The OQR reviews sample cases to ensure the evidentiary record supports the determination and that the evidence and the determination conform to SSA operating policies and procedures (see GN 04440.007 for additional information). The cases selected are representative of the universe of cases the adjudicating components review each year. The review results are extrapolated to all cases adjudicated in each case or sample type.
Federal quality reviews are virtual. Any OQR review component may review any case without regard to the adjudicating component's location. The OQR only reviews cases with certified electronic folders (CEF). (See GN 04440.010 for a definition of CEF.)
An automated selection process selects quality review sample cases, when adjudicating components input determinations, and sends cases to review components prior to effectuation of the determinations.
Quality reviewers review adjudicating components' determinations using the same policy and procedural guidelines adjudicating components use. Quality reviewers follow the steps of sequential evaluation and consider all available evidence when assessing policy compliance, sufficiency of evidence, and determination accuracy.
Quality reviewers record review results, including any medical reviews, directly to the OQR’s case processing system. The case processing system transmits review data to the OQR in Central Office, where the data are stored and used to produce national reports and to provide reports to the Commissioner of the SSA, Congress, and other agency components, as requested.
If a case contains no returnable deficiency and is otherwise correct, the review component inputs the case information into the OQR case processing system and effectuates the determination.
If a case is deficient, the quality reviewer makes the necessary correction(s) or returns the case to the adjudicating component for correction, based on the criteria listed below in section D.
If an adjudicating component disagrees with a deficiency return, they can submit an Informal Resolution Request (IRR) (see GN 04440.401) and/or file a Request for Program Consultation (RPC) (see GN 04440.405).