SSA's Office of Quality Review (OQR) conducts ongoing QA reviews of adjudicating components' disability determinations to ensure effective and uniform administration of the disability program and to conform to the statutory requirements set forth in section 221(a) of the Social Security Act (Act).

QA reviews evaluate the accuracy of adjudicating components' disability determinations to determine performance accuracy, as required by SSA regulations. SSA uses data produced by QA reviews to determine whether states perform at acceptable levels in terms of decisional accuracy and documentation requirements, as explained in DI 30005.001B.6.

SSA conducts the PER to meet statutory requirements of the Act. Section 221(c) of the Act requires SSA to review at least 50 percent of favorable Title II and concurrent Title II/Title XVI initial and reconsideration determinations made by adjudicating components on a pre-effectuation basis.

Section 1633(e)(1) of the Act requires SSA to review at least 50 percent of favorable Title XVI adult initial and reconsideration determinations made by the adjudicating components on a pre-effectuation basis.

A predictive model randomly selects a sample of claims from those determinations most likely to be incorrect.

Favorable Title XVIII Medicare for Qualified Government Employee disability claims (disabled worker, disabled widow(er), and childhood disability) are also subject to PER review.

OQR performs other disability process quality reviews and special studies to evaluate disability program performance in areas of concern and to alert adjudicating components and SSA management of current and potential problems.

Other quality reviews include:

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  Targeted denial review (TDR) - TDRs are discretionary reviews of denial determinations. This review uses a predictive model to identify and select cases based on deficiency-prone case characteristics, similar to the method used in PER case selection. The sample size for each adjudicating component varies. Deficiencies cited under the TDR are informational and do not count against an adjudicating component’s performance accuracy. However, OQR does control the returns and adjudicating components must correct all deficiencies. (See GN 04440.202 for an explanation of controlled returns.)

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  Disability hearing officer (DHO) review - OQR reviews continuing disability review decisions from DHOs prior to effectuation. The DHO review is discretionary and the percentage of cases reviewed may vary.

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  OQR may also conduct ad hoc studies, including early information studies and systems reviews, to validate new policies or procedures.