in 16 states. We’re a major vendor in this marketplace, and all of our customers benefit from our combined experience.
Do you have the longest tenure on your team?
Actually no. One of our account managers has been here for 35 years, and several others have been dedicated to working with the DDS’s for two decades or more — including my husband. We’re a loyal bunch.
Walk me through the steps in a disability benefits case.
Whether it involves social security, worker’s compensation, or temporary disability, the basic steps are claims processing, determination, and potentially appeal. For social security disability, it looks like this: A claimant applies for benefits, and that information is entered into the system and verified. Additional information is gathered to support the claim, such as medical records from the claimant’s doctors. When there is insufficient information to make a decision, then a new medical assessment is scheduled with an affiliated practitioner. Once all available information has been received and verified, an examiner evaluates whether the claim meets the SSA’s complex web of rules for a favorable determination. The examiner must thoroughly document the reasons for his or her decision, especially for a denial, which may have to withstand several levels of appeal.
How much of that process have you automated?
We have automated virtually everything that can be automated in order to free valuable resources to focus on what cannot: making the determination based on evidence. MicroPact’s software can ingest claims received electronically and auto-assign the case to an examiner with the right credentials, based on the information received. It can also determine which letters to send to whom and at what verified address, in order to gather medical evidence from practitioners or additional information from the claimant. Those letters can be sent electronically via fax or posted to SSA’s Electronic Records Express website for practitioners. We can even set up calendars to auto schedule appointments with contracted practitioners within specified timeslots, and to auto notify stakeholders accordingly.
Once a determination is made, we can automatically close the claim, notify various SSA systems electronically, and generate any necessary letters informing the claimant of the decision. For quality assurance, we even have an automated process that each DDS can configure to review cases at various stages of development.
Our software also handles the first level of appeals, called reconsideration. If denied, a claimant has 60 days to request that another DDS examiner issue a new determination after reviewing previous actions taken on the case, along with any new information provided by the claimant or their medical sources. Upon second denial, the case goes to SSA’s Office of Disability Adjudication and Review (ODAR) for review by an administrative law judge. If the judge requests a new medical examination, our software can also be used to set up the appointment and notify the stakeholders. ODAR doesn’t have the state-level information about local practitioners and services that each DDS stores in our system.
Impressive. What have you seen change the most over the years?
Certainly technology has evolved. When I began working with the DDS’s, the state of the art was Wang minicomputers. Today, software is much more flexible and user friendly. That’s important, because as budgets have been cut and clerks have retired without being replaced, the demand for automation has increased.
Over time, the eligibility rules have become increasingly complex. Some changes require code updates, but we build as much flexibility into the software as possible, so when there are changes in the law or a business process, the DDS’s can configure many of them on their own. That saves them a lot of time and money.
What has stayed the same?
The strong relationships with the customers. I’ve known some of our users for decades, and we’re very close. MicroPact participates in bi-weekly teleconference calls with 47 DDS and SSA representatives to discuss new rules, policy issues, and ideas for additional automation. Sometimes the right approach isn’t straightforward. Networking is the best way for us to understand our customers’ business processes and to design the right solutions for them. It’s also the best way for the DDS’s to share innovations with each other.
So the customers are the real innovators?
Absolutely. Customers know what they need. We work with them to develop their ideas into solid solutions that can be shared across the whole user base.
Track disability cases from receipt through adjudication to disposition, ensuring that claims are processed accurately and efficiently the first time.
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