Section_6_DFEC_Imaging_Legacy_version_20140106.doc

Requirements Specification Document (LEGACY DRAFT)

DFEC Imaging (Section 6)

Central Bill Process

DFEC Imaging (PWS Section 6) Requirements Specifications Document

(LEGACY DRAFT)

Prepared for:

U.S. Department of Labor Office of Worker’s Compensation Programs

Revision History:

SPECIAL NOTICE: This document is a legacy draft requirements specification document developed between 2011 and 2012. As outlined in the Performance Work Statement, the Contractor will be required to review this RSD and make appropriate updates wherever necessary. (Please refer to PWS R0052 for more details.)

Table of Contents DFEC Imaging Overview

DFEC Imaging Business Process Description

72.1 Track Each Document to the Appropriate Imaging Process and Enter Incoming Mail to Inventory Control Process

82.2 Document Imaging

82.3 Assign Category Code

82.4 Assign Unique Identifier

82.5 Reconcile number of paper documents equals number of scanned pages

82.6 Electronic/Physical Out sort of documents

82.7 Perform Case Number Lookup/ Use the case number as the primary index data element for all documents

92.8 Bulk Ship Non Scannable Attachments

102.9 Perform all DFEC document indexing and transmit images in electronic data files

102.10 Determine category code from the subject matter of the document

102.11 Provide standardized reports

102.12 Provide Daily QA

102.13 Storage and Destruction

DFEC Imaging Business Process Flow

113.1 DFEC Imaging

DFEC Imaging Business Requirements

124.1 Functional Requirements

144.2 Business Rules

DFEC Imaging Supporting Functional Components

215.1 Initial Data Migration

215.2 Interfaces

225.3 Reports

245.4 Letters

Constraints

266.1 Assumptions

266.2 Dependencies

266.3 Issues/Open Items

Appendices

277.1 Terms and Definitions

297.2 DOL Software/OASIS Document Category

1 DFEC Imaging Overview The CBP Central Mail Room receives documents related to DFEC compensation claims. It will receive, classify, and image the various paper forms and attachment sets that will be input to the OWCP iFECS Case Management System. Mailroom staff will open all envelopes using automatic mail cutters that also provide a count of items processed, which will be used as the initial input to the central mailroom’s tracking/inventory control process. During the document preparation step, mailroom staff will assemble the documents into stacks of a predetermined size and submit them to the scanning operation. The system will identify and log all responsible parties to the processing.

The contents of each envelope will be manually extracted, all paper clips and staples removed, any torn documents repaired, and a manual screen for the FECA case number will be performed. For any documents that are missing this critical data element, a manual lookup will be performed and the applicable case number annotated to each document before processing.

CBP will scan all documents (including envelopes) at the earliest point in the process. The information necessary for tracking and inventory balancing will be captured and input into the imaging application software for the corresponding DO. CBP will maintain envelope integrity by issuing an envelope ID and ensuring that all pages/attachments received in a single envelope will receive a single DCN and be imaged together unless documents for different claims, claimants, or providers are received in a single envelope. In that event, a separator page will be manually inserted during the document processing step and will be used to allow unique DCN’s for each logical separation of pages and the DCN will be complemented by the additional assigned envelope identification number to provide integrity. The document is then stored according to DOL defined retention schedules specific to each program.

CBP will image all DFEC documents for all cases including retired cases, except for documents predefined to be out sorted (PWS Requirement R0265). The exceptions will be electronically out sorted and forwarded to the correct DO for processing. The imaging application software will be used to automatically classify all DFEC documents as belonging to one of the categories: Decisions, Nurse, Fiscal, Rehab, Forms, Incoming Correspondence, SOAF, or Miscellaneous.

Manual classification will occur when documents do not meet set confidence thresholds. These documents will be electronically routed to manual classification operators. These operators will utilize image-enabled workstations and a software module that allows them to view thumbnails of each document image in a batch along with the full image display of each document failing the threshold. Operators will view each document, manually assign a document type, and resubmit the batch for further processing.

2 DFEC Imaging Business Process Description

2.1 Track Each Document to the Appropriate Imaging Process and Enter Incoming Mail to Inventory Control Process Daily counts of all mail received for each program will be provided, broken down by PO Box as well as 3rd party courier. Documents will be tracked at each phase of the workflow. When a document enters the imaging application workflow, it is tracked by process and operator. Details are available about each process such as operator id, date, time and action taken. Documents will be associated with the correct District Office utilizing the validity check of the applicable case number. "Special" case numbers that correlate to each DO will be applied for documents that were received with no case number and a valid number could not be determined utilizing the DOL supplied reference file.

2.2 Document Imaging

All prepared documents will be scanned and submitted to the imaging application pipeline for document classification and processing. Exceptions to those documents submitted to the imaging application pipeline, are those documents identified as physical out sort as referenced and listed in 2.6 of this document.

2.3 Assign Category Code

A category code will be assigned to all documents received based on the subject matter of the document. Documents shall be identified as belonging in one of the following categories:

· Decisions

· Nurse

· Fiscal

· Rehab

· Forms

· Incoming Correspondence

· Medical and Statement of Accepted Fact (SOAF)

· Outgoing Correspondence and Calls

· Miscellaneous

Authorizations will be indexed as category code "Medical and Statement of Accepted Fact (SOAF)" with a subject code of "request for authorization"

2.4 Assign Unique Identifier

During the scanning process, a Document Control Number will be applied to each document and displayed in the upper left hand corner of each image. The DCN will contain year, Julian date of receipt and sequence. Multipage documents will have the same unique identifier applied to each page. No data on an image will be obscured by the DCN.

2.5 Reconcile number of paper documents equals number of scanned pages

A report is created with the daily count of documents processed (DCNs), number of pages scanned, number of images and the number of images deleted. The number of pages scanned multiplied by 2 (front/back) will equal the number of images added to the number of pages deleted. Any discrepancy will be researched and corrected prior to submission of the report to the government.

2.6 Electronic/Physical Out sort of documents

CBP will scan and, index the following form types and other special documents, including all attachments, using Government approved case numbers that relate to district office and form type. Specific documents will be out sorted using the following rules:

X

X

Direct Deposit forms

X

Contains bank account number and routing

X

Checks

X

Federal Health Benefit Election Form

X

X

Worker's Compensation Medical Report Form

X

Birth Certificates

X

Death Certificates

X

Marriage Certificates

X

2.7 Perform Case Number Lookup/ Use the case number as the primary index data element for all documents

The case number will be the primary index data element for all documents. Documents will be manually checked for the presence of a case number. If a case number is not found, a manual lookup will be performed using the government supplied case number file. If a case number is found, it will be annotated on the upper right corner of the document image. During the indexing step, documents will be checked for presence and validity of an approved case number using validation tables provided from the claimant eligibility file for each program. If a valid case number is not present or cannot be determined, the claimants address will be used to route the document images to the appropriate District Office's "unknown” special case number listed in the table below. If multiple case numbers for a claimant are listed on a document (or found during either the manual lookup or validation), the document will be imaged into the most recent active case record, meaning the case record with the most recent date of injury where the case status is C1, C2, C4, MC, DR, ON, OP, PR, PS, LS, PN, or PW. Additionally, if the case is not in an active status, CBP will still image the documents in the most recent non-active case as well that will equal; UN, UD, C3, C5, and DE, not to include RT and XX. If all claim numbers reflected on the document do not belong to the same claimant, the document will be imaged into the appropriate District Office's "unknown” special case number listed in the following table:

Each unknown claim number begins with a 2 digit district office locater code:

01 – Boston

02 – New York

03 – Philadelphia

06 – Jacksonville

09 – Cleveland

10 – Chicago

11 – Kansas City

12 – Denver

13 – San Francisco

14 – Seattle

16 – Dallas

25 – Washington, D.C.

The subsequent 7 number case file number scheme is:

9000001 – CA-1, CA-2 and CA-2a claim forms

9000005 – CA-5 and CA-6 claim forms

9000007 – CA-7, CA-7a and CA-7b claim forms (although CA-8 claim forms are obsolete should any be received they would be imaged into this dummy file)

9000009 – Congressional inquiries

9000010 – Documents with unknown claim numbers

9000016 – CA-16 claim forms

2.8 Bulk Ship Non Scannable Attachments

When non-scannable items are submitted as part of a document, the Contractor staff will prepare a non scannable attachment form. A three part label containing a control number will be used to link the physical item with the form. One label will be placed on the non scannable attachment form and scanned with the other pages in the document. The corresponding label will be affixed to the physical non-scannable attachment in a manner agreeable with the government. The third label will be placed on the packaging (e.g., x-ray envelope) of the non-scannable item. CBP will hold all non scannable items (e.g., x-rays and three-dimensional objects) for one week, prepare a shipping log detailing the items and control numbers, prepare the items for shipping and ship them to the appropriate District Office via third party mail service.

2.9 Perform all DFEC document indexing and transmit images in electronic data files

Index data will be captured from imaged DFEC documents using a combination of OCR technology and a manual Key From Image (KFI) application. CBP will index the following critical items and apply the BSP indicator when applicable: Received Date; Case Number; Author Date; Description (where applicable); Category; Subject (limited); Scan Date; District Office Number Code; DCN; Page Count; and Retired Case Flag. Using the imaging application output , all image and index data files will be formatted for output, compressed into ZIP file format, and transmitted to District Office share folders on the CBP landing zone within a monthly average of 2 business days of receipt. Quality Assurance checks will be performed to verify that image and index data for each DO is for that specific DO only, and that the ZIP file contains an index data file and the .TIFF images that are associated with the index data.

2.10 Determine category code from the subject matter of the document

CBP will assign a category code to all documents received based on the subject matter of the document and the criteria supplied in the OASIS Resource Book Glossary Guide provided by DOL. CBP will use a list of "key words or phrases" using the OASIS Glossary Guide document to create a classification table to be used by the imaging applicationsoftware to assign category codes. Authorizations will be indexed as category code "Medical and Statement of Accepted Fact (SOAF)" with a subject code of "request for authorization".

2.11 Provide standardized reports

The following reports will be provided:

· Field Accuracy

· Job Life Cycle (Aging) Report

· Reject Detail Report

· Reconciliation Report Details – Job in pipeline status The reports will reflect real time statistics relating to production and turnaround service levels. The reports will be generated in summary and detail format.

2.12 Provide Daily QA

CBP will verify the appropriate amount of critical index fields to meet the minimum-field-scan accuracy level of 99.5 percent for all key fields, and 97 percent for all other fields. QA results will be provided from a daily random sample of 2 percent, checking that annotated case numbers are correct, documents are categorized correctly, all fasteners have been removed and documents are correctly separated, pages have been repaired, and each document is correctly identified and traceable throughout the process. A random check of envelopes will be performed to ensure all mail has been extracted from envelopes. Reports will be provided showing the results of the quality check.

2.13 Storage and Destruction

All DFEC paper documents will be stored for 90 days in its central storage facility. All boxes of documents over 90 days old will be prepared for destruction and a destruction log created. The Contractor will provide offsite confidential destruction services using a designated document recycler. A certificate of confidential destruction will be provided by the designated document recycler after the documents have been destroyed. DFEC non bill images will be stored for 90 days.

3 DFEC Imaging Business Process Flow The following diagram captures the DFEC Imaging Business Process flow.

3.1 DFEC Imaging

4 DFEC Imaging Business Requirements

The following section documents the functional requirements and business rules needed to implement the requirements outlined in Section 6 – DFEC Imaging of the PWS.

4.1 Functional Requirements

PWS

Req # Functional

Req ID

R0251

R0254

R0266 R0271

R0272

B1-06-BR002

B1-06-BR003

R0252 R0256

R0257

R0015

R1010

B1-06-BR015

R0249

R0250 R0251

R0015

B1-06-BR006

B1-06-BR007

R0260 R0261

R0290

B1-06-BR007

R0255

R0265 R0266

R0269

R0270

R0271

R0273

R0274

R0275

R0277

B1-06-BR003

B1-06-BR008

B1-06-BR009

B1-06-BR010

R0255 R0274

R0275

B1-06-BR012

R0269 R0278

R0279

R0280

R0281

R0258

R0259

R0262

R0264

R0276

R0015

R0286 R0287

R0288

R0289

R0282

R0283

R0284

R0285

R0267

R0291

R0292

R0293

B1-06-BR021

R0248 R0278

R0286

R0295

4.2 Business Rules

· For a post-out sorting document that doesn't have a case number, the user should (1) look for a social security number. If one is found then he/she should use the SSN to look up and find a valid case number in the Claimant Eligibility File.

· If that doesn't work then the user should (2) look for the claimant's name. If one is found then he/she should use the claimant's name to look up and find a valid case number in the Claimant Eligibility File.

· If the case number is found in the case number file, it should be annotated, for later index entry, on the upper right hand corner of the document image.

· If a valid case number is not available in the DOL supplied reference file, the district office should be determined by the geographic location of the claimant’s address and the unknown claim number should be constructed as described in Section 2.7, using 9000010 "Documents with unknown claim numbers".

· If the case is not in an active status, the documents will still be imaged in the most recent non-active case as well that will equal; UN, UD, C3, C5, and DE, not to include RT and XX.

· All scanned documents, will be created using standard Tagged Image File Format (TIFF) Group IV format at 200 x 200 dots per inch (DPI) images. Please note that documents accepted from other electronic sources (i.e. faxes and image files are placed in the image repository as is. These documents are not rescanned, and the Contractor cannot control the DPI for these images.

· Each document must be correlated with the correct DOL program and District Office, using the validity check of the applicable case number.

· A unique Document Control Number (DCN) must automatically be assigned and applied to each page in the upper left hand corner of each image.

· Multi-page documents must include the same unique document control number on each page.

· The DCN will contain year, Julian date of receipt and sequence.

· No data on an image will be obscured by the DCN.

· DCN must be used to identify rejected documents on the Reject Report.

· For envelopes containing documents for multiple claimants, the separator and “Patch” sheet pages inserted during preparation of the documents for scanning will be used to allow for unique DCNs image assignment for each logical separation of pages as well as the envelope identification number.

· Received Date

· Case Number (use as primary index data element for all documents)

· Author Date

· Description (where applicable)

· Category

· Subject (limited)

· Scan Date

· District Office Number Code

· DCN

· Page Count

· Retired Case Flag

· CA-1 Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation

· CA-2 Notice of Occupational Disease and Claim for Compensation

· CA-2a Notice of Recurrence

· CA-5 Claim for Compensation by Widow, Widower, and/or Children

· CA-6 Official Supervisor's Report of Employee's Death

· CA-7 Claim for Compensation

· CA-7a Time Analysis Form, used for claiming compensation, including repurchase of paid leave

· CA-7b Leave Buy Back (LBB) Worksheet/Certification and Election

· CA-8 Claim for Continuing Compensation on Account of Disability.

· CA-16 Contractual obligation by DOL to pay for medical services by or at the direction of the provider whose name appears on the form

· Congressional or Senate Inquiry

· Letters from members of Congress or the Senate responding to questions or complaints from claimants in regards to a case

· Direct Deposit forms

· Contains bank account number and routing

· Checks

· Federal Health Benefit Election Form

· W9 Request for Tax Payer Identification number and Certification

· Worker's Compensation Medical Report Form

· Birth Certificates

· Death Certificates

· Marriage Certificates

· Documents assigned with missing case number that have been assigned the district’s office “unknown” special case number will be indexed with Category of “Incoming Cor and Calls”

· Except for authorizations all other documents will not be indexed at subject matter level.

· Documents shall be identified as belonging in one of the following categories:

· Decisions

· Nurse

· Fiscal

· Rehab

· Forms

· Incoming Correspondence

· Medical and Statement of Accepted Fact (SOAF)

· Miscellaneous

· Recognized forms and their subject matter classification in the OASIS Glossary Guide will be used by the Imaging application to automatically classify all DFEC documents into one of the approved category listed in PWS requirement R0255.

· For unrecognized forms and other documents, the list of “key words or phrases” compiled from the OASIS Glossary Guide will be used by the imaging application to automatically assign the category code.

· Manual classification will occur when documents do not meet set confidence thresholds. These documents will be electronically routed to manual classification operators. Operators will view each document, manually assign a document type using the OASIS Glossary Guide, and resubmit the batch for further processing.

· See Appendix 7.2 below for matrix of OASIS Glossary Guide prepared for Central Mailroom use as part of SOP.

· Data transmitted to a District Office share folders on the ESA network should only contain the image and index data for that District Office.

· Image and data files should be transmitted to DOL within a monthly average of 2 business days from receiving the mail into the facility.

· During the data capture process, the matching identification/tracking sticker number on the manually prepared placeholder sheet for the non-scannable attachment (see Section 5-Central Mailroom RSD Business Rule #B1-05-BR014) must be captured and viewable on the image.

· Non-scannable items will be held for 1 week; a shipping log detailing the items and control numbers will be prepared; the items will be prepared for shipping; and the packaged items will be shipped in bulk to the appropriate District Office via third party mail service.

· Reasonable attempts to achieve a legible image of poor quality originals should be done. Images identified as having poor quality during the indexing process should be rejected and rescanned.

· Any images identified as being scanned incorrectly or of insufficient quality will be rescanned at no cost to DOL.

· Any blank images will be automatically deleted at no cost to DOL

· Poor quality documents will be re-scanned to improve quality. Any images that continue to be of marginal quality after re-scanning will contain an annotation that states “Best Scan Possible” ( i.e., “BSP” indicator in the Doc_Desc field of each image’s associated index file)

· The number of pages scanned multiplied by 2 (front/back) should equal the number of images added to the number of pages deleted.

· Any discrepancy will be researched and corrected prior to submission of the report to DOL.

· Annotated case numbers are correct

· Documents are categorized correctly

· All fasteners have been removed

· Documents are correctly separated

· Pages have been repaired

· Each document is correctly identified and traceable throughout the process

· A minimum field-scan accuracy level of 99.5 percent for FECA document key fields and 97 percent for all other fields must be maintained.

· A random check of envelopes in the recycling bins should be completed daily to ensure that all contents have been removed.

· Results of quality control checks should be documented and provided to DOL. (see Section 5.3 Reports)

· Must be available in summary and detail formats

· Must be downloadable/importable

· See Section 5.3 Reports for listing

· DFEC paper documents will be stored for 90 days in the Contractor’s central storage facility.

· All boxes of documents over 90 days old will be prepared and logged for offsite destruction by designated document recycler.

· A certificate of confidential destruction will be provided by designated document recycler after the documents have been destroyed.

· Non-bill images should be stored for 90 days.

· Prior Authorizations should be processed within a monthly average of one business day from receipt.

· A minimum field-scan accuracy level of 99.5 percent for FECA document key fields and 97 percent for all other fields must be maintained.

5 DFEC Imaging Supporting Functional Components The following functional components serve as inputs or outputs to the DFEC Imaging process.

5.1 Initial Data Migration

The following table identifies the initial data migration required by the DFEC Imaging process. Specific details (i.e., file layout, business rules, etc.) of each data migration will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Initial Data Migration IDs have been assigned to each Initial Data Migration requirement. The first two digits represent the PWS Section, followed by a system component identifier (IDM01=DFEC; IDM02=DEEOIC; IDM03=DCMWC; IDM99=Misc/Global), followed by a 4 digit sequentially assigned number within each PWS Section and system identifier.

Data Migration

ID

Source

System Target

System Description

5.2 Interfaces

The following table identifies the interfaces required by the DFEC Imaging process. Specific details (i.e., file layout, business rules, etc.) of each interface will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Interface IDs have been assigned to each interface requirement. The first two digits represent the PWS Section, followed by a system component identifier (INTF01=DFEC; INTF02=DEEOIC; INTF03=DCMWC; INTF99=Misc/Global), followed by a 4 digit sequentially assigned number within each PWS Section and system identifier.

Future State Interface ID Source

System Target

System

Images and index data of DFEC Case documents, Medical Reports from Providers, Images of Prior Authorizations and Authorization Letters to Providers

Acknowledgement file from DOL detailing success or failure of image/index file transmission

DFEC Claimant eligibility file used for verification of valid case number

5.3 Reports

The following table identifies the reports required by the DFEC Imaging process. Specific details (i.e., report templates, data elements, business rules, etc.) of each report will be outlined under a separate document, Detailed Design Specifications. . For requirements traceability purposes, Report IDs have been assigned to each report requirement. The first two digits represent the PWS Section, followed by a system component identifier (RPT01=DFEC; RPT02=DEEOIC; RPT03=DCMWC; RPT99=Misc/Global), followed by a 4 digit sequentially assigned number within each PWS Section and system identifier.

Future State

Report ID Current State

Report ID

Document Imaging (IFECs) Daily Summary

Data Elements:

Process Date

Decision Documents #

Fiscal Documents #

Forms Documents #

Incoming Correspondence#

Medical Documents #

Misc. Documents #

Nurse Documents #

Outgoing Correspondence #

Rehab Documents #

Prior Authorizations Documents #

Non-Scan Documents #

Multi-Documents #

Single Documents

Data Elements:

File Name

Transmission Date

Document Count

Page Count

XMIT Time

Data Acknowledge (Y or N)

District Office ID

6-RPT01_003

Daily count of documents processed (DCN's), number of pages scanned, number of images and the number of images deleted

6-RPT01_004

Real-time batch status (Summary and Detail) Imaging application Job Life Cycle Report Data Elements:

Scan Date

Document Type

Age(In Hours)

Job Total

DCN Total

6-RPT01_005

Backlog/Reconciliation Report (Summary and Detail) Imaging application Reconciliation Report Data Elements:

Date

Job ID

Scanned Count

IP Count

OCR Count

Edit Count

Verify Count

Post Edit Count

Post Verify Count

Inserted Count

Uploaded Count

6-RPT01_006

Turnaround Report – Snapshot of batch status (Summary and Detail) Imaging application Job Life Cycle Report

Data Elements:

Scan Date

Document Type

Age(In Hours)

Job Total

DCN Total

6-RPT01_007

Quality Report (Summary and Detail) #1 Imaging application Operator Field Audit Report Data Elements:

Date

Operator ID

DCN

Error Indicator

Field ID

Field Name

Presented Value

Verified Value

QA’d value

QA Operator Name

Date/Time

Error message

6-RPT01_008

Reject Report (Summary and Detail) Imaging application Reject Report

Data Elements:

Date

DCN

Job ID

Doc Type

Reject Code

Reject Reason

Reject Date/Time

6-RPT01_009

Quality Report (Summary and Detail) #2

Imaging application Field Accuracy Report

Data Elements:

Date

Fields Sampled

Combined Field Errors

Field Accuracy %

5.4 Letters

The following table identifies the letters required by the DFEC Imaging. Specific details (i.e., letter templates, data elements, business rules, etc.) of each letter will be outlined under a separate document, Detailed Design Specifications. For requirements traceability purposes, Letter IDs have been assigned to each letter requirement. The first two digits represent the PWS Section, followed by a system component identifier (LTR01=DFEC; LTR02=DEEOIC; LTR03=DCMWC; LTR99=Misc/Global), followed by a 4 digit sequentially assigned number within each PWS Section and system identifier.

**NOTE: All Letters will be distributed electronically or through the DFEC Imaging. Each respective letter will be listed in its respective RSD (i.e. DOL Prior Authorization Letter will be captured in the Authorization RSD.

Future State

Letter ID Current State

Rpt ID

6 Constraints

6.1 Assumptions

· N/A

6.2 Dependencies

· N/A

6.3 Issues/Open Items

Section Issue/

Resolution

Resolved

Resolution: N/A

7 Appendices

7.1 Terms and Definitions

Program administered by the Division of Coal Mine Workers’ Compensation (DCMWC) that provides compensation benefits to eligible coal miners and their families and medical benefits to eligible coal miners in the event of total disability or death due to pneumoconiosis. These benefits are financed through direct Federal appropriations, earmarked tax revenues, and legislatively mandated private sector liability insurance arrangements.

A medical bill processing operation that processes bills for three OWCP programs: FECA under DFEC; BLBA under DCMWC;EEOICPA under DEEOIC and using one centralized process, but with customized business rules for each program.

Administers The Black Lung Benefits Act (BLBA) and provides compensation benefits to eligible coal miners and their families and medical benefits to eligible coal miners in the event of total disability or death due to pneumoconiosis. These benefits are financed through direct Federal appropriations, earmarked tax revenues, and legislatively mandated private sector liability insurance arrangements.

Provides benefits to employees or survivors of employees of the Department of Energy (DOE), its Contractors, and subcontractors, companies that provided beryllium to DOE and atomic weapons employers who suffer from a radiation-related cancer, beryllium-related disease, chronic silicosis, or exposures to other toxic substances resulting in occupational illnesses. The program also covers certain uranium workers who suffer from radiation-related illnesses as a result of their work in producing or testing nuclear weapons.

Act/program that provides wage replacement and medical benefits to civilian employees of the Federal Government who were injured at work and to certain designated groups.

Note: Based on the approach taken in identifying CBP Functional Requirements as requested by DOL, Functional Requirements, in the context of Section 4.1 of this document, cover both system and operational requirements.

Disability compensation programs, administered under the Department of Labor’s (DOL) which mitigate, through the provision of wage replacement and cash benefits, medical treatment, vocational rehabilitation, and other benefits, the financial burden on certain workers, or their dependents or survivors, resulting from work-related injury, disease, or death.

7.2 DOL Software/OASIS Document Category

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DOL OASIS Document Category

Decisions

This category includes all formal decisions (both preliminary and final), as well as written acceptances of claim.

Nurse

This category contains documents related to OWCP nurse intervention.

Fiscal

This category contains all payment forms, ACPS Reports, Address Changes and HBI/LI documents.

Rehab

This category contains most of the essential documents related to formal OWCP Rehabilitation Programs and Work History.

Forms

This category is not what it appears. Not all forms belong in the Forms Category.

Non-Scannable Documents

Incoming Correspondence

This category contains most incoming correspondence, calls and faxes covering a wide variety of subjects.

Medical & SOAF

This category contains all medical documents.

Miscellaneous

This category contains documents that are not specifically indexed in other categories.

Decisions

Nurse

Fiscal

Rehab

Forms

Non-Scannable

Documents

Incoming Correspondence

Medical & SOAF

Miscellaneous

Includes:

CA180

CA181

CA1047

CA1048

CA1050

CA2201

CA2202

CA2223

CA2224

CA2225

CA2226

Acceptance:

Formal acceptance letters concerning:

· Initial claims

· Recurrences

· Specific medical conditions (i.e., either consequential injuries or acceptance of conditions after the initial acceptance of the claim)

All Sanctions:

· Formal sanctions

· Penalty decisions

· Sanction warning letters that provide due process:

· Nurse/rehab (failure to cooperate),

· Office directed examinations

· Non receipt of CA1032 and/or CA12, 8106(c) denials, etc.

· Forfeiture decisions

Attorney Fee:

All attorney fee approvals and denials

Claim for Compensation:

· Formal decisions regarding claims for compensation (for specific periods)

· Acceptance (CA180) or denial of survivor benefits

· Decisions regarding death claims

COP:

· CA1050

· Other narrative decision denying Continuation of Pay

ECAB:

· Employees’ Compensation Appeals Board decision, including the cover letter

· Any letter from the Employees’ Compensation Appeals Board regarding the final disposition of the appeal

FD/Overpayment:

· Final decisions regarding overpayments, i.e. CA2223, CA2224, CA2225, CA2226, etc.

· Attachments to the final overpayment decision (i.e. final memos, amortization schedules, compromise order, etc.)

FR – Final Reduction:

· CA1048, as well as the cover letter, Notice of Decision/Memo to the Director, and any applicable attachments

· CA1047 for wage loss

FT – Final Termination:

· Decisions that terminate wage loss and/or medical benefits (including all applicable attachments)

· Fraud decision

Hearing:

· Hearing Representative’s decision and cover letter

· Any letter from Hearings and Review regarding the final disposition of the hearing request

Initial Denial:

Denials of primary and c-closure cases.

PF/Overpayment:

· All preliminary findings regarding overpayments:

· CA2201

· CA2202

· Attachments, including the overpayment calculation memo and the preliminary memo

PR-Proposal/Reduce:

Notice of Proposed Reduction with all applicable attachments

PT-Proposal/Terminate: Notice of Proposed Decision to terminate wage loss and/or medical benefits with all applicable attachments

Reconsideration:

All decisions issued in response to a request for a reconsideration:

· Prima facie denials

· Decisions denying modification

Recurrence:

Decisions denying recurrences of a disability

Schedule Award/Denial:

· Decisions concerning lump sum schedule awards

· CA181

· Any decisions denying a schedule award (i.e. not ratable or 0% impairments)

Zero LWEC:

· CA1047

· Any similar decision issued in cases where the employee has no loss of wage earning capacity ( i.e., a return to modified work with no wage loss)

· Does not include decisions reducing compensation to zero due to non-cooperation, refusal of suitable work, etc.

Other:

· All other decisions (with appeal rights) issued by the office:

· FOIA/PA denials

· Consequential injury denials

· Denial of a specific treatment

· Denial of travel

· Denial or approval of vehicle and housing modifications

· Suspensions for felony convictions

· Contains only formal decisions (with appeal rights) and formal acceptances of claims/conditions

Includes:

OWCP57

COP Nurse:

All COP Nurse Reports and any document pertaining to the COP Nurse

Ext/Int/Closure:

All memos, letters, calls or faxes regarding the extension, interruption, or closure of Field Nurse services

Incoming Nurse Letters/ Calls:

· All incoming letters, calls and faxes from:

· OWCP field nurse or TCM

· Any party in the case about the OWCP Field Nurse or TCM

· All letters sent from the Field Nurse to other parties (i.e. the physician or agency) of which the office receives a copy

· Does not include Field Nurse/TCM reports

Nurse Memo:

· All other memos relating to the OWCP Field Nurse or TCM, i.e. memos to the Staff Nurse regarding a Field Nurse’s or TCM’s actions, etc.

· Does not include memos regarding extension, interruption, or closure of nurse services

Outgoing Nurse Letters/Calls:

· All outgoing letters, calls and faxes to the nurse, claimant or other interested party concerning the OWCP Field Nurse or TCM

· Letters to the claimant and nurse regarding the referral itself

· Does not include the “QAP” letter to the physician

Referral/OWCP57:

Actual referral to the Staff Nurse for assignment of a Field Nurse or TCM

Reports-Field Nurse/TCM:

Actual Field Nurse and TCM reports

Note:

The attachments to the nurse reports will be indexed separately.

Any other document regarding nurse intervention that is not specifically mentioned above, i.e., copies of nurse bills when retained in the file

Includes:

CA24

CA25

CA58

CA160

CA161

CA162

CA164

CA203

ACPS Reports and Forms:

· Certified CA25 forms

· Payment Sheets (i.e., CP040)

· Worksheets

· Overpayment Calculations

· Adjustments

· Compensation History

Address Change:

· OWCP generated address change memos

· ACPS reports verifying address changes

EFT Forms:

· Completed EFT form from the financial institution

· ACPS report verifying the EFT change

File Transfer Sheets:

· Movement of cases from office to office

· FRC routing sheets

Fiscal/Payrate Memo:

· Memo to/from the Fiscal Department

· Memos concerning calculation of a payrate

· Memos concerning DMS Actions (overpayments)

Incoming Cash:

· All DMS postings

· Returned checks

· Refunds from medical providers

· Payments on 3rd party settlements

· Overpayments

HBI/LI:

· Enrollment change forms

· Incoming/outgoing letters or OPM forms regarding these issues

· OWCP calculation memo outlining deduction amounts for basic, post-retirement or optional life insurance

Tracers:

· Request for a check tracer

· Check tracer forms Letters to providers/ claimants about tracers

· Any document relating to fiscal actions not otherwise identified above

· Bill payment history

Includes:

CA66

SF171

OF612

OWCP3

OWCP9

OWCP14

OWCP16

OWCP17

OWCP24

OWCP35

OWCP44

OWCP57

Assisted Re-Employment:

All letters/calls/memos/ faxes regarding and/or approving assisted re-employment.

Incoming Rehab Letters/ Calls:

· Incoming correspondence about all aspects of the rehabilitation program from any source ( i.e. the claimant, the Rehabilitation Counselor, the agency, etc.)

· Any applicable faxes

· All letters sent from the Rehabilitation Counselor to other parties (i.e. the physician or agency) of which the office receives a copy

· Does not include the Rehabilitation Counselor’s reports

Labor Market/DOT Desc/

CA66:

· Labor Market Surveys

· DOT job descriptions

· CA66

Outgoing Rehab Letters/ Calls:

· All correspondence sent from OWCP about the rehabilitation program, i.e. the Claims Examiner or the Rehabilitation Specialist

· Does not include letters to a physician about a claimant’s ability to participate in a rehabilitation program

RC Reports:

Actual rehabilitation reports from the Rehabilitation Counselor

The attachments, including labor market surveys, DOT job descriptions and medical reports, would be indexed separately.

Rehab Memo:

· Any memo regarding a rehabilitation issue, i.e. a rehab referral (if not on an OWCP3)

· Any memo to or from the Rehabilitation Specialist or the Claims Examiner

School Transcripts:

Official school transcripts and professional certifications from a claimant’s approved training program

Vocational Tests:

Test results from vocational testing during any stage of the rehabilitation program

Work History/SF171/

OF612:

· All federal applications for employment (i.e. the SF171 and OF612)

· Resumes

· Any document recording a claimant’s work history

Any other document regarding the rehabilitation program that is not specifically mentioned above

Includes:

CA1

CA2

CA2a

CA3

CA5

CA6

CA7

CA7a

CA7b

CA8

CA12

CA674

CA721

CA722

CA816

CA935

CA936

CA1032

CA1036

LS202

SF50

SSA581

All Claim Forms:

CA1, CA2, CA2a, CA5, CA6, CA7, CA7a, CA7b and CA8

Some Periodic Review Forms:

CA935, CA936, SSA581, CA1032, CA1036, CA12 and CA674

Personnel Action Forms:

Including the SF50 and all similar agency specific forms

Special Claims Forms:

CA721, CA722 and LS202

LWEC Calculation:

CA816 (When not attached to a decision)

CA3

Electronic Counterparts to the CA1 and CA2

Includes:

Includes:

OWCP20

Address Change:

· Claimant’s request for an address…