GN 04410.030: Reported RSDI Quality Review Findings: Jurisdiction and Actions

changes
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~~Effective Dates: 04/18/2016 - Present~~
Effective Dates: 02/20/2018 - Present
TN 6 (04-16)
GN 04410.030 Reported RSDI Quality Review Findings: Jurisdiction and Actions
A. Analyzing Office of Quality Review (OQR) reported findings
OQR reports case findings to the field office (FO) and processing center (PC) with jurisdiction via email on the SSA-93 Quality Review Feedback Report. The SSA-93 describes the error or condition needing correction.
1. Corrective actions to the servicing FO
OQR sends the following corrective actions to FOs:
* updates to the numident
* beneficiary failure to cooperate
* request for field contact
* whereabouts unknown
* change of address
* some representative payee issues (e.g., new payee development needed, capability determination, failure to account)
* missed entitlements when an application is required
* leads
* new application needed or closeout letter needs to be sent
* work notices (current and past year)
* FO initiated work CDR actions; and
* DDS referrals.
2. Corrective actions to the PC of jurisdiction
OQR sends all other corrective action requests to the PC of jurisdiction.
If the feedback contains one of the corrective actions listed in section GN 04410.030A.1. in this section and another requiring correction by the PC, OQR sends the feedback to the PC. The PC is responsible for all corrective actions listed on the feedback.
3. OQR distribution of corrective actions
OQR emails the SSA-93 along with any related attachments not uploaded to the electronic folder or Non-Disability Repository for Evidentiary Documents (NDRED). OQR annotates on the SSA-93 feedback the location of any uploaded documentation.
* For stewardship review, OQR:
* reports cases with dollar deficiencies to the appropriate Office of the Regional Commissioner (ORC) and describes the necessary corrective action;
* determines the appropriate ORC based on the geographical address of the selected beneficiary. EXCEPTION: If PC 7, Office of Disability Operations (ODO) or PC 8, Office of International Operations (OIO), is the PC of jurisdiction, the controlling office is the Associate Commissioner (AC) of the Office of Central Operations (OCO); and
* sends a copy of the feedback to the servicing FO or PC of jurisdiction to make the correction.
* For Workers’ Compensation, Title II Post Entitlement, Transaction Accuracy Review, and Work Continuing Disability reviews, OQR:
* reports cases with dollar deficiencies to the appropriate ORC/AC of OCO and describes the necessary corrective action;
* determines the appropriate ORC based on the geographical address of the servicing FO. If PC 7, ODO or PC 8, OIO, is the PC of jurisdiction, the controlling office is the AC of OCO;
* sends the feedback to the servicing FO to make the correction and a copy to the office that processed the sampled action, if different; or
* sends the feedback to the PC of jurisdiction to make the correction and a copy to the office that processed the sampled action, if different.
B. FO and PC action on reported deficiency
When you receive a SSA-93 from the OQR field site:
* evaluate the information received; and
* redevelop only if the necessary documentation is insufficient, outdated, or missing.
NOTE: If you receive a SSA-93 in error or have other issues with jurisdiction and access to cases on the SSA-93 Quality Review website, contact your ORC/AC of OCO. A copy of the SSA-93 is viewable on the website via a link if needed. Refer to the SSA-93 Quality Review Website User Guide for more information including instructions for removing or transferring a case.
1. FO or PC agrees with the OQR field site’s findings
If you agree with the OQR field site’s findings:
* make corrective input within 90 days of the SSA-93 transmission,
* upload any additional supporting documentation to the electronic folder or NDRED and reference the location in the comments area on the website, and
* post the completion on the SSA-93 website.
NOTE: Do not enter the completion until all required actions are complete. This includes:
* disability decisions,
* FO system exceptions pending corrective action in the PC,
* additional development, etc.
2. FO or PC disagrees with the OQR field site’s findings
If you disagree with the OQR field site’s findings:
* use the SSA-93 website to send a rebuttal request, rationale, and documentation directly to the reviewing OQR field site. See Protesting Deficiency Citations GN 04410.040.
* The SSA-93 website will automatically notify the ORC/AC of OCO of the rebuttal request.
NOTE: Absent evidence of timely rebuttals, OQR determines accuracy results based on current findings.
C. Monitoring and reporting corrective actions
The ORC/AC of OCO uses the SSA-93 Quality Review website to monitor cases to ensure the FOs and PCs take corrective action within the established timeframes.
1. FO or PC agrees with OQR’s findings
The FO or PC must take corrective action within 90 days of the feedback transmission to the SSA-93 website. FO or PC management must confirm corrective actions before annotating the SSA-93 website.
There may be cases that require more than 90 days for correction. Examples are cases requiring:
* cross component activities,
* FO system exceptions pending corrective action in the PC,
* amended disability decisions, and
* fraud or similar fault determinations.
The FO and PC can request an extension past the 90-day deadline by submitting a request via the SSA-93 website to the ORC (AC of OCO for PC 7 and 8) with an estimate of the extra time needed and a justification for the extension. The ORC/AC of OCO enters the approval or denial of the extension request in the SSA-93 website. The website will notify the requesting PC or FO once the QRC/AC of OCO enters the decision. The website will retain documentation of the request for audit purposes.
The FO and PC can request an extension past the 90-day deadline by submitting a request via the SSA-93 website to the ORC (AC of OCO for PC 7 and 8) with an estimate of the extra time needed and a justification for the extension. The ORC/AC of OCO enters the approval or denial of the extension request in the SSA-93 website. The website will notify the requesting PC or FO once the ORC/AC of OCO enters the decision. The website will retain documentation of the request for audit purposes.
2. FO or PC disagrees with OQR’s findings
If you disagree with OQR’s findings:
* submit a rebuttal via the SSA-93 website within 45 calendar days as outlined in GN 04410.040F through GN 04410.040G, and
* take corrective action within 90 days of OQR’s final rebuttal decision.
NOTE: The ORC/AC of OCO may request a report on the corrective action taken.
3. OQR oversight of FO and PC corrections
In order to ensure FOs and PCs take proper action on SSA-93 information, OQR also monitors the SSA-93 website. OQR reviews each case flagged with a SSA-93 indicator (referred to as High Risk cases) when the FO or PC annotates “Corrective Action Complete” on the SSA-93 website.
The OQR reviewer in central office uses the SSA-93 website to send an email to the responsible component with a description of the issue if:
* the FO or PC took no action,
* their action was incomplete, or
* the action was incorrect.
The ORC/AC of OCO also receives this email to ensure that the FO or PC with jurisdiction completes the necessary action as timely as possible. The SSA-93 website sends automated follow-ups every 15 days.
When the OQR reviewer determines all corrective actions are complete, they use the SSA-93 website to update the status of the case to “Correct Action Taken”. The website sends an email and moves the case to the completed listing.

POMS Reference

GN 04410.030: Reported RSDI Quality Review Findings: Jurisdiction and Actions