TN 1 (05-89)
GN 04447.110 Selecting and Routing Sample Claims under GLPSC - DRS Procedures
A. Operating Policy - Sample Selection
1. WHO SELECTS THE SAMPLE
Sample claims are selected by the DRS and sent to the DQB for QA review.
2. WHEN THE SAMPLE IS SELECTED
Claims are selected for review:
afterthe regional medical consultant and DRS examiner have signed the determination; and
afterall notices have been prepared; and
aftercoordinating with or informing the RRB; but
beforethe determination is effectuated; and
beforeclaimants and beneficiaries are notified.
B. Procedure - Sample Selection
1. CLAIM SELECTION
Select sample claims using the sample interval provided by OPIR.
NOTE:Do not count excluded claims when applying the interval.
2. FOLDER ACTION
Staple the sample flag (SSA-1146), exhibited in GN 04442.900 to the folder.
Send the claim to the Chicago DQB.
C. Operating Policy Improperly Selected Claims
The DQB will return improperly selected claims to the DRS.
D. Procedure - Improperly Selected Claims
Claims Without An SSA-415, Notice of Disability Determination and Transmittal
Claims Effectuated Before QA Review
If a claim is inadvertently effectuated before QA review, the DQB will still review it. If the determination is deficient, you may have to:
adversely reopen determination, or
recontact the claimant, or
prepare a subsequent notice.
Excluded Claims Returned Without QA Review (See GN 04447.105.)
Process as a nonselected case according to existing instructions.