When a DDS requests an RPC, the RPC tool automatically:

1. 1. 

   Assigns a case number;

2. 2. 

   Enters the date of the submission; and

3. 3. 

   Adds the case to the Workload Management screen.

   DDS has the option to request a panel discussion or have their claim expedited. They should select the appropriate box when submitting their claim to RPC. Cases that do not specify an option will be processed in a way which is most advantageous to all parties involved.

Upon receipt of an RPC submission:

1. 1. 

   The RPC technical expert reviews the submission for personally identifiable information (PII). If the DDS submission contains PII, the technical expert returns the submission to the DDS for correction.

2. 2. 

   If there is no PII in the RPC submission, or after the DDS corrects the submission, the technical expert accepts the submission and the RPC tool automatically emails the DDS, the DQR, and the DC, notifying them of the acceptance of the RPC submission.

3. 3. 

   The technical expert assigns the submission to an RPC reviewer who serves as the DP panel member in the RPC panel discussion.

1. All three panel members (DP, DA, and QR):

• •

  Review the DDS's RPC submission and the DQR's SSA-1774 (Request for Corrective Action) for the involved policy issues and policy references.

• •

  Review the entire case record and prepare to resolve the policy issues in question.

2. The DP panel member:

• •

  Completes the DDS and DQR data screens in the RPC tool.

• •

  Reviews the RPC tool database for cases with similar issues.

• •

  Determines the need for additional medical or policy component expertise. If the panel member finds additional expertise is necessary, the panel member will not schedule the case for panel discussion. The panel member will provide a synopsis of the case issues to the RPC Technical Expert (TE) and request the appropriate policy guidance. The TE will forward the request to the consulting component. Upon the policy component response, the panel member may expedite the case or schedule it for discussion.

• •

  Expedites the claim when appropriate. If the DP panel member finds the case record supports using the expedited process, the DP panel member applies the procedures for DI 30007.135F. and DI 30007.135G. in this section.

• •

  Schedules the RPC panel discussion using the RPC tool, allowing two business days notice to all interested parties, if the case record does not support use of the expedited process or DDS requests panel discussion. When the RPC panel discussion is scheduled, the RPC tool automatically sends an email to the involved DDS, DQR, and DC, notifying them of the date and time of the RPC panel discussion.

  NOTE: RPC makes every attempt to schedule RPC panel discussions in a timely manner. If RPC has not resolved a submission within 21 calendar days of the DDSs RPC request, the DDS may request status using the ^LP DP RPC Controls mailbox. In the email subject line, enter RPC Status Request and the RPC case number.

When a DDS chooses to withdraw an RPC request prior to the RPC panel discussion, the DDS sends an email to the ^LP DP RPC Controls mailbox, indicating RPC Withdrawal and the RPC case number in the subject line. Generally, RPC will honor the withdrawal request, unless it is clear the withdrawal will result in an incorrect determination.

The purpose of the expedited RPC process is to identify cases where the areas of dispute can be appropriately resolved without the full RPC panel discussion process, as outlined in DI 30007.145.

An RPC staff member decides whether the facts of a case are consistent with the expedited process. Examples of cases that may be appropriate for the expedited process include those in which:

• •

  The only disputed issue is medical and RPC receives a written medical opinion that resolves the issue. In this case, the DP panel member enters the written opinion or clarification into the CEF.

• •

  The DQR cites a documentation deficiency, but the missing documentation is in the CEF.

• •

  The existing policy on the disputed issue(s) is well defined and the resolution of the case is not in question, considering the case facts and disability policy.

• •

  RPC has previously provided guidance on the same policy issue in a previous RPC resolution; or

• •

  Any case where, based on the experience of the RPC reviewer, technical expert, or manager, the resolution of the case is not in question.

  NOTE: All QA cases will only be expedited if QR, DA, and DP all agree that the case facts support RPC expedited processing.

The expedited RPC procedure:

1. 1. 

   DDS can request a case be expedited or discussed in panel. However, if DP/RPC reviews the case evidence and determines the expedited process may apply, the reviewer discusses the case with the RPC technical expert.

2. 2. 

   The RPC technical expert reviews the case and the recommendation and determines whether the expedited process is appropriate.

3. 3. 

   If RPC determines a case can be expedited instead of scheduling for a panel discussion, the RPC technical expert will contact the DDS to discuss this option and get approval.

   EXAMPLE: DDS requests panel discussion and review of case reveals that DDS followed all policy and their determination is correct. The deficiency can be rescinded with no policy issue to discuss.

4. 4. 

   Upon receiving approval to expedite, the reviewer prepares an RPC resolution and puts the resolution into the RPC tool. The resolution will include a notice under both the DP summary and the DP narrative stating Expedited RPC No RPC Panel Discussion Held.

5. 5. 

   The reviewer will code the case as an expedited RPC in the Categories of Issue on the RPC tools DP Data Screen.

6. 6. 

   The reviewer will submit the case to the RPC technical expert for closure in the RPC tool.

DC is not required to take any action on an initial RPC request submitted within the appropriate time frame (see DI 30007.125B.). However, DC has access to the RPC database for use in their ongoing oversight, liaison, training, and leadership responsibilities.

If DC has comments regarding a DDS RPC, DC should email comments to RPC (include the RPC case number in the subject line) at ^LP DP RPC Controls with a copy to DA at

|||DA DICompliance HearingsQuality DAB

and QR at ^DCDA.OQR.DDQ.Controls@ssa.gov.