Once the appropriate field office has received an active case record from a CAO, QC will:
Review the record to examine the facts on which the CAO determined eligibility and computed benefits;
Interview the recipient, if necessary, to confirm that the information in the record agrees with the information the recipient gave the CAO;
Seek verification from outside sources to establish that the CAO decision on eligibility and benefits is correct;
Record findings on prescribed forms;
Enter findings into QCIES or the FTR; and
Submit findings to the appropriate federal agencies, as required. 55 Pa. Code ยง 111.3(a)(1)
When the QC field office receives a case that is not active (either a closed case or a rejected application), in most cases, they will review the record but not interview the client. These types of reviews are called negative action case reviews. QC will mail findings from these cases to the CAO and enter findings into the QCIES.
QC error findings for active cases will be in one of five categories:
the recipient was underpaid;
the recipient was overpaid;
the recipient is totally ineligible for benefits.
the case contained demographic errors for federal TANF reporting; or
the case was deficient in meeting TANF work participation requirements.
QC findings for program reviews will be one of two categories:
the office had deficiencies in adherence to policy and procedures and a findings memo will be issued; or
information was found during the review that was not adverse to policy and procedures and an information memo will be issued.
QC further notes in what element (area of eligibility, e.g., income, resources, semiannual reporting, etc.) the error occurred, the nature of the error, and the cause of the error. Once QC determines the cause of the error, it will attribute the error either to the client or to the agency.
NOTE: TANF and SNAP eligibility errors will be cited if the difference between the benefit issued and the benefit QC determines the budget group or household was eligible to receive is greater than 25 dollars. Medicaid eligibility error findings are cited if the difference between the benefit issued and the benefit QC determines the budget group or household was eligible to receive is greater than 5 dollars.
Reissued September 20, 2012, replacing March 16, 2012