Enhanced Leads and Appointment System (eLAS) Screens

Screen Package Document

ENHANCED LEADS AND APPOINTMENT SYSTEM

(ELAS)
PROJECT
SCREEN PACKAGE

ENHANCED L EADS AND APPOINTMENT S YSTEM (E LAS)

Table of Contents
Appointment/Referral Menu .............................................................................................................................. 5
Appointment/Referral Menu .............................................................................................................................. 5
LPF1 ..................................................................................................................................................................... 6
Profile Page ......................................................................................................................................................... 6
LPF1 Extended ..................................................................................................................................................... 7
Profile Page Extended ......................................................................................................................................... 7
Number Holder Query Screen ............................................................................................................................ 8
Numberholder Query Page ................................................................................................................................. 9
Numberholder Query Page - Continued ........................................................................................................... 10
Claimant SSN Unknown Screen ........................................................................................................................ 10
Claimant SSN Unknown Page............................................................................................................................ 11
Claimant Unknown Screen Extended ............................................................................................................... 12
Verify Person Information Screen..................................................................................................................... 13
LPF2 Screen ....................................................................................................................................................... 14
Create a New lead Screen ................................................................................................................................. 15
Create a New lead Screen with Disability ......................................................................................................... 16
Leads Protective Filing Information Page ......................................................................................................... 18
Leads Protective Filing Information Screen ...................................................................................................... 19
Informal Denial Page ......................................................................................................................................... 20
Informal Denial Screen...................................................................................................................................... 21
Informal Denial (Issue Second) Screen ............................................................................................................. 22
Appointment Page ............................................................................................................................................ 24
Appointment Screen ......................................................................................................................................... 25
Appointment Calendar Menu Page .................................................................................................................. 26
Appointment Calendar Menu Screen ............................................................................................................... 26
Appointment Calendar Menu Screen ............................................................................................................... 28
Manager Create a New Calendar Page ............................................................................................................. 29
Manager Create a New Calendar Screen .......................................................................................................... 30
Manager Create New Calendar Screen – Calendar Availability........................................................................ 31
View Calendar Screen ....................................................................................................................................... 32
Edit Calendar Screen – Edit Label/Descriptions................................................................................................ 33
Edit Calendar Screen – Edit Calendar Availability ............................................................................................. 34
Calendar Assignment for Claim Types Page(s) ................................................................................................. 35
Title 16 Calendar Assignment Page .................................................................................................................. 36
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Title 2 & Title 16 Concurrent Calendar Assignment Page................................................................................. 36
Title 18 Calendar Assignment Page .................................................................................................................. 37
Calendar Assignment for Claim Types Screen(s) – Title 2 ................................................................................ 37
Calendar Assignment for Claim Types Screen(s) – Title 16 .............................................................................. 38
Calendar Assignment for Claim Types Screen(s) – Title 2 & Title 16 ................................................................ 39
Calendar Assignment for Claim Types Screen(s) – Title 18 .............................................................................. 40
Calendar Assignment for Claim Types Screen(s) – All Claim Types .................................................................. 41
Summary Screen ............................................................................................................................................... 42
Worksheet Page ................................................................................................................................................ 43
Edit Leads Protective Filing Information Screen ............................................................................................... 46
Edit Informal Denial Page ................................................................................................................................. 46
Edit Informal Denial Page 2............................................................................................................................... 47
Edit Informal Denial Screen .............................................................................................................................. 48
Edit Informal Denial (Issue Second) Screen ...................................................................................................... 49
Update Appointment Page ............................................................................................................................... 50
Update Appointment Screen ............................................................................................................................ 50
Reschedule Appointment Screen ..................................................................................................................... 51
Field Office Information Page(s) - Query Mode................................................................................................ 52
Field Office Information Screen(s) .................................................................................................................... 52
Field Office Information Screen(s) – ZIP Code Search ...................................................................................... 53
Field Office Information Screen(s) – City/State Search .................................................................................... 53
Field Office Informational/Referral Page .......................................................................................................... 54
Field Office Informational/Referral Page 2 ....................................................................................................... 54
Field Office Informational/Referral Screen....................................................................................................... 55
Field Office Informational/Referral Screen - Expanded ................................................................................... 56
Field Office Informational/Referral Main Page - Update ................................................................................. 57
Field Office Informational/Referral Page - Update ........................................................................................... 58
Field Office Informational/Referral Page 2 - Update ........................................................................................ 58
Field Office Informational/Referral Screen – Update Mode ............................................................................ 59
Field Office Informational/Referral Screen – Update Mode Expanded ........................................................... 60
Field Office Informational/Referral Menu Page - Query .................................................................................. 61
Field Office Informational/Referral Page - Query ............................................................................................. 61
Field Office Informational/Referral Screen - Query.......................................................................................... 62
Listing Request Menu Page ............................................................................................................................... 62
Listing Request Menu Screen............................................................................................................................ 62
Referral and Appointment Screen .................................................................................................................... 63
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Listing Request Menu Screen - Appointments ................................................................................................. 63
Appointment List Request Page........................................................................................................................ 64
Appointment List Request Screen .................................................................................................................... 64
Appointment List For Date Screen .................................................................................................................... 65
Pending List Request Page ................................................................................................................................ 65
Pending List Request Menu Screen .................................................................................................................. 66
Pending List Request Menu Screen - Expanded ............................................................................................... 67
Pending List Request Page ................................................................................................................................ 68
Teleservice/DSU Listing Request Page .............................................................................................................. 69
Teleservice/DSU Listing Request Screen........................................................................................................... 69
Teleservice/DSU List Report Screen.................................................................................................................. 70
Query Page Screen ............................................................................................................................................ 71

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Introduction:
For your information, the screens below show the legacy system (in black background) along with the
proposed web-based screens (in white background).
Appointment/Referral Menu

Appointment/Referral Menu

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LPF1

Profile Page

Respondent Name

SSN

Birth Date

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LPF1 Extended

Profile Page Extended

Respondent Name
SSN

Birth Date

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Number Holder Query Screen
Respondent Name

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Numberholder Query Page

Respondent Name
Birth Date

SSN

Respondent Name
Respondent other names

Parent/Mother's name

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Numberholder Query Page - Continued

Claimant SSN Unknown Screen

Respondent Name

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Claimant SSN Unknown Page

Respondent Name

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Claimant Unknown Screen Extended

Respondent Name

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Verify Person Information Screen

SSN

Respondent Address
Phone number

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LPF2 Screen

First Name
Last Name
Birth Date

First Name
Last Name
Birth Date

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Create a New lead Screen

Respondent Name

SSN

Birth Date

Respondent Name
SSN

Birth Date

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Create a New lead Screen with Disability

Respondent Name
SSN

Birth Date

Respondent Name
SSN

Birth Date

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“Is Caller different than claimant” question by default will be “No” but if you select “Yes” then the caller
container pops-up prompting information about the caller.

Respondent Name
SSN

Birth Date

Respondent Name
SSN

Birth Date

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W-2/Earnings input boxes will appear if “W-2/Earnings” is chosen as a Proof Requested – one at a time
allowing the user to request up to three.

Leads Protective Filing Information Page

First Name

Last Name

First Name

Last Name

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Leads Protective Filing Information Screen

Respondent Name

SSN

Birth Date

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Informal Denial Page

First Name

First Name

eLAS Project Screen Package

Last Name

Last Name

SSN

SSN

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Informal Denial Screen

Respondent Name
SSN

Birth Date

Address

Phone #

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Informal Denial (Issue Second) Screen

Respondent Name
SSN

Birth Date

Address

Phone #

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The “Income is too high”, “Resources are too high”, and “Other reason” options will produce additional
mandatory fields to enter.

LPFP Screen (the data elements in the LPFP screen is split in to Create a new lead screen, LPFI screen).

First Name

Last Name

First Name

Last Name

eLAS Project Screen Package

SSN
SSN

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Appointment Page

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Appointment Screen

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Appointment Calendar Menu Page

Appointment Calendar Menu Screen

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MCAL screen:

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Appointment Calendar Menu Screen

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Manager Create a New Calendar Page

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Manager Create a New Calendar Screen

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Manager Create New Calendar Screen – Calendar Availability

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View Calendar Screen

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Edit Calendar Screen – Edit Label/Descriptions

Edit Calendar Screen – Edit Calendar Template

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Edit Calendar Screen – Edit Calendar Availability

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Calendar Assignment for Claim Types Page(s)

Title 2 Calendar Assignment Page

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Title 16 Calendar Assignment Page

Title 2 & Title 16 Concurrent Calendar Assignment Page

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Title 18 Calendar Assignment Page

Calendar Assignment for Claim Types Screen(s) – Title 2

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Calendar Assignment for Claim Types Screen(s) – Title 16

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Calendar Assignment for Claim Types Screen(s) – Title 2 & Title 16

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Calendar Assignment for Claim Types Screen(s) – Title 18

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Calendar Assignment for Claim Types Screen(s) – All Claim Types

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Summary Screen

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Worksheet Page

Worksheet Screen

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Edit a Lead Page

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Edit A Lead Screen

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Edit Leads Protective Filing Information Screen

Edit Informal Denial Page

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Edit Informal Denial Page 2

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Edit Informal Denial Screen

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Edit Informal Denial (Issue Second) Screen

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Update Appointment Page

Update Appointment Screen

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Reschedule Appointment Screen

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Field Office Information Page(s) - Query Mode

Field Office Information Screen(s)

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Field Office Information Screen(s) – ZIP Code Search

Field Office Information Screen(s) – City/State Search

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Field Office Informational/Referral Page

Field Office Informational/Referral Page 2

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Field Office Informational/Referral Screen

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Field Office Informational/Referral Screen - Expanded

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Field Office Information Screen - Edit Mode

Field Office Informational/Referral Main Page - Update

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Field Office Informational/Referral Page - Update

Field Office Informational/Referral Page 2 - Update

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Field Office Informational/Referral Screen – Update Mode

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Field Office Informational/Referral Screen – Update Mode Expanded

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Field Office Informational/Referral Menu Page - Query

Field Office Informational/Referral Page - Query

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Field Office Informational/Referral Screen - Query

Listing Request Menu Page

Listing Request Menu Screen

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Referral and Appointment Screen

Listing Request Menu Screen - Appointments

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Appointment List Request Page

Appointment List Request Screen

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Appointment List For Date Screen

Pending List Request Page

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Pending List Request Menu Screen

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Pending List Request Menu Screen - Expanded

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Pending List Request Page

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Teleservice/DSU Listing Request Page

Teleservice/DSU Listing Request Screen

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Teleservice/DSU List Report Screen

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Query Page Screen

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