Quality Review (QR) performs case reviews to ensure the evidentiary records support the adjudicating component determination and the evidence and the determination conform to the Social Security Administration (SSA) operating policies and procedures. Deficiencies are cited based on adjudicating component action relative to the evidence in the case (e.g., medical evidence, statements by the claimant, information from other sources) at the time of adjudication. For an explanation of what constitutes evidence, see DI 24503.005.

The review component sometimes receives additional evidence (trailer material) while the case is undergoing review. In some instances, the trailer material changes a correct case to a deficient case or a deficient case to a correct case. The review component must determine if corrective action is necessary and whether or not to cite the adjudicating component with a deficiency.

In CEF cases, the review component can receive an UAT while a case is undergoing review. The UAT results when a field office (FO) without jurisdiction of the case initiates changes as follows.

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  The FO can update mainframe data (e.g., claimant name, address, telephone number) on SSA mainframe systems (Modernized Claims System/Modernized Supplemental Security Income Claims System) and propagates that information into the Electronic Disability Collect System (EDCS) using the UAT utility. This action produces an alert under the Alerts and Messages section and Record of Change (ROC) under the Case Data section in eView.

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  The FO can update disability report information (e.g., new medical source, new allegations, tests, medications) and add that information to the CEF by creating a Form SSA-5002 (Report of Contact) in EDCS. This action produces an alert under the Alerts and Messages section, ROC under the Case Data section, and SSA-5002 under the Case Documents section in eView.

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  The FO can add a claim to a case when another claim has been transferred to the adjudicating component. This action produces an alert under the Alerts and Messages section and ROC under the Case Data section in eView.

In some instances, the UAT changes a correct case to a deficient case or a deficient case to a correct case. The review component must determine if corrective action is necessary and whether or not to cite the adjudicating component with a deficiency.

To view UATs, the review component should access eView or SSN History in the National Case Processing System (NCPS) case processing system.

The review component may receive trailer material while a case is undergoing review. For CEF cases, the review component may also receive UATs while a case is undergoing review. However, the review component must base the QR evaluation of the adjudicating component’s determination on the evidence included in the case as a whole at the time of the adjudicating component’s case clearance.

The review component must consider any trailer material or UAT received while a case is undergoing review for purposes of case adjudication and correction, if necessary.

In some instances, the trailer material or UAT changes a correct case to a deficient case or a deficient case to a correct case. The review component must then determine if corrective action is necessary.

The review component should review the CEF to identify trailer material and UATs that may have been received while the case is undergoing review. This can be accomplished by reviewing the date the document or UAT was received into the CEF. A gap between the review sample date and the date an additional document or UAT was received into the CEF generally indicates the presence of trailer material or UAT received after adjudicating component case clearance. You can view the review sample date in the top frame of eView, or you can identify it by using the “Query” case search in the National Case Processing System (NCPS).

NOTE : NCPS allows for cases to be transferred from the review component to the adjudicating component, then re-closed by the adjudicating component back to the review component. When Trailer Mail is considered, use the most recent date the case was returned to the review component instead of the NCPS sample date.

Any component can add documents to the CEF regardless of jurisdiction of the CEF; however, only the component with jurisdiction of the CEF will be able to take adjudicative actions on that case.

NOTE: The review component should not rely solely on checking the “CEF Received?” date of documents under the Case Documents section in eView to identify trailer material. The adjudicating component may send documents to the CEF during the closure process. In addition, delays in the adjudicating component closure process (i.e., system problems) may result in a “CEF Received?” date that is later than the review sample date. When discrepancies are noted, the review component should also consider the information provided on the adjudicating component Disability Worksheet, which is under the Case Documents section, in Section F - Medical Records (Yellow Back).

The following chart explains the procedure required when trailer material and UATs are received during review.