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:

  1. afterthe regional medical consultant and DRS examiner have signed the determination; and

  2. afterall notices have been prepared; and

  3. aftercoordinating with or informing the RRB; but

  4. beforethe determination is effectuated; and

  5. 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

  1. Staple the sample flag (SSA-1146), exhibited in GN 04442.900 to the folder.

  2. 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

  1. Claims Without An SSA-415, Notice of Disability Determination and Transmittal

    • Prepare an SSA-415

    • Coordinate with or inform RRB.

    • Send the claim back to the DQB for review.

  2. 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.

  3. Excluded Claims Returned Without QA Review (See GN 04447.105.)

Process as a nonselected case according to existing instructions.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0204447110
GN 04447.110 - Selecting and Routing Sample Claims under GLPSC - DRS Procedures - 01/26/1999
Batch run: 01/27/2009
Rev:01/26/1999