Pre-Effectuation Review (PER) / Targeted Denial Review (TDR) Models
Description
This AI use case identifies high likelihood of error in certain claims and refers them for review. This use case reduces incorrect benefits payment.
Detailed example
Probability scores via an in-line mainframe process
AI / analytics pattern
Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relationships.
Automation level / stage
c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.
Expected benefit
Pre-Effectuation Review (PER) and Targeted Denial Review (TDR) benefit public, taxpayers, and claimants in ensuring that SSA provides benefits for those who qualify for benefits based on the SSA policy and guidelines.
Controls / human review
ATO: No; PIA: Not published
Data needed
Models use administrative data for Title II (retirement, survivors, and disability benefits) and Title XVI (Supplemental Security Income) programs including form SSA-831 (Disability Determination and Transmittal) data.