Medical Evidence to Support SSI Applications

Revised on: July 1, 2020

Medical Evidence at the SSI Initial, Reconsideration, or Hearing Level

When an additional evaluation or testing is necessary to support a SSI application at any level of the determination process, and DDDS will not pay per their policy, use the following procedures:

  1. If payment is within the medical evidence fee schedule, generate a referral in ICMS using the appropriate DSHS 14-150 to authorize payment, and document the reason for the referral in ICMS case notes.
  2. If payment for medical evidence is outside of the medical evidence fee schedule, submit a request for an expenditure approval through the ETR process in Barcode. Please include the following information in the request:
    1. The specific evaluation or testing being requested, including the credentials of the provider needed to perform or author the evidence (e.g. physician, psychologist, neurologist, etc.);
    2. An explanation of why the evaluation is necessary;
    3. An explanation of why DDDS will not pay for the evaluation or testing; and
    4. If the SSI application was denied, the reason(s) for the denial.
  3. If approval is obtained from CSD Headquarters through the ETR process, clearly document the approval in ICMS case notes.
  4. In order to receive reimbursement for an approved evaluation or additional testing, the provider must submit a claim in ProviderOne.

EXAMPLE: An ABD recipient with a mental illness has missed multiple DDDS consultative exams despite coordination with DDDS to arrange transportation. DDDS has refused to schedule another consultative examination. Submit an expenditure request through the Barcode ETR process for an evaluation that meets DDDS consultative examination criteria.