TN 13 (12-10)

A. Explanation and purpose of QRs

1. Quality assurance (QA) review

SSA conducts ongoing QA reviews of the adjudicating components to ensure effective and uniform administration of the disability program and to conform to the statutory requirements set forth in section 221(a) of the Social Security Act (Act).

The review component’s QA review measures the accuracy of the adjudicating component’s disability determinations to determine performance accuracy, as required by SSA regulations. SSA uses statistics produced by the QA review to determine if individual adjudicating components perform acceptably in terms of decisional accuracy and documentation requirements.

See Details

DI 30005.001C.6., The Quality Review (QR) Process

2. Preeffectuation review (PER)

Section 221(c) of the Act requires SSA to review at least 50 percent of favorable Title II and concurrent Title II/Title XVI initial and reconsideration determinations made by the adjudicating components on a preeffectuation basis.

Section 1633(e)(1) of the Act requires SSA to review at least 50 percent of favorable Title XVI adult initial and reconsideration determinations made by the adjudicating components on a preeffectuation basis.

The review components perform the PER to detect and correct erroneous favorable Title II and Title XVI determinations before the determination is effectuated.

The review components select a sample from those determinations most likely to be incorrect, as selected by a predictive model.

Favorable Title XVIII Medicare for Qualified Government Employment disability claims (disabled worker, disabled widow(er), and childhood disability) are also subject to PER review.

3. Other QRs

The Office of Quality Review performs other disability process QRs and special studies to evaluate current disability program performance in areas of concern and to alert adjudicating components and SSA management of current and potential problems (e.g., random denial reviews, early information system reviews).