A prepayment review is a review of the non-disability eligibility factors before authorizing payment.

Low-risk cases (LRC) are those SSI initial claims (ICs) with characteristics that are not error-prone.

Underpayment at risk is the SSI underpayment amount, minus the potential Title II offset for the underpayment period, per SI 02006.100C.1.

NOTE: Exclude a case from underpayment review if the amount "at risk" is less than the review threshold of $15,000. Refer to SI 02101.025C.1 in this section.

An adjudicator is a Claims Specialist (CS) or above, who performs the prepayment review. The adjudicator can be the individual who made the original determination.

A reviewer is a CS or above, and is someone other than the adjudicator. The reviewer examines the file after the adjudicator completes the prepayment review, but before the release of the underpayment. The reviewer completes the Underpayment Process (UOUP) screen and releases the underpayment.

Conduct a prepayment review for any SSI case (IC or post eligibility (PE)) when an individual is due an underpayment of $15,000 or more through the month prior to the current computation month (CCM). For a definition of the CCM, refer to SM 02101.001.

Do not conduct a prepayment review if the case:

• •

  Involves Title II offset and the SSI underpayment “at risk” is less than $15,000 per SI 02006.100; or

• •

  Is a low-risk criteria (LRC) case as described in SI 02101.025C.2.

A case meeting LRC criteria has all of the listed characteristics for all months of the underpayment period:

• •

  An initial claim;

• •

  An individual record (TMR = DI, BI, etc.) with a payment status code of C01 or E01;

• •

  An automated computation;

• •

  The only chargeable income includes these types on the UMIH field of the Supplemental Security Record (SSR):

  1. a. 

     Type A, G, or W (Title II benefits);

     b. Type I (deeming allocations);

     c. Type J (systems posted VTR);

     d. Type RL (rental or lease);

     e. Type RH (royalties or honoraria);

     f. Type RI (interest or dividends) totaling $5 or less per month; and

• •

  Living arrangement is either:

  1. a. 

     B continuously,

  2. b. 

     A, continuously, with the same UMIH income type as living arrangement B, and General Assistance Grant Reimbursement (GA/GR) involvement and no State supplement category, or

  3. c. 

     Congregate care, as defined in SI 01401.001C.3.

An adjudicator and a reviewer perform the prepayment review.

The rules of administrative finality apply to underpayment cases; however, failure to release an underpayment is not an initial determination and is not subject to administrative finality. For administrative finality rules, refer to SI 04070.010 and SI 04070.070.

When the system computes an underpayment of $15,000 - $49,999.99, it holds the underpayment and sets a U2 diary until the reviewer releases the underpayment.

After the prepayment review, the reviewer accesses the Direct SSR Update to provide authorization for release of the underpayment through the UOUP screen. To view the UOUP screen, refer to MS 00304.018. The reviewer releases the underpayment to the individual or representative payee (payee) unless one of the listed criteria are met:

• •

  Interim Assistance Reimbursement (IAR) applies, per SM 01311.662;

• •

  Direct fee payment to an authorized representative, per SM 01311.664;

• •

  Installment only payments (the system will automatically release the payments), per SM 01311.668; or

• •

  Dedicated account case (the system will set all appropriate diaries, issue an alert and release an automated notice to the payee), refer to SI 01130.601 and SM 01311.667.

NOTE: For underpayments of $50,000 or more, refer to SI 02101.055.

The system releases an underpayment of $15,000 or more (except in dedicated account cases) after:

• •

  Completion of the UOUP screen. For UOUP screen information, refer to MS 00304.018 and SM 01311.661 (PE);

• •

  Force due(s). For instructions on when to use force due procedures, refer to SM 01701.001; or

• •

  One-Time Payment(s) (OTPs). For instructions on the OTP process, refer to SM 01901.001 and MS 00303.025.

For cases involving IA, refer to the instructions listed:

• •

  SI 02003.020 Field Office Processing of IAR Authorization

• •

  SI 02003.022 Processing eIAR Field Office Intervention Cases

• •

  SI 02003.023 Processing eIAR Exception Cases

• •

  SI 02003.025 IAR Payment Processing for Exception Cases and Proration Cases

• •

  SM 01005.623 Grant Reimbursement (GR) Field

• •

  SM 01005.627 Exception Processing (GR)

• •

  SM 01311.662 Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

For cases involving dedicated accounts or installment payments, refer to the instructions listed here:

• •

  SI 02101.010 Past-Due Benefits Payable – Individual Alive Under Age 18 with Representative Payee – Dedicated Account Required

• •

  SI 02101.020 Large Past-Due Supplemental Security Income Payments by Installments – Individual Alive

• •

  SM 01301.450 Special Action Code (SZ)

• •

  SM 01311.661 How to Resolve a U2 Diary to Release Underpayments of $15,000.00 or More

The system generates the listed diaries and alerts associated with underpayment reviews:

After the reviewer selects the appropriate code from the UOUP screen, the system may set additional diaries and generate additional alerts for installment and or dedicated account cases as shown in the chart:

For instructions on resolution of these diaries and alerts, refer to the instructions listed:

• •

  SI 02003.022 Processing eIAR Field Office Intervention Cases

• •

  MS 00303.024 One Time Payment Amount (UPOP)

• •

  SM 01005.470 SZ Edits and Alerts

• •

  SM 01301.450 Special Action Code (SZ)

• •

  SM 01301.470 SZ Reject and Alert Conditions – Procedure

• •

  SM 01311.660 Overview of SSI Underpayment Processing

• •

  SM 01311.661 How to Resolve a U2 Diary to Release Underpayments of $15,000.00 or More

• •

  SM 01311.662 Processing Interim Assistance Reimbursement (IAR) from an SSI Underpayment

• •

  SM 01311.668 Processing Payments in Installments from an SSI Underpayment

• •

  SM 01311.669 How to Resolve a U1 Diary

• •

  SM 01311.670 How to Resolve a U3 Diary

• •

  SM 01311.675 How to Resolve a U4 Diary

Take these steps to process underpayment alerts.

1. a. 

   Management is responsible for overseeing prepayment reviews added to the Underpayment Case Control Log until payment reflects on the SSR.

2. b. 

   Make employees aware of their responsibilities in the process.

Conduct a prepayment review if the underpayment is $15,000 or more, unless:

• •

  Title II offset reduces the underpayment at risk to less than $15,000. (For instructions on documenting no money at risk, refer to SI 02006.100F.2.); or

• •

  The LRC criteria outlined in SI 02101.025C are met.

Follow these steps to prepare the underpayment for release.

Follow these steps for reviewer's responsibilities.

For the SSI underpayment workload, follow these instructions:

Paste into the Report of Contact screen, or the SSA-5002:

• •

  To paste into the Report of Contact screen, navigate to the Report of Contact screen. Select CTRL+V. The text will appear on the screen.

• •

  To paste into the SSA-5002, open the SSA-5002 form. Select CTRL+V and the text will appear on the form.