TN 11 (04-16)
GN 04461.027 Reported Findings for Supplemental Security Income (SSI) Quality Review: Jurisdiction and Actions
A. Analyzing Office of Quality Review reported findings
The Office of Quality Review (OQR) uses the SSA-93 (Quality Review Feedback Report) to request field office (FO) corrective actions and to provide information to the FO. The FO documents its actions on the Seattle SSA-93 Quality Review website.
The FO receives feedback from OQR for the:
Stewardship review only if there is a payment deficiency (in any amount) or an informational item that requires FO action.
Transaction Accuracy Review (TAR) on every case (even if there is no payment error or informational item.)
OQR loads supporting materials to the electronic folder or Non-Disability Repository for Evidentiary Documents (NDRED) or sends them with the SSA-93 as attachments. OQR names any documents they load to NDRED “REVDOC 93” to distinguish them from FO documents.
OQR sends copies of the SSA-93 to the Office of the Regional Commissioner (ORC) for Stewardship payment errors, TAR cases with dollar deficiencies of $5.00 or more, and for informational items that require FO action. OQR only sends cases to the SSA-93 website for tracking purposes when FO action is required.
NOTE: If you receive an SSA-93 in error or have other issues with jurisdiction or access to cases on the SSA-93 Quality Review website, contact your ORC. You may also refer to the SSA-93 Quality Review website user guide. The SSA-93 Quality Review website has a link to the SSA-93 for each case if the FO did not receive the original email.
B. FO action on reported findings
1. FO deficiency citation agreement
If the FO agrees with the deficiency citation, the FO takes corrective action and reports completion via the Seattle SSA-93 Quality Review website. The FO must complete corrective action within 90 days from the date OQR transmits the SSA-93 to the Quality Review website.
2. FO deficiency citation disagreement
If the FO disagrees with an error, the FO should rebut the issue following the procedures outlined in GN 04461.030. The FO delays corrective action only on the contested issue.
3. FO deficiency reversal or modification - recipient disagreement
If a recipient rebuts any determination of ineligibility, overpayment, or underpayment, the FO takes the necessary action to resolve the disagreement. If the results of the FO action are a reversal or modification of OQR’s determination, the FO returns the development results to OQR via the SSA-93 website so they can modify their database. The FO uses the comments area in the website to describe the necessary action and provides the location of any evidence stored electronically.
4. FO action differs from the SSA-93 findings
There may be situations, for example a system limitation exists, where the FO cannot correct the case in the manner requested on the SSA-93. This may occur if the Supplemental Security Record was in current pay when OQR sent the SSA-93 but the record is now in terminated status and the FO must correct it using a different method. When this type of situation exists, the FO should document the file and the comments area of the SSA-93 website explaining why their action differs from the SSA-93.
C. Monitoring and reporting corrective actions
The ORC monitors cases with dollar deficiencies and informational items requiring FO action on the SSA-93 Quality Review website to ensure the FO takes corrective action within the established timeframes. The website sends periodic automated follow-ups until the FO completes all actions and updates the website.
FO agrees with OQR’s findings
If the FO agrees with OQR’s findings, take corrective action within 90 days of the SSA-93 transmission to the Quality Review website. FO management must confirm all actions were taken before annotating the case is complete on the SSA-93 website.
There may be cases that require more than 90 days for correction. Examples include cases requiring;
cross component activities,
amended disability decisions, and
fraud or similar fault determinations.
To obtain more time for correction, the FO can request an extension past the 90-day deadline by submitting an email request to the ORC through the SSA-93 website with an estimate of the extra time needed, and a justification for the extension. Use the comments area of the website to record these items.
The ORC either grants or denies an extension request as follows:
document the SSA-93 website comments area with the determination and rationale for audit purposes, and
notify OQR via email through the SSA-93 website with the name, SSN, reason for the extension, and the time granted.
the website will continue to send follow-ups at the regular scheduled intervals, however, there is an indicator to show that an extension was approved.
FO disagrees with OQR’s findings
If the FO disagrees with OQRs findings, they need to submit a rebuttal within 45 calendar days as outlined in GN 04461.030 and annotate the SSA-93 Quality Review website. If the final rebuttal decision affirms the deficiency, the FO takes corrective action within 90 days.
OQR oversight of FO corrective actions
In order to ensure FOs take proper action on SSA-93 information, OQR monitors the SSA-93 Quality Review website. OQR conducts an additional review for some cases when the FO annotates the case “complete” or the FO has not completed it after 90 days.
The reviewer sends an email via the SSA-93 website to the responsible component with a description of the issue if; he or she did not take an action, or took an action that was incomplete or incorrect.
Upon receipt of the email, the FO should take the necessary action as timely as possible. The SSA-93 website sends a follow-up every 15 days. If the FO disagrees with the requested action, they should contact their regional office and have them contact OQR for informal resolution of the issue.
D. Other SSA-93 requested actions
1. Potential entitlement or eligibility for other benefits
In certain situations, OQR may discover that the SSI recipient is potentially entitled or eligible for other benefits. The FO develops the potential entitlement or eligibility per SI 00510.000 and updates the SSA-93 Quality Review website. Review the website to ensure all corrective actions are complete.
2. Wage verification
OQR uploads the wage verification to the electronic folder or NDRED or attaches it to the SSA-93. OQR includes complete wage documentation for the period covered by the OQR review so the FO does not have to re-contact the recipient or the employer and redevelop the same period(s).
However, in some cases, there may be additional development required to update wages for months within the administrative finality period that were not included in OQR’s period of review. The SSA-93 identifies this additional development as an informational issue that the FO must complete.