PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 044 – Quality AppraisalSubchapter 61 – SSI Quality ReviewsTransmittal No. 14, 04/09/2020
This is a Quick Action Transmittal. These revisions do not change or introduce new policy. The Office of Quality Review (OQR) is updating this POMS section because of the release of the Allegation Referral Intake System (ARIS). As of 01/18/2020, ARIS will be used to report all instances of potential programmatic fraud.
Summary of Changes
GN 04461.020 Procedures for Supplemental Security Income (SSI) Quality Review Cases with Paper Folders
In Section A.3., we removed the extra space between the first and second paragraphs.
In Section B.3., we removed the second bullet as Form SSA-8551-U3 has been replaced by the Allegation Referral Intake System (ARIS). New bullet will read, "An allegation of fraud has been referred to the Office of the Inspector General (OIG) through the Allegation Referral Intake System (ARIS). (Completed fraud allegations and status can be checked on the ARIS home page.)"
The Office of Quality Review (OQR) requests field office (FO) folders for Stewardship review in limited situations to resolve coding issues, for analytical purposes, and to determine the accuracy of payments (e.g., recipient refuses to cooperate or cannot be located).
OQR requests FO folders for Transaction Accuracy Review (TAR) sample cases where the Modernized System Indicator field of the Supplemental Security Record is coded “1” or “4” (indicating the FO established the case or processed a transaction outside of the Modernized SSI Claims System. FOs should forward any paper case file to the appropriate OQR field site as shown on the email. Discuss problems in locating or sending the cases with the appropriate OQR contact. If the FO is still developing the case, they should photocopy the case file materials needed in the FO and send the originals to OQR.
OQR makes all requests for FO action through the SSA-93 Quality Review website on an SSA-93 feedback form. There is a block in the response area of the website for each case called “Other” which states “Only Use If Applicable”. When the FO responds to an assistance request from OQR for issues like those above, they select “Other” and use the comments area to reply to OQR.
When finished, the website sends an automated email reply to OQR and moves the case to the completed list. A copy of the SSA-93 is available on the website via a link if needed. Refer to the SSA-93 User Guide for more information.
TAR: When requested, reconstruct initial claims per GN 03105.010 and forward the case file to OQR.
TAR: Attach a copy of the email notification to each folder as a transmittal slip and forward the case file to OQR. Circle or highlight the name and account number of the folder sent.
Stewardship and TAR: If one of the following criteria applies, do not send the folder. Annotate the email with the criteria met, attach the supporting documentation, and send it to OQR.
Reconsideration or hearing is pending with no decision. Attach a query showing an appeal is pending or a copy of the SSA-561-U2 or HA-501-U5.
An allegation of fraud has been referred to the Office of the Inspector General (OIG) through the Allegation Referral Intake System (ARIS). (Completed fraud allegations and status can be checked on the ARIS home page.)
Non-medical denial is input when a medical denial also exists. Attach a copy of Form SSA-831-U5.
Disability Quality Branch or Disability Determination Services reverses a medical allowance. Attach a query showing the claim in medical denial status.