When the adjudicating component disagrees with any cited group I deficiency, group II deficiency, or technical corrective action (TCA), in a fully electronic case, they may attempt to resolve the disagreement on an informal basis by submitting an IRR via the Office of Disability Policy’s (ODP)
IRR web-based
tool , within twenty (20) calendar days, beginning with the date the review component returned the deficient case. For any IRR submitted after the twenty (20) calendar-day time limit, the adjudicating component must provide an explanation of the unusual circumstances that caused the delay. The review component will determine whether to accept the IRR due to the unusual circumstances.
NOTE: RPC will not accept submissions when the disagreement involves a change in deficiency type only, otherwise known as a "wrong deficiency cited", unless the case has first been through the IRR process. A wrong deficiency citation occurs when one type of deficiency is cited, but program instructions support a different type; e.g., documentation vs. decisional, or group I vs. group II. In these situations, there is no rescission of the deficiency, but the review component updates the QR case processing system database with the correct deficiency. This still only results in one chargeable deficiency against the adjudicating component.
EXAMPLE: The review component cites a decisional deficiency, changing an allowance determination to a denial determination, but fails to recognize in doing so, that the adjudicating component must first develop all allegations or medical sources prior to denying the claim. The adjudicating component requests the review component change, or replace, the decisional deficiency to a documentation deficiency, agreeing that the evidence does not currently support an allowance, but acknowledging the adjudicating component must develop all allegations or medical sources before making a denial determination. The review component updates the QR case processing system database with the correct deficiency, thus there is only one chargeable deficiency for the adjudicating component.
NOTE: The QR case processing system allows recording more than one deficiency code when applicable to the Federal quality review results. However, only the deficiency marked as "Primary" is counted against the adjudicating component. Deficiencies marked as "Other" do not count against the adjudicating component unless they subsequently become "Primary" as a result of the IRR or RPC.
If the adjudicating component chooses not to attempt to resolve the disagreement through the IRR process, or if they cannot resolve the deficiency after the IRR process, the adjudicating component may submit an RPC to OPCA for a fully electronic case (see DI 30007.125 - Submitting a Case for RPC). The adjudicating component may not simultaneously submit an IRR and RPC.
If the adjudicating component does not resolve the deficiency through the IRR process, they must complete the request for corrective action(s) noted on the Request for Corrective Action, or Request for Case Action, or submit an RPC, if the case meets the criteria for RPC submission (see DI
30007.125 - Submitting a Case for RPC).
For subsequent returns and corrective action inquiries, which are precluded from the IRR/RPC process, the adjudicating component may choose to contact reviewing component directly to discuss concerns informally prior to completion of the action(s) noted on the Request for Corrective Action or Request for Case Action. (see QR 04440.205 - Quality Review Subsequent Returns).