There are two methods of resolving deficiency disagreements between adjudicating and review components:

1. 1. 

   The IRR process, administered by the Office of Quality Review (OQR), attempts to resolve deficiency disagreements informally between the adjudicating and review components. The adjudicating component directs the IRR submission to the review component that cited the deficiency for another impartial review of the case facts and applicable policies in contention. The review component will prepare a policy-based IRR resolution to address the adjudicating component's deficiency disagreement.

2. 2. 

   The RPC process, administered by the Office of Policy Consultation and Analysis (OPCA), resolves deficiency disagreements between the adjudicating and review components through an RPC Panel Discussion. For an explanation of the RPC process, see DI 30007.000.

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 are encouraged to 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.

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 OQR case processing system database to reflect the correct deficiency, thus there is only one chargeable deficiency for the adjudicating component.

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, if the criteria is met, 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 in the SSA-1774-U5, Request for Corrective Action or SSA-847-U3, SSA 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).

The adjudicating component uses the IRR process to:

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  resolve disagreements in group I deficiencies, group II deficiencies, or TCAs, in a fully electronic case;

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  request a rescission of a group I deficiency or group II deficiency, in a fully electronic case; or,

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  resolve disagreements, within the appropriate time frames, regarding cases with group II deficiencies routed directly from the review component to the Field Office (FO).

When the adjudicating component prepares an IRR, the adjudicating component:

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  cannot use the federal quality review administrative procedure of probability of reversal (POR), as defined in GN 04440.110 and DI 30005.110, as the basis of an IRR for a documentation deficiency;

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  can use substitution of judgment (SOJ), as defined in GN 04440.118, as a basis of an IRR for a decisional deficiency;

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  cannot use SOJ as the basis of an IRR for a documentation deficiency; and,

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  is not required to perform any development actions requested on the SSA-1774-U5, Request for Corrective Action, or the SSA-847, SSA Request for Case Action, prior to submitting an IRR, except for those development actions not in dispute.

The adjudicating component must initiate an IRR through ODP's IRR web-based tool to attempt to resolve any disagreement or to request a rescission, if applicable, of any group I deficiency, group II deficiency, or TCA. The adjudicating component must:

• •

  submit the IRR request in the web-based tool within 20 calendar days, beginning with the date the review component returned the deficient case, and

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  include a policy based narrative, with applicable citations, explaining the basis for the IRR.

If the review component disagrees with the IRR rationale for policy compliance submitted by the adjudicating component, the adjudicating component must complete the requested corrective action(s) noted in the SSA-1774-U5, Request for Corrective Action or SSA-847-U3, SSA 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).

When the adjudicating component does not request rescission of a deficiency or is not in disagreement with the deficiency citation, the adjudicating component may email or phone the review component contact found in the SSA-1774-U5, Request for Corrective Action or SSA-847-U3, SSA Request for Case Action, without submitting an IRR, to discuss the issues of the case, and/or the necessary required actions:

• •

  to clarify the requested corrective action(s) noted the SSA-1774-U5, Request for Corrective Action, or SSA-847-U3, Request for Case Action,;

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  to ask a specific question about the deficiency; or,

• •

  to ask about a policy citation(s).

The review component has 14 calendar days to respond to the IRR. When the review is complete, the review component will:

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  code the IRR web-based tool,

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  prepare a narrative response to the IRR in the IRR web-based tool,

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  ensure that the IRR response addresses all relevant policy concerns or questions raised by the adjudicating component, and

• •

  include policy and procedural references to support the response, unless the review component agrees with the adjudicating component’s IRR, rescinds the deficiency, and no further action is needed.

After the review component completes and closes the IRR in the IRR web-based tool, the tool will upload the adjudicating component IRR submission and review component IRR response to the certified electronic folder and will notify the adjudicating component by email that the response is available to view.

If the review component agrees that the adjudicating component’s determination was policy compliant, the review component will rescind the deficiency in the IRR web-based tool. Once the case is returned by the adjudicating component, the review component will update the OQR case processing system database and clear the case according to normal business processes.

If the review component disagrees with the adjudicating component’s IRR rationale for policy compliance and affirms the deficiency, the adjudicating component must take the requested corrective action(s) noted on the SSA-1774, Request for Corrective Action or SSA-847, SSA 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).

If the adjudicating component decides to complete the requested corrective action(s), the adjudicating component will return the case to the review component after completing the actions. The review component will code and clear the case according to normal business processes.

If the review component rescinds or corrects the deficiency within the IRR web-based tool, the OQR case processing system database will be automatically updated with the applied revisions to ensure that the rescinded or corrected deficiency is appropriately recorded.