Identification Number:
EM-10090
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/ODARHQ
Originating Office:DCO OPSOS
Title:Case Processing Information on the Pre-effectuated Cases Sampled By the New ODAR Appeals Council Quality Review Branch—One-Time- Only Instructions
Type:EM - Emergency Messages
Program:Disability
Link To Reference:See References at the end of this EM.
 
Retention Date : March 18, 2017

Retention Date : March 18, 2016
Retention Date : September 23, 2015
Retention Date: November 22, 2014

A. Introduction

This message provides case processing information to Field Offices and Processing Centers on cases selected for review by the ODAR Appeals Council (AC) Quality Review Branch (QRB). ODAR AC/QRB is instituting a pre-effectuation review of ALJ favorable and partially favorable decisions. They have already pulled approximately 50 cases for their initial review. The AC/QRB expects to sample approximately 3500 cases per year, equally divided among all regions, when at full capacity.

B. Cases for AC/QRB Review

The AC/QRB will consider under own motion review a random sample of unappealed favorable or partially favorable decisions in Certified Electronic Folder (CEF) cases. These will be limited to disability cases.

C. Cases Excluded from AC/QRB Review

The following cases are excluded from review
    • Critical/TERI cases
    • Compassionate allowances
    • DSI claims
    • CDRs.
    • EDCS Exclusion/Modular Disability Folder claims

D. Process for reviewing randomly selected cases for AC/QRB Review
    1. After an ALJ renders a hearing decision on a CEF case and inputs the decision data
      • CPMS/ARPS will show when a case is selected for review by the AC/QRB. These cases should have a cover notice advising the claimant that the AC/QRB may review the decision within 60 days after the date of the ALJ hearing.
      • An ARPS record is established with a workload type: Unappealed Review – Reversal (URR).
      • The action will provide the alerts to effectuating components that payments cannot begin until the AC/QRB has completed its action on the case. For Title II selected claims, the normal PSC alert is suppressed.
          • For Title XVI selected claims, an alert has been added to EDCS that advises the field office to not effectuate the claim, (AC Own Motion Review-Do Not Effectuate).
          • In addition, in E-view, under the Status/History tab, the Claims Action History will show