TN 15 (02-11)

GN 04440.300 Trailer Material and Update after Transfer (UAT) Alerts

A. Background on trailer material and UAT alerts

The Office of Quality Review (OQR) reviews quality review (QR) cases to ensure the evidentiary record supports the adjudicating component determination and the evidence and the determination conform to the Social Security Administration (SSA) operating policies and procedures. Deficiencies are cited based on adjudicating component action relative to the evidence in the case (e.g., medical evidence, statements by the claimant, information from other sources) at the time of adjudication. For an explanation of what constitutes evidence, see DI 24503.005.

B. Introduction to trailer material

The review component sometimes receives additional evidence (trailer material) while the case is undergoing QR. In some instances, the trailer material changes a correct case to a deficient case or a deficient case to a correct case. The review component must determine if corrective action is necessary and whether or not to cite the adjudicating component with a deficiency.

C. Introduction to UAT alerts for certified electronic folder (CEF) cases

In CEF cases, the review component can receive an UAT while a case is undergoing QR. The UAT results when a field office (FO) without jurisdiction of the case initiates changes as follows.

  • The FO can update mainframe data (e.g., claimant name, address, telephone number) on SSA mainframe systems (Modernized Claims System/Modernized Supplemental Security Income Claims System) and propagates that information into the Electronic Disability Collect System (EDCS) using the UAT utility. This action produces an alert under the Alerts and Messages section and Record of Change (ROC) under the Case Data section in eView.

  • The FO can update disability report information (e.g., new medical source, new allegations, tests, medications) and add that information to the CEF by creating a Form SSA-5002 (Report of Contact) in EDCS. This action produces an alert under the Alerts and Messages section, ROC under the Case Data section, and SSA-5002 under the Case Documents section in eView.

  • The FO can add a claim to a case when another claim has been transferred to the adjudicating component. This action produces an alert under the Alerts and Messages section and ROC under the Case Data section in eView.

In some instances, the UAT changes a correct case to a deficient case or a deficient case to a correct case. The review component must determine if corrective action is necessary and whether or not to cite the adjudicating component with a deficiency.

To view UATs, the review component should access eView or SSN History in OQR’s legacy system.

D. Policy for reviewing trailer material and UATs

The review component may receive trailer material while a case is undergoing QR. For CEF cases, the review component may also receive UATs while a case is undergoing QR. However, the review component must base the QR evaluation of the adjudicating component’s determination on the evidence included in the case as a whole at the time of the adjudicating component’s case clearance.

The review component must consider any trailer material or UAT received while a case is undergoing QR for purposes of case adjudication and correction, if necessary.

In some instances, the trailer material or UAT changes a correct case to a deficient case or a deficient case to a correct case. The review component must then determine if corrective action is necessary.

1. If the case was deficient at the time of adjudication

If the case was deficient at the time of adjudication, and the trailer material or UAT changes the case to a correct case, the review component cites the appropriate group I or group II deficiency that existed at the time of adjudication. If corrective action is necessary, or a group I deficiency existed at the time of adjudication, return the case to the adjudicating component. Do not assume jurisdiction and prepare a new determination.

2. If the case was correct at the time of adjudication

If the case was correct at the time of adjudication, and the trailer material or UAT changes the case to a deficient case, the review component will not cite the deficiency, but request corrective action, if appropriate. This is so even if the adjudicating component had requested the evidence, but adjudicated the case without waiting for receipt of it, as long as the case was correct when adjudicated.

NOTE: For CEF cases, the review component must fax any paper trailer material received that has not already been scanned or faxed into the CEF.

E. Procedure for recognizing trailer material and UATs for CEF cases

The review component should review the CEF to identify trailer material and UATs that may have been received while the case is undergoing QR. This can be accomplished by reviewing the date the document or UAT was received into the CEF. A gap between the OQR sample date and the date an additional document or UAT was received into the CEF generally indicates the presence of trailer material or UAT received after adjudicating component case clearance. You can view the OQR sample date in the top frame of eView, or you can identify it by using the “Query” function in OQR’s legacy system.

Any component can add a document to the CEF whether or not they have jurisdiction of the CEF; however, only the component with jurisdiction of the CEF will be able to take adjudicative actions on that case.

NOTE: The review component should not rely solely on checking the “CEF Received?” date of documents under the Case Documents section in eView to identify trailer material. The adjudicating component may send documents to the CEF during the closure process. In addition, delays in the adjudicating component closure process (i.e., system problems) may result in a “CEF Received?” date that is later than the OQR sample date. When discrepancies are noted, the review component should also consider the information provided on the adjudicating component Disability Worksheet, which is under the Case Documents section, in Section F - Medical Records (Yellow Back).

F. Chart for trailer material and UATs

The following chart explains the procedure required when trailer material and UATs are received during QR.

IF Trailer Material or UAT ...

THEN...

is medical evidence and the case was already reviewed by medical staff,

refer the case to medical staff and ask them to:

  1. reevaluate medical severity and residual functional capacity, when necessary; and,

  2. prepare a form SSA-416 (Case Analysis) with the additional medical comments, if necessary.

does not change review component action,

  1. complete the original review, and

  2. take action to either approve the determination or return the case to the adjudicating component.

changes a correct case to a deficient case,

  1. do not record a deficiency;

  2. use a Form SSA-847-U3 (SSA Request for Case Action) when return to the adjudicating component is necessary; and,

  3. inform the adjudicating component that no deficiency was charged.

changes a deficient case to a correct case,

  1. record the deficiency;

  2. notify the adjudicating component of the original deficiency citation and explain how the new evidence corrected the case, if the review component can take the corrective action. If the adjudicating component needs to take corrective action, or the review component would have returned the case before the trailer material or UAT regardless of whether corrective action is necessary, return the case to the adjudicating component; and

  3. if the cited deficiency would normally result in a controlled adjudicating component return, include language in the deficiency explanation that adjudicating component action is not necessary.

  4. For a controlled return, the review component will capture the final determination on the return WU.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204440300
GN 04440.300 - Trailer Material and Update after Transfer (UAT) Alerts - 03/24/2017
Batch run: 03/28/2017
Rev:03/24/2017