Download:
pdf |
pdfSocial Security Administration
SEPTEMBER 2020 ERE Screen Shots
For OMB Clearance 0960-0753
1
Table of Contents
ERE Login ..................................................................................................................................... 1
Login Screen ............................................................................................................................... 1
Private Act Statement ................................................................................................................. 2
ERE Home Page ............................................................................................................................ 3
Administrator’s Home Page View .............................................................................................. 3
Individual End-User Home Page View....................................................................................... 4
Account Services ........................................................................................................................... 5
Create an Individual End-User Account ..................................................................................... 5
Basic Information.................................................................................................................... 5
Organization Information........................................................................................................ 6
Review .................................................................................................................................... 7
Confirmation ........................................................................................................................... 8
Duplicate e-Mail warning message for multiple ERE accounts ............................................. 8
Manage End-User Relationships................................................................................................. 9
Search Criteria ........................................................................................................................ 9
Search Results ....................................................................................................................... 10
Create Individual End-User Account Summary ................................................................... 11
Search Accounts........................................................................................................................ 12
Search Page ........................................................................................................................... 12
Search Results ....................................................................................................................... 13
Delete Account.......................................................................................................................... 14
Delete Account Summary ..................................................................................................... 15
Change Your Password ............................................................................................................. 16
Change Your Password Confirmation .................................................................................. 16
Modify Account ........................................................................................................................ 17
Modify Account Confirmation ............................................................................................. 20
Manage E-Mail Notification ..................................................................................................... 21
Manage E-Mail Notification Confirmation .......................................................................... 21
Evidence Services ........................................................................................................................ 22
Send Individual Response ......................................................................................................... 22
Destination and Request Information ................................................................................... 22
i
Review & Add Information .................................................................................................. 23
Tracking Page (no fiscal) ...................................................................................................... 24
Tracking Page (fiscal) ........................................................................................................... 25
Send Grouped Response ........................................................................................................... 26
Destination Information ........................................................................................................ 26
Review & Add Information .................................................................................................. 27
Confirmation ......................................................................................................................... 28
Send CE Report......................................................................................................................... 29
Destination & Request Information ...................................................................................... 29
Review & Add Information .................................................................................................. 30
Tracking Page (no fiscal) ...................................................................................................... 31
Tracking Page (with fiscal) ................................................................................................... 32
Send CE Report(s) with Scanned Signature ............................................................................. 33
Destination Information ........................................................................................................ 33
Review & Add Information .................................................................................................. 34
Confirmation ......................................................................................................................... 35
Send CE No Show Response .................................................................................................... 36
Destination and Request Information ................................................................................... 36
Review & Add Information .................................................................................................. 37
Tracking Page (no fiscal) ...................................................................................................... 38
Tracking Page (fiscal) ........................................................................................................... 39
Prepare CE Report for Provider ................................................................................................ 40
Destination Information ........................................................................................................ 40
Review & Add Information .................................................................................................. 41
Tracking Page ....................................................................................................................... 42
Access Electronic Requests ...................................................................................................... 43
Open Requests Page .............................................................................................................. 43
View / Submit CE Request – Upload Files ........................................................................... 44
Tracking Page – Upload Files (Site does not do fiscal) ........................................................ 47
View / Submit CE Request – No Show Response ................................................................ 48
Tracking Page – No Show Response (Site does not do fiscal) ............................................. 50
Tracking Page – Upload Files (Site does fiscal) ................................................................... 51
ii
Submit Payment Request for CE .............................................................................................. 52
Patient Information ............................................................................................................... 52
Services Performed ............................................................................................................... 54
Review – Upload Invoices .................................................................................................... 56
Add Invoices ......................................................................................................................... 58
Tracking Page – Uploaded Invoices ..................................................................................... 59
Review – No Invoices to Upload .......................................................................................... 62
Tracking Page – No Invoices Uploaded ............................................................................... 64
View / Submit Evidence Request – Upload Records............................................................ 67
Tracking Page – Upload Records (Site does not do fiscal) .................................................. 69
Tracking Page – Upload Records (Site does fiscal).............................................................. 70
View / Submit Evidence Request – No Records .................................................................. 71
Tracking Page – No Records (Site does not fiscal) .............................................................. 73
Tracking Page – No Records (Site does fiscal) .................................................................... 74
Submit Payment Requests for MER ......................................................................................... 75
Patient Information ............................................................................................................... 75
Review – Upload Invoices .................................................................................................... 77
Upload Invoices .................................................................................................................... 78
Review – No Invoices ........................................................................................................... 79
Upload Invoices Tracking Page ............................................................................................ 81
No Invoices Tracking Page ................................................................................................... 83
Access Provider’s Electronic Requests ..................................................................................... 85
Access Provider’s Electronic Requests – Open Requests..................................................... 85
View / Submit CE Request ................................................................................................... 86
Tracking Page ....................................................................................................................... 88
Review / Submit Prepared Requests ......................................................................................... 89
List of Requests..................................................................................................................... 89
non-eOR - Patient Information & Destination and Request Information ............................. 90
non-eOR - Review & Add Files............................................................................................ 91
non-eOR - Tracking Page ..................................................................................................... 93
eOR - Review and Add Files ................................................................................................ 94
eOR – Tracking Page ............................................................................................................ 96
iii
Messaging Services...................................................................................................................... 97
Secure Messaging ..................................................................................................................... 97
Inbox ..................................................................................................................................... 97
Compose Message ................................................................................................................ 98
Search Contacts ..................................................................................................................... 99
Compose Message – Confirmation ..................................................................................... 100
Contact OHO Office ............................................................................................................... 101
Send Message and Files ...................................................................................................... 101
Confirmation ....................................................................................................................... 102
Payment Services ...................................................................................................................... 103
Submit Payment Request (non-eOR) ...................................................................................... 103
MER - Destination and Request Information ..................................................................... 103
MER - Add Invoices ........................................................................................................... 104
MER - Tracking Page ......................................................................................................... 105
CE - Destination and Request Information ......................................................................... 106
CE – Add Invoices .............................................................................................................. 107
CE – Tracking Page ............................................................................................................ 108
Access Provider’s Electronic Requests ................................................................................... 109
Open Payments (no reports submitted yet) ......................................................................... 109
Open Payments (report submitted) ..................................................................................... 110
iv
ERE Login
Login Screen
1
Private Act Statement
See Revised Privacy Act
Statement attached
2
SSA will insert the following revised Privacy Act Statement into the collection as
soon as possible:
Privacy Act Statement
Collection and Use of Personal Information
Section 205 of the Social Security Act, as amended, allows us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the
information may prevent you from registering with Electronic Records Express (ERE) or
electronically submit reimbursement requests.
We will use the information to register you to use ERE, collect medical or education records, or
disburse payment. We may also share your information for the following purposes, called
routine uses:
•
To student volunteers, individuals working under a personal services contract, and other
workers who technically do not have the status of Federal Employees, when they are
performing work for SSA, as authorized by law, and they need access to personally
identifiable information (PII) in SSA records in order to perform their assigned agency
functions; and
•
To applicants, claimants, prospective applicants or claimants, other than the data subject,
their authorized representatives or representative payees to the extent necessary to pursue
Social Security claims and to representative payees when the information pertains to
individuals for whom they serve as representative payees, for the purpose of assisting
SSA in administering its representative payment responsibilities under the Social Security
Act and assisting the representative payees in performing their duties as payees, including
receiving and accounting for benefits for individuals for whom they serve as payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal
laws. For example, where authorized, we may use and disclose this information in computer
matching programs, in which our records are compared with other records to establish or verify a
person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent
debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice
(SORN) 60-0320, entitled Electronic Disability (eDib) Claim File, as published in the Federal
Register (FR) on June 4, 2020, at 85 FR 34477 and 60-0089, entitled Claims Folders System, as
published in the Federal Register (FR) on October 31, 2019, at 84 FR 58422. Additional
information and a full listing of all our SORNs are available on our website at
www.ssa.gov/privacy/.
ERE Home Page
Administrator’s Home Page View
3
Individual End-User Home Page View
4
Account Services
Create an Individual End-User Account
Basic Information
5
Organization Information
6
Review
7
Confirmation
Duplicate e-Mail warning message for multiple ERE accounts
8
Manage End-User Relationships
Search Criteria
9
Search Results
10
Create Individual End-User Account Summary
11
Search Accounts
Search Page
12
Search Results
13
Delete Account
14
Delete Account Summary
15
Change Your Password
Change Your Password Confirmation
16
Modify Account
17
18
19
Modify Account Confirmation
20
Manage E-Mail Notification
Manage E-Mail Notification Confirmation
21
Evidence Services
Send Individual Response
Destination and Request Information
22
Review & Add Information
23
Tracking Page (no fiscal)
24
Tracking Page (fiscal)
25
Send Grouped Response
Destination Information
26
Review & Add Information
27
Confirmation
28
Send CE Report
Destination & Request Information
29
Review & Add Information
30
Tracking Page (no fiscal)
31
Tracking Page (with fiscal)
32
Send CE Report(s) with Scanned Signature
Destination Information
33
Review & Add Information
34
Confirmation
35
Send CE No Show Response
Destination and Request Information
36
Review & Add Information
37
Tracking Page (no fiscal)
38
Tracking Page (fiscal)
39
Prepare CE Report for Provider
Destination Information
40
Review & Add Information
41
Tracking Page
42
Access Electronic Requests
Open Requests Page
43
View / Submit CE Request – Upload Files
44
45
46
Tracking Page – Upload Files (Site does not do fiscal)
47
View / Submit CE Request – No Show Response
48
49
Tracking Page – No Show Response (Site does not do fiscal)
50
Tracking Page – Upload Files (Site does fiscal)
51
Submit Payment Request for CE
Patient Information
52
53
Services Performed
54
55
Review – Upload Invoices
56
57
Add Invoices
58
Tracking Page – Uploaded Invoices
59
60
61
Review – No Invoices to Upload
62
63
Tracking Page – No Invoices Uploaded
64
65
66
View / Submit Evidence Request – Upload Records
67
68
Tracking Page – Upload Records (Site does not do fiscal)
69
Tracking Page – Upload Records (Site does fiscal)
70
View / Submit Evidence Request – No Records
71
72
Tracking Page – No Records (Site does not fiscal)
73
Tracking Page – No Records (Site does fiscal)
74
Submit Payment Requests for MER
Patient Information
75
76
Review – Upload Invoices
77
Upload Invoices
78
Review – No Invoices
79
80
Upload Invoices Tracking Page
81
82
No Invoices Tracking Page
83
84
Access Provider’s Electronic Requests
Access Provider’s Electronic Requests – Open Requests
85
View / Submit CE Request
86
87
Tracking Page
88
Review / Submit Prepared Requests
List of Requests
89
non-eOR - Patient Information & Destination and Request Information
90
non-eOR - Review & Add Files
91
92
non-eOR - Tracking Page
93
eOR - Review and Add Files
94
95
eOR – Tracking Page
96
Messaging Services
Secure Messaging
Inbox
97
Compose Message
98
Search Contacts
99
Compose Message – Confirmation
100
Contact OHO Office
Send Message and Files
101
Confirmation
102
Payment Services
Submit Payment Request (non-eOR)
MER - Destination and Request Information
103
MER - Add Invoices
104
MER - Tracking Page
105
CE - Destination and Request Information
106
CE – Add Invoices
107
CE – Tracking Page
108
Access Provider’s Electronic Requests
Open Payments (no reports submitted yet)
109
Open Payments (report submitted)
110
| File Type | application/pdf |
| Author | Shah, Dhaval K. |
| File Modified | 2020-12-04 |
| File Created | 2020-07-17 |