TN 13 (11-11)

GN 01010.375 Payment Center (PC) Responsibilities in Preparing or Reviewing Special Determinations

A. Policy on PC responsibilities and special determinations

Field Office (FO) adjudicators usually prepare the special determinations for both, claims and earnings discrepancy cases. However, in some situations, the PC has information not available to the FO; therefore, those determinations are the responsibility of the PC. For initial determinations, refer to GN 01010.365 for instructions and development.

The PC is responsible for reviewing FO special determinations as needed to ensure all conflicting information is resolved and proper adjudication actions are complete.

B. Procedure for reviewing special determinations

  • If the original determination requires substantial modifications, you must prepare a new determination. However, do not indicate on the new determination that it is a reversal or modification.

  • Do not prepare a new determination if the FO determination is correct and it only requires an additional statement to strengthen the conclusion. In this situation, write “COMMENT” in the bottom of the determination and add the additional statement.

  • If a determination is revised or modified, write “REVISED” or “MODIFIED” on the original FO determination.

  • Maintain the original of the revised determination in the claims file either the “paper” or the “electronic”;

  • Fax a copy of the new determination to the Non Disability Repository (NDR) or electronic DIB folder (eDIB) as per GN 00301.322 and inform the FO of the modification using the Modernized Development Worksheet (MDW).

C. Additional development needed

If additional development is required in connection with a determination prepared by the FO, you must:

  • Provide the FO with a full explanation of the kind of development needed and request the additional development using the Payment Center Action Control System (PCACS).

  • Fax a copy of the FO original determination to (NDR) or the (eDIB) if one is not already filed, and;

  • Set a PCACS diary to control the request until development is completed.

  • Once the FO completes all the development, continue the review following the steps in section B of this chapter.

D. References

  • GN 01010.365 Formal and Informal Determinations

  • GN 00301.322 Retention of Paper Material After Faxing into Either the eDIB Folder or Claims Folder using NDRed

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GN 01010.375 - Payment Center (PC) Responsibilities in Preparing or Reviewing Special Determinations - 01/12/2000
Batch run: 11/10/2011