After a CAO scans or sends the case record to QC and the review is completed, QC will notify the CAO and the Area Manager electronically if an error is found. Any supporting documentation will be electronically attached. Upon receipt of the message, the CAO will:
Access the document through the hyperlink provided in the email or through DocuShare's BPE folder to review the QC error findings. A program specific folder will contain the findings;
Review the information in the findings memo to determine whether the QC findings are correct according to current policy and verification of the facts;
Decide whether it agrees or disagrees with the QC findings; and
Respond to the findings memo during ERC.
Participate in the Error Review Committee (ERC) process. See Section 900.41, Error Review Committee.
NOTE: QC Memo Reports are available monthly for TANF demographic and work participation deficiencies and a Daily Status is posted about the 21st of each month when the reports are available.
The CAO's position regarding the QC findings will be stated during the ERC.
Documentation to support the CAO's disagreement must be faxed or scanned to the appropriate QC Program Manager at (717) 783-0899 and can be forwarded either before or after the meeting.
The CAO must address the factual data presented by QC and the applicable policy. If the CAO determines that QC used an incorrect policy, it must identify the appropriate policy reference or submit additional clarification if QC is believed to have misinterpreted the cited policy. The CAO must also provide verification to dispute the QC findings.
The CAO where the case is currently active must respond to the findings memo if there is a basis for challenge, even if the error occurred while the case was active in another county. QC attributes the error to the county where the case was active as of the review month.
NOTE: If QC does not find an error, it will not notify the CAO. However, the CAO can access MAPPER or FTR periodically to view the entries for each specific case in the sample and will learn from that information that QC did not take an error on the case.
Error cases for SNAP, TANF, Medicaid, EBT and FTI are addressed by the Error Review Committee (ERC). The ERC is made up of members from the Bureaus of Policy, Operations, Program Evaluation and Program Support who meet as needed to discuss both positive and negative SNAP and Medicaid findings, TANF, EBT and FTI findings. Meetings are held in Harrisburg and staff members from the CAO participate either in person or via speakerphone. The functions of the ERC are to discuss the circumstances surrounding each review finding. This includes, but is not limited to:
Policy
Computer systems
Training
QC procedures
CAO procedures
ERC provides a means to examine the various systems which contribute to the eligibility and allotment process and aids in the identification and implementation of possible changes which may prevent future errors. The forum affords all those who participate an opportunity to offer suggestions for system-wide changes that may help reduce the state’s payment error rate.
The basic steps of the ERC processes are as follows:
1. The CAO receives a QC Review Findings Memo QC Memo Report.
2. The QC Program Manager reviews the findings memos to determine when a case will be scheduled for ERC.
3. The Division of Quality Control (DQC) e-mails a list of cases to be discussed with the CAOs along with the date of the meeting.
4. At the meeting, the ERC members will contact the CAO representative to obtain the CAO’s position on the review and to supply any additional information about the review. The ERC and the CAO will discuss the issues of the case. As needed, requests for or discussion of corrective action plans and strategies will be made.
5. ERC makes a decision to affirm, withdraw, or pend each error finding for further discussion.
6. If the QC representative or the Area representative disagree with the ERC decision, an Area Manager challenge can be initiated. To initiate an Area Manager’s challenge, both the QC and the Area representative must notify and provide supporting documentation for discussion to the Area Manager and the BPE director within 5 days of the notification of the ERC decision. A decision on the final review results will be made by the BPE Director and the Bureau of Operations Director or the Area Manager.
7. DQC issues an ERC Summary which summarizes the decisions made on that week’s review.
8. QC Memo Reports have a CAO Response column which should be completed for cases that require a corrective action response and QC Memo Reports should be returned to the PW, TANF sample mailbox by the 20th of each month.
Reminder: If QC does not find an error, it will notify the CAO via Clean Case Letter. The letters are transmitted automatically on a monthly basis via e-mail to CAOs and Area Managers. If there are no QC Memo Reports for a county or district for a particular month, the QC Memo Report will display "No Data Found."
Reissued September 20, 2012, replacing March 16, 2012