Identification Number:
GN 04440 TN 80
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 80, 11/12/2019

Audience

PSC: DE, DEC;
OCO-OEIO: FDE;
DQB: DE, PL;
OCO-ODO: DE, DEC, DS, RECONE;

Originating Component

OQR

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

 

Summary of Changes

GN 04440.020 The Scope of Quality Review (QR) for Certified Electronic Folder (CEF) Cases

References to paper cases were removed because OQR no longer performs quality reviews on paper cases. Changes are being made to subsections A2 and B2.

GN 04440.020 The Scope of Quality Review (QR) for Certified Electronic Folder (CEF) Cases

A. Current folder (no prior folder)

Most disability claims are established in the Electronic Disability Collect System (EDCS) and the CEF is the agency's official record.

When one or more claims are established in EDCS but one or more claims are EDCS exclusions, an electronic folder exists – but this is not a CEF.

CEF cases

Federal quality reviewers, regional medical contractors (MC), and psychological contractors (PC) consider all evidence in the CEF to evaluate the accuracy of the adjudicating component’s disability determinations.

B. Prior folder(s) exists for current claim

Prior folder is a CEF case

Review the prior CEF to determine if it affects the review of the current claim.

NOTE: For detailed information regarding PFIs and PPFIs, refer to operating instructions in Paper Folder Indicators DI 81020.010.


GN 04440 TN 80 - Federal Quality Review of Disability Determinations - 11/12/2019