TN 10 (02-11)

DI 30005.005 Types of Federal Quality Reviews

Explanation and purpose of quality reviews

1. Quality assurance review

SSA conducts ongoing quality assurance (QA) reviews of the adjudicating components to ensure effective and uniform administration of the disability program and to conform to the statutory requirements set forth in section 221(a) of the Social Security Act (Act).

The QA review measures the accuracy of the adjudicating component’s disability determinations, which SSA regulations require to determine performance accuracy. The QA review statistics determine whether individual adjudicating components perform acceptably in terms of decisional accuracy and documentation requirements, as explained in DI 30005.001C.7.

2. Preeffectuation review

Section 221(c) of the Act requires SSA to review at least 50 percent of favorable Title II and concurrent Title II and Title XVI initial and reconsideration determinations that adjudicating components make on a preeffectuation basis. To the extent feasible, the sample selection is comprised of those determinations most likely to be incorrect.

Favorable Title XVIII Medicare for Qualified Government Employment disability claims and deemed disabled widow(er) Medicare claims are also included in the preefectuation review (PER) sample of adjudicating component favorable determinations.

The PER review detects and corrects erroneous favorable Title II determinations before the determination is effectuated.

3. Other quality reviews

The Office of Quality Review performs other disability process quality reviews (QR) and studies to evaluate current disability program performance in areas of concern and to alert adjudicating components and SSA management to current and potential problems (e.g., random denial reviews, early information system reviews).

To Link to this section - Use this URL:
DI 30005.005 - Types of Federal Quality Reviews - 01/15/2014
Batch run: 01/15/2014