Identification Number:
EM-23015
Intended Audience:RO/DDS/DPU/DPB/OQR
Originating Office:DCO ODD
Title:Archival of DDS Administrators’ Letter #968 - DDS Quality Review Business Process for BBA 812 Claims Containing Excluded Medical Sources of Evidence
Type:EM - Emergency Messages
Program:Title XVI (SSI); Disability
Link To Reference:See Reference at the end of this EM
 
Retention Date: Sept 09, 2023

A. Purpose


    This emergency message (EM) announces archival of DDS Administrators’ Letter (DDSAL) 968, DDS Quality Review Business Process for BBA 812 Claims Containing Excluded Medical Sources of Evidence.
B. Background

    Section 812 of the Bipartisan Budget Act of 2015 (BBA 812), effective November 02, 2016, requires the agency to disregard evidence from statutorily excluded sources, unless specific exceptions apply.
    DDSAL 968, issued November 3, 2016, instructs state and federal adjudicating components to add List Code 978 to the transmittal at case closure on claims containing evidence from excluded medical sources.
    This code routes the claims to the Office of Quality Review (OQR) for an advisory review to ensure BBA 812 procedures were appropriately applied.
C. Prior Process for Routing BBA-812 Claims

    With implementation of DDSAL 968, when closing the claim, the adjudicator enters List Code 978 in item 26C on the SSA-831 and in item 34 on the SSA-832 and SSA-833.
    Entering this code routes the claims to OQR for an advisory review. NOTE: Paper claims are excluded from the process.
D. New Process for Routing BBA-812 Claims

    With archival of DDSAL 968, when closing the claim, the adjudicator does not enter List Code 978 in item 26C on the SSA-831 or in item 34 on the SSA-832 and SSA-833, and the claim will follow normal routing procedures.

Direct all program-related and technical questions to your Regional Office (RO) support staff. RO support staff may refer questions or concerns to their Central Office contacts.

Reference

Archived DDSAL 968 - DDS Quality Review Business Process for BBA 812 Claims Containing Excluded Medical Sources of Evidence


EM-23015 - Archival of DDS Administrators’ Letter #968 - DDS Quality Review Business Process for BBA 812 Claims Containing Excluded Medical Sources of Evidence - 03/09/2023