Hearings & Appeals
The Hearings & Appeals subsystem of the ECM system will provide a client-facing portal that allows individuals and providers, or authorized representatives on behalf of an individual, to appeal a decision on benefits or services under the Bureau of Hearings and Appeals (BHA) jurisdiction. The goal of the ECM system for BHA is to improve the access to and management of all appeal processes, allowing for a near paperless appeal process and increased access to appeal information by all necessary parties.
BHA currently uses two standalone systems and a reconsideration system to capture information about appeals that will be decommissioned with the implementation of the Hearings & Appeals subsystem. The Hearings & Appeals subsystem will allow for case management of appeals by DHS, PDA program offices, and third parties before being routed to BHA for adjudication. ECM will include all BHA portal functionalities, eliminating the need to maintain separate BHA portals. With the implementation of ECM, BHA will be able to receive electronic submissions of appeal requests, manage electronic correspondence, and increase communication efficiency between departments and program offices, which will provide an overall improvement to the appeal process. The system will also accommodate the management of the appeal process from the appeal submission to resolution, and to the potential escalation of a request to the Commonwealth Court.
DHS expects to achieve the following business goals with the implementation of Hearings & Appeals functions on the ECM system:
- Eliminate the need for physical files, where possible, allowing documentation to live within the ECM system or an integrated content management system for access by authorized users.
- Comply with CMS regulations by allowing appeals to be submitted online.
- Provide for management and tracking of appeals for BHA from submission through final adjudication in one system.
- Increase efficiency of communication between appellants, program offices, BHA, and the Secretary's Office to provide an overall improvement in the appeal process.
- Leverage leading technologies that are easier to maintain and respond to changes in laws, regulations, and program policies.