TN 13 (12-10)
GN 04440.025 Processing Concurrent Claims or Split Samples in Certified Electronic Folder (CEF) Cases
A. How are concurrent cases received?
The claims in a concurrent case (e.g., the claimant filed claims for both Title II and Title XVI benefits) may arrive at the review component for quality review (QR) at the same time, or
One or more of the non-sample claims in a concurrent case may arrive at the review component subsequent to the other claim(s).
NOTE: For Federal sampling purposes, treat concurrent cases as one case (i.e., count a concurrent claim as one case in the sample selection process).
B. What is a split sample in a concurrent case?
The National Disability Determination Services System (NDDSS) or the Electronic Folder Interface (EFI) splits the routing of one or more of the claims within a concurrent case (e.g., in a concurrent case, the Title II claim is routed to review component 1 and the Title XVI claim is routed to review component 2).
C. Policy for reviewing concurrent cases
In a concurrent case situation, the quality reviewer is responsible for reviewing (and initiating corrective action, when appropriate) each of the disability determinations, even though QR data are only recorded for the sample case determination.
NOTE: It is the responsibility of the program leader or administrative assistant to resolve split samples, as described in GN 04440.025D., GN 04440.025E., and GN 04440.025F.
D. Background on how concurrent cases become split samples
NDDSS or EFI splits the routing of one or more of the claims in a concurrent case, see GN 04440.025A.2. in this section.
“Split samples” occur when all claims filed in a concurrent case do not arrive in the same download. Specifically, a “split sample” situation occurs when one or more of the claims in a concurrent case are sampled (i.e., the claim(s) that the field office (FO) and the adjudicating component processed correctly), but the other non-sample claim(s) is still pending in the FO, adjudicating component, or another review component; thus, the claims become split.
The FO does not process the mainframe (i.e., Modernized Claims System (MCS), Modernized Supplemental Security Income Claims System (MSSICS)) or Electronic Disability Collect System (EDCS) case transfers for one or more of the concurrent claims in the case; or
The adjudicating component does not properly process and transfer one or more of the concurrent claims in a case (e.g., the adjudicating component does not clear both claims in a concurrent Title II/Title XVI case at the same time). The review component encounters this situation most often.
E. Identifying split samples
In eView, determine the status of a claim by reviewing the information displayed after selecting the “Status/History” tab on the eView “Case Selection” page (if accessing the claim through the Office of Quality Review (OQR’s) legacy system or on the Search window in eView).
NOTE: The Search screen is usually bypassed when using OQR’s legacy system to open eView.
On the Search screen, after entering the SSN or claimant's name and selecting the Search button, several items appear (e.g., the claimant's name, claim type, status and office code). This is the same information that displays after selecting the Status/History tab. If the review component has jurisdiction, “Pending” shows under Case Status and the Office Code shows “R##” (i.e., the numeric review component’s office code displays).
If there is a split sample situation in a concurrent case, and one or more claims have been sampled, the remaining non-sampled claim(s) still shows as pending in the FO or the adjudicating component (the component that last had jurisdiction). There may be instances where the remaining non-sampled claims do not always show as “pending” but may be “closed”.
If one or more non-sampled claims exist, verify the status of the non-sampled claim(s) by using email or a phone call to contact the component shown as having the claim(s). Document the CEF or the paper MDF with an SSA-5002 (Report of Contact).
NOTE: If EDCS exclusions apply and you cannot access the claim in eView; it is the review component’s responsibility to use MCS, MSSICS, or other queries to determine if a concurrent claim situation exists
F. Procedure on split samples involving multiple review components
1. Situation 1 – multiple auxiliary Title II claims
In this situation, central office will consolidate the claims in one review component.
2. Situation 2 – involving SSI PER claim
Take manual action to add the Title XVI to the Title II workload unit (WU).
G. Procedure for split samples involving non-sampled claims
Actions taken on one claim often affect the other claim(s) in a concurrent claim situation. Therefore, as early in the review process as possible and before the review component clears the sampled claim(s), determine if a concurrent case situation exists by using eView. Verify the status of the non-sampled claim(s) to ensure that it has not been inadvertently overlooked.
If the non-sampled claim(s) is a denial due to technical reasons or a no determination, complete case review actions and clear the sampled claim(s).
If the non-sampled claim(s) is not a denial due to technical reasons, ask the FO or adjudicating component to expedite processing and transfer the claim(s) to the review component for review. Do not clear the sampled claim(s) in the interim.