Basic (02-06)

DI 80830.076 Pre-effectuation (PER) Review

In the Office of Quality Assurance (OQA) the Disability Examiners (DE) from the Division of Disability Quality Operations (DDQO) review Administrative Law Judge (ALJ) allowance decisions before the action is effectuated to detect and correct erroneous allowance decisions. The case is selected in the Case Processing and Management System (CPMS). At the time of case selection a “DO NOT PAY” message is generated to the MBR to prevent effectuation of the claim until the review is completed. If the DDQO agrees with the ALJ decision, the claim is forwarded to the appropriate Processing Center (PC). In a future release the claim will be routed electronically to the servicing PC from the PER Review System.

Until the automated process is implemented, the DDQO Support Staff will fax a SSA-559 to the PC for Title II decisions and will take the ‘DO NOT PAY’ message off the MBR. The SSA-559 will identify the case as a fully electronic disability case, and bear the appropriate TOEL combination (APPEAL/HEARING for PC 1-6 and 8, APPEAL/DHEAR for PC7). See DI 80830.110B., Example 1 – DDQO Dispatch. The SSA-559 will be indexed in the Paperless Processing Center (PPC) system and routed to the appropriate component for action.