Below is a general overview of the RSDI quality review process.

1. a. 

   The RSDI quality review verifies eligibility factors and determines the accuracy of payment amounts.

2. b. 

   There are several ongoing reviews:

   • •

     Stewardship is a review of ongoing Master Beneficiary Record (MBR) payments. Cases are selected from SSNs on which at least one RSDI beneficiary received a recurring payment.

   • •

     Enumeration, Title II Postentitlement, Transaction Accuracy, Work Continuing Disability Reviews, and Processing Center (PC)-related workloads, such as PC Overpayment, T2 Redesign, and MACADE, target specific workloads under the RSDI program.

     NOTE: QR also conducts ad hoc and special studies in specific program areas. For example, QR conducts the Medicare Part D Low-Income Subsidy Review triennially to measure the accuracy of the agency's eligibility determinations.

3. c. 

   QR selects a random sample of cases each month based on recently processed transactions or updates to the MBR. Quality reviewers in QR field sites throughout the country review the selected cases.

4. d. 

   The quality review consists of one or more of the following actions by the QR reviewer:

   • •

     a review of the RSDI claims material and other documents and records related to the case;

   • •

     a contact (mail or telephone) with the beneficiary or representative payee; and

   • •

     contacts with third party collateral sources of information.

5. e. 

   QR prepares reports for publication and develops corrective action recommendations based on the data. Recommendations may take the form of legislative proposals or suggestions for changes in Program Operations Manual System (POMS) policy or procedures.

Below is a description of the RSDI quality review and contact with the public.

1. a. 

   For some reviews, the quality reviewer sends the beneficiary or representative payee an appointment letter to explain the purpose of any required interview and schedules an appointment.

2. b. 

   The appointment letter provides the quality reviewer’s name and the telephone number of the QR Field Site so that the beneficiary or representative payee can call with questions about the quality review.

3. c. 

   QR uses mail and telephone to contact the beneficiary and third parties.

4. d. 

   The beneficiary or representative payee may contact the field office (FO) or teleservice center (TSC) to verify the authenticity of the QR or identity of the QR employee. When the TSC receives an inquiry, follow the instructions in TC 00101.035.

   When the FO receives an inquiry, the FO should follow the steps below to verify the identity of the interviewer and provide the individual with further assistance or information regarding the QR:

   • •

     Open Outlook Exchange System and access the address book, known as the “Global Address List” (GAL). Use the GAL in Outlook to confirm that the reviewer is an employee of QR.

   • •

     Did you verify the employee’s name?

     • –

       If yes, advise the caller that the individual is a QR employee who is responsible for contacting beneficiaries. Assure the caller that QR does request documents and or forms by mail for reviews.

     • –

       If no, treat this as a suspicious contact and prepare a report via the Allegation Referral Intake System (ARIS). Users may access ARIS from SSA's IMAIN page, select the ARIS - Allegation Referral Intake System link. The link to ARIS is also on the Fraud Security and PII and the Office of Program Integrity homepages.

You can find contact information for QR field sites at this link: QR Field Sites.

QR sends the following corrective actions to FOs:

• •

  updates to the numident

• •

  beneficiary failure to cooperate

• •

  request for field contact

• •

  whereabouts unknown

• •

  change of address

• •

  some representative payee issues (e.g., new payee development needed, capability determination, failure to account)

• •

  missed entitlements when an application is required

• •

  leads

• •

  new application needed or closeout letter needs to be sent

• •

  work notices (current and past year)

• •

  FO initiated work CDR actions; and

• •

  DDS referrals.

QR sends all other corrective action requests to the PC of jurisdiction.

If the feedback contains one of the corrective actions listed in subsection A.1. in this section and another requiring correction by the PC, then QR sends the feedback to the PC. The PC is responsible for all corrective actions listed on the feedback.

QR emails the SSA-93 along with any related attachments not uploaded to the electronic folder or Non-Disability Repository for Evidentiary Documents (NDRED). QR annotates on the SSA-93 feedback the location of any uploaded documentation.

1. a. 

   For stewardship review, QR:

   • •

     reports cases with dollar deficiencies to the appropriate Office of the Regional Commissioner (ORC) and describes the necessary corrective action;

   • •

     determines the appropriate ORC based on the geographical address of the selected beneficiary. EXCEPTION: If PC 7, Office of Disability Operations (ODO) or PC 8, Office of International Operations (OIO), is the PC of jurisdiction, the controlling office is the Associate Commissioner (AC) of the Office of Central Operations (OCO); and

   • •

     sends a copy of the feedback to the servicing FO or PC of jurisdiction to make the correction.

2. b. 

   For Workers’ Compensation, Title II Post Entitlement, Transaction Accuracy Review, and Work Continuing Disability reviews, QR:

   • •

     reports cases with dollar deficiencies to the appropriate ORC or AC of OCO and describes the necessary corrective action;

   • •

     determines the appropriate ORC based on the geographical address of the servicing FO. If PC 7, ODO or PC 8, OIO, is the PC of jurisdiction, the controlling office is the AC of OCO;

   • •

     sends the feedback to the servicing FO to make the correction and a copy to the office that processed the sampled action, if different; or

   • •

     sends the feedback to the PC of jurisdiction to make the correction and a copy to the office that processed the sampled action, if different.

If you agree with the QR field site’s findings:

• •

  make corrective input within 90 days of the SSA-93 transmission,

• •

  upload any additional supporting documentation to the electronic folder or to NDRED using the Evidence Portal (EP). You can access the EP at View Evidence - Evidence Portal (ssa.gov). Reference the location in the comments area on the website, and

• •

  post the completion on the SSA-93 website.

  NOTE: Do not enter the completion until all required actions are complete. This includes:

  • –

    disability decisions,

  • –

    FO system exceptions pending corrective action in the PC,

  • –

    additional development, etc.

If you disagree with the QR field site’s findings:

• •

  use the SSA-93 website to send a rebuttal request, rationale, and documentation directly to the reviewing QR field site. See Protesting Deficiency Citations QR 04410.040.

• •

  The SSA-93 website automatically notifies the ORC or AC of OCO of the rebuttal request.

  NOTE: Absent evidence of timely rebuttals, QR determines accuracy results based on current findings.

The FO or PC must take corrective action within 90 days of the feedback transmission to the SSA-93 website. FO or PC management must confirm corrective actions before annotating the SSA-93 website.

There may be cases that require more than 90 days for correction. Examples are cases requiring:

• •

  cross component activities,

• •

  FO system exceptions pending corrective action in the PC,

• •

  amended disability decisions, and

• •

  fraud or similar fault determinations.

The FO and PC can request an extension past the 90-day deadline by submitting a request via the SSA-93 website to the ORC (AC of OCO for PC 7 and 8) with an estimate of the extra time needed and a justification for the extension. The ORC or AC of OCO enters the approval or denial of the extension request in the SSA-93 website. The website notifies the requesting PC or FO once the ORC or AC of OCO enters the decision. The website retains documentation of the request for audit purposes.

If you disagree with QR’s findings:

• •

  submit a rebuttal via the SSA-93 website within 45 calendar days as outlined in QR 04410.040F through QR 04410.040G, and

• •

  take corrective action within 90 days of QR’s final rebuttal decision.

To ensure FOs and PCs take proper action on SSA-93 information, QR also monitors the SSA-93 website. QR reviews each case flagged with a SSA-93 indicator (referred to as High Risk cases) when the FO or PC annotates “Corrective Action Complete” on the SSA-93 website.

The QR reviewer in central office uses the SSA-93 website to send an email to the responsible component within 20 calendar days of receipt of the case with a description of the issue if the FO or PC:

• •

  took no action,

• •

  action was incomplete, or

• •

  action was incorrect.

The ORC or AC of OCO also receives this email to ensure that the FO or PC with jurisdiction completes the necessary action as timely as possible. The SSA-93 website sends automated follow-ups every 15 days.

When the QR reviewer determines all corrective actions are complete, they use the SSA-93 website to update the status of the case to “Correct Action Taken” within 20 calendar days of receipt of the case. The website sends an email and moves the case to the completed listing.

If the AIPQB director agrees with the FO rebuttal (i.e., disagrees with the original position of QR), QR removes the deficiency from the QR database. QR notifies the PC feedback coordinator and the FO (if they initiated the rebuttal) of the decision. The PC feedback coordinator notifies all operational components.

If the AIPQB director believes an interpretation of policy is involved, the AIPQB will consult with Division of Title II Quality and Special Studies (DT2QSS) in central office to determine if a policy submittal to the Office of Income Security Programs (OISP) is appropriate before responding. Notify the PC feedback coordinator and the FO of the possible delay in responding pending a reply from OISP.

When the AIPQB affirms all or part of the error findings, the AIPQB provides an explanation of the decision and information about supporting documentation in the Comments box and transfers jurisdiction back to the FO or PC. The decision will explain the additional corrective actions the FO or PC needs to take.

If, after review of the material, the ORC/AC of OCO agrees with the decision of the AIPQB they will explain the decision in the Comments box. The SSA-93 website sends an automated email to the FO or PC. The decision is final and the FO or PC must complete the corrective action. The follow-up process resumes until the FO or PC updates the SSA-93 website to show all actions are complete.

If the ORC/AC of OCO disagrees with the position of the AIPQB, the ORC/AC of OCO must submit a second level rebuttal on the SSA-93 website within 10 days. The ORC/AC or OCO must provide the rationale for the disagreement in the Comments box. The SSA-93 website sends an automated email to QR headquarters (HQ) with the request and rationale for review.