TN 13 (08-97)

DI 12015.005 Identifying FPM Claims - Procedure

No data exists on the MBR/SSR to identify FPM cases. Identify claims and appeals as FPM cases as follows:

A. Obtain a DDSQ

The presence of the NDDSS data described below indicates that a claim was selected as a FPM claim.

1. National Test

When the DDS selects a FPM claim, it inputs a Study List Code (SLC) of “G”. Additionally, NDDSS closure input includes listing code (LC) 978 when recording the disability determination. The presence of this data indicates that the claim was selected as a FPM claim.

2. Federal Tests

Both WNPSC DTU and ODIO input SLC of “G” when receipting a case selected for FPM processing. The DTU and ODIO includes on NDDSS closure input Listing Code (LC) 979 when recording the disability determination.

B. Review the SSA-831

The DDS/DTU/ODIO enters in remarks on the SSA-831 “FPM Case” when they adjudicate a claim in the FPM test.

C. Read the Disability Notices

The following notices are unique to FPM cases.

  1. a. 

    PDI notice: The DDS/DTU/ODIO issues, in advance of a formal determination notice, predecision notices to claimants for whom the medical evidence does not support a fully favorable determination. The notice explains:

    • that the case facts do not support a fully favorable determination, and;

    • gives the claimant 10 days to request a predecision interview and/ or to submit evidence prior to a final initial disability determination.

  2. b. 

    Disability determination (denial) notice: The DDS/DTU/ODIO personalized disability notices of denials of FPM claims include appeals language to a hearing rather than to a reconsideration as well as an explanation of the Adjudication Officer.

  3. c. 

    Disability award notices: All FPM award notices explain the right to reconsideration for non-disability issues and the right to a hearing for disability issues.

D. Look for a FPM Case Flag

A FPM Case Flag, if present, is generally either stapled to the outside of the claims folder or filed in the red section of the modular disability folder.

NOTE: This flag may not be present because the prior servicing FO/ ODIO/DTU is instructed to remove the flag when the claimant move drops the case out of the test.

To Link to this section - Use this URL:
DI 12015.005 - Identifying FPM Claims - Procedure - 08/06/2013
Batch run: 04/14/2014