Medical Visits and Diagnosis Management is an essential component of the Interact Social Security Administration System (Interact SSAS) that ensures accurate tracking of medical visits, diagnoses, and assessments related to benefit claims. The module allows healthcare providers to enter medical records directly into the system, ensuring that all relevant medical data is available for review by the Social Security Administration. This data supports benefit eligibility determinations for sickness, maternity, disability, and invalidity benefits.

Features and Processes

Medical Record Management

• Fully integrated with various modules in Interact SSAS to streamline medical record tracking.
• Ensures confidential and secure storage of medical diagnoses and visits.
• Supports electronic submission of medical records by healthcare providers.
• Enables Social Security Officers to review, validate, and approve medical records for benefit claims.

Medical Visit and Diagnosis Tracking

• Captures details of all medical visits required for benefit eligibility.
• Stores visit information including healthcare provider, visit number, date, time, status, visit procedure, labtest, prescriptions and diagnosis.
• Medical records are directly linked to employee and beneficiary electronic profiles.
• Supports real-time updates and tracking of medical visit history.

Medical Certificate Processing

• Medical certificates are required for sickness, maternity, disability, and invalidity benefit claims.
• The system enables healthcare providers to generate and submit medical certificates electronically.
• Certificates include essential details such as diagnosis, incapacity period, and recommended benefits.
• Once submitted, medical certificates are available for inclusion in medical benefit requrests, and sent for review by Social Security Officers.

Medical Referee Review and Assessment

• If required, a Social Security Officer can request a secondary review from a medical referee.
• Medical referees review submitted diagnoses and confirm, reject, or modify the findings.
• The review process ensures accurate determination of benefit eligibility.

Workflow for Medical Visits and Diagnosis Management

Initiating a Medical Visit Record

• Healthcare providers access the system through the e-Services portal.
• Patient visit details, including diagnosis and recommended benefit, are entered.
• The system generates a unique visit number and stores all related information.

Submitting a Medical Certificate

• After the visit, the healthcare provider completes and submits the medical certificate.
• The system verifies the completeness of the submitted document.
• If required, the medical certificate is forwarded to a medical referee for further review.

Benefit Claim Submission

• Beneficiary can submit medical claim using medical certificate in the system
• Depending on configuration, employer may approve medical claim and forward to SSA

Review and Approval by Social Security Administration

• Social Security Officers access submitted medical certificates for verification.
• Officers review diagnosis details, incapacity period, and recommended benefits.
• Approved medical certificates are linked to benefit claims for processing.
• If discrepancies are found, the claim is sent for further review or correction.

Medical Referee Assessment Process

• The system allows Social Security Officers to request a secondary diagnosis review.
• Medical referees assess submitted medical records and issue a final decision.
• The final assessment is recorded and linked to the beneficiary’s profile.

Integration with Benefit Claims Processing

• Approved medical certificates are directly linked to the claimant’s benefit application.
• Ensures all medical records are securely stored and accessible for future reference.
• Provides Social Security Officers with a complete medical history for informed decision-making.

Security and Compliance

• Only authorized users can access, submit, or modify medical visit records.
• Ensures compliance with medical data privacy and security regulations.
• Tracks all changes and updates made to medical records for audit purposes.

Medical Visits and Diagnosis Management is a crucial module for ensuring the accurate recording and validation of medical data in the Social Security Administration System. By integrating healthcare provider submissions, medical referee assessments, and Social Security Officer reviews, the module supports efficient and transparent processing of medical benefit claims. With robust security and compliance measures, it ensures the integrity and confidentiality of medical records while facilitating streamlined decision-making for social security benefits.

Medical Record Management

Since Interact SSAS provides a single suite of modules which are all seamlessly integrated to streamline the processes of Social Security Administrations.  This also applies to how Medical Records are managed as they can be crucial in determining eligibility for specific Medical Benefits.

Typically Medical Benefits include:

• Sickness Benefits
• Maternity Benefits
• Disability Benefits
• Invalidity Benefits

In each case, a doctor will need to provide a Diagnosis and file it with the Social Security Administration so that this information can be treated confidentially and reviewed to ensure eligibility of a Claimant for the Benefit that is Claimed.

Lastly, the system also provides a Medical Referee feature which allows the Social Security Officer to request another Opinion for a specific case in order to pay a Benefit Claim. The user can select a specific Medical Practitioner to be a referee.

Figure 1: Medical Doctor e-Services Home Screen

Before an individual can claim any type of Medical Benefit, they will need to first have an (approved) Medical Certificate in the system which needs to be submitted together with the Medical Benefit Claim.

In order to have this in the system, the individual will need to visit with a medical doctor who can enter the Patient Visit directly into the system so that the information will be validated immediately and is ready for submission with the Medical Claim.

In the above screenshot you can see the Medical Doctor’s home screen where they will access the Patient/Medical Visit menu to be able to fill in the appropriate Medical Certificate.

Figure 2: Medical / Healthcare Provider Certificate

In Figure 2 you can see the Medical Certificate as completed by the doctor, indicating the diagnosis, the visit details and the recommended Medical Benefit as well as the Start and End Date of the Incapacity Period as per the doctor’s finding.

This same Certificate and any other follow up information will be on record with the Social Security Administration and will build a Medical Profile for the Individual which can be used by Doctors or Medical Boards in charge of reviewing important claims for Medical Benefits.

A summary of the information will also be available on the Employee Electronic Record as shown below.

Medical Visits 

Figure 3: Employee Electronic Record – Medical Visits

Details on Medical Visits are captured in the system in order to justify various Medical Benefits, including Sickness Benefits, Maternity Benefits, Invalidity and/or Disability Benefits.  For this reason, the diagnosis reported by a Healthcare Provider will be transmitted directly from the doctor to the Social Security Administration.  If required, the information can be available on the Employee Electronic Record online with access to more detailed reporting for authorized users.

The summary view includes:

• Healthcare Provider
• Visit Number
• Visit Date
• Visit Time
• Visit Status
• Diagnosis
• Medical Benefit Required