EEOICPA BULLETIN NO. 03-20

EEOICPA BULLETIN NO. 03-20

Issue Date: July 29, 2003 ________________________________________________________________

Effective Date: July 29, 2003 ________________________________________________________________

Expiration Date: July 29, 2004 ________________________________________________________________

Subject: Quality Control Checklists

Background: The purpose of this bulletin is to introduce and explain the procedures for the Quality Control(QC)checklists. There are four categories of checklists, which include: Initial Development, Follow-Up Development, NIOSH Referral and Recommended Decisions. The checklists will be used to assure quality control of the claims process at the time of each type of action and/or during random review by the Supervisory Claims Examiner (SCE). Each checklist has two sections: 1)Questions relevant to the quality control of the action, and 2)Data integrity of ECMS elements. Included with each checklist is an "Errors for QC Checklist" page, where an explanation of any errors for either section would be explained. [The following procedures will be updated when the Quality Control Checklists are moved on-line into ECMS.]

Previous instructions from the "DEEOIC Quality Control Checklist Policy" memo dated July 10, 2002, noted that "the original QC checklists were developed to help correct errors that were observed in recommended decisions/development letters to claimants and to provide additional guidance for the Energy Case Management System (ECMS)."

Prior to the issuance of the draft Procedure Manual (January 2002), these documents were developed for Claims Examiners (CE) and Senior/Supervisory CEs to help identify any errors (i.e. factual, policy, grammatical, etc). The original intent was to have them serve as a mechanism to ensure that accurate/non-redundant information was being requested from claimants in a courteous manner. These procedures incorporate a more detailed method of review to ensure the quality of work in each District Office.

References: "DEEOIC Quality Control Checklist Policy" memo dated July 10, 2002.

Applicability: Claims Examiners, Senior Claims Examiners, All Supervisors, District Directors.

Actions:

The CE selects the appropriate checklist, based on the development or decision action.

For Initial Development checklist (Attachment 1) and Follow-Up Development checklist (Attachment 2):

These checklists are completed by trainee CE’s for every initial and follow-up development letter written.

The trainee CE prepares Initial Development action or Follow-Up Development action, including but not limited to, letter(s) or correspondence to claimants and/or employment verification facilities. The CE uses either the Initial Development checklist (Attachment 1) for first action, or Follow-Up Development checklist (Attachment 2) for subsequent actions, and fills in the Employee SSN and Employee Name fields. The CE will also either enter all relevant data EXCEPT CLAIM STATUS CODES into the appropriate ECMS fields (employee data, claimant data, worksite data, and medical condition type data), or ensure that they were entered correctly by the case create clerk. On Section 2 of the checklist, for "Claim Status Code," the CE will write the recommended claim status code for the type of development action that is being taken (i.e. DE,DO,ES). The CE will NOT enter the claim status code into ECMS until the development letter has been approved and returned by the Senior CE, and has been dated. The status effective date that will be entered by the CE along with the status code will be the date on the development letter (this will be the date that the letter is ready to be sent). The checklist and the correspondence representing the development action is put together on the inside of the case file jacket.

For the first three months that a trainee CE has been assigned a caseload, the trainee CE routes the case file to the Senior Claims Examiner (SrCE), and completes the location change in ECMS on the Case screen. The checklists will be completed by the SrCE and shared with the Supervisory Claims Examiner (SCE) as part of the training and mentoring process. The checklists may also be completed by the SCE as part of the training and developmental process.

The SCE may require that CE’s other than trainees complete these checklists. In this instance, the CE follows the same procedures as discussed above, except the CE will provide the checklists to the SCE not to the SrCE for review and correction.

3. For NIOSH Referral checklist (Attachment 3)and Recommended Decisions checklist (Attachment 4):

These checklists are completed by all CE’s.

The CE prepares the NIOSH Referral Summary Document (NRSD) or the Recommended Decision (RD). The CE uses either the NIOSH Referral checklist or Recommended Decisions checklist and fills in the Employee SSN and Employee Name fields. The CE will also either enter all relevant data EXCEPT CLAIM STATUS CODES related to NIOSH referral/Recommended Decision into the appropriate ECMS fields (employee data, claimant data, worksite data, and medical condition type data), or ensure that they were previously entered correctly. On Section 2 of the checklist, for "Claim Status Code," the CE will write the recommended claim status code for the type of development action that is being taken (i.e. NI, or recommended decision codes). The CE will NOT enter the claim status code into ECMS until the action has been approved and returned by the Senior CE, and has been dated. The status effective date that will be entered by the CE along with the status code will be the date on the NRSD or recommended decision (this will be the date that the letter is ready to be sent). The checklist and the correspondence representing the NIOSH Referral Summary Document or Recommended Decision action is put together on the inside of the case file jacket. The CE routes the case file to the SrCE, and completes the location change in ECMS on the Case screen.

4. The SrCE reviews each item on the checklist, marking the boxes appropriately. For Section 1 of the checklist, (the quality control questions), the SrCE answers either "Yes", "No", or "N/A" for each question. For each "No" answer, the SrCE completes the Errors for QC Checklist. The Errors for QC Checklist (Attachment 5) is a continuation page for each checklist, wherein the SrCE explains deficiencies for all of the "No" responses. If there are errors noted on the checklist for which the SrCE needs to see the corrections, the SrCE will mark the checklist in the "Check here to Return to SrCE/SCE" box.

For Section 2 of the checklist, (the ECMS data elements), the SrCE checks the data entry in ECMS for each numbered question. Each question requires a "Yes" or "No" answer, depending on whether all of the data elements listed below a question are correct. If all elements in ECMS for that question are correct, the SrCE checks the "Yes" box and continues to the next question. If any of the data elements for a question are incorrect, the SrCE checks the "No" box, and then checks off each individual element that is incorrect. For each "No" answer, the SrCE completes the Errors for QC Checklist. If there are errors noted on the checklist for which the SrCE needs to see the corrections, the SrCE will mark the checklist in the "Check here to Return to SrCE" box.

After the SrCE completes the checklist, he/she provides a copy to the CE and maintains the original copies in a folder. Separate folders should be maintained for each type of checklist. The complete contents of the Initial Development and Follow-up Development folders may be provided to the SCE. A random sample of the NIOSH Referral and Recommended Decisions checklists, from a list provided by the SCE, will be provided to the SCE periodically as required for appraisal purposes.

The SrCE records the completion of each review by writing on the inside of the case file jacket, as follows:

Review Type Location of SrCE Date Checklist Completed

DI (e.g.) CBB (review completion date)

[for Follow-Up Development]:

Review Type Location of SrCE Date Checklist Completed

DF (e.g.) CBC (review completion date)

Review Type Location of SrCE Date Checklist Completed

NI (e.g.) CBB (review completion date)

[for Recommended Decisions]:

Review Type Location of SrCE Date Checklist Completed

RD (e.g.) CBC (review completion date)

The SrCE routes the file to the CE, and changes the location in ECMS on the Case screen. The CE makes all corrections based on the checklist and the Errors for QC Checklist, if any.

9. For Initial Development checklist and Follow-Up Development checklist:

13. The QC Checklist review process is now complete. It is then within the discretion of the CE as to whether or not s/he wants to maintain the photocopy of the completed checklist.

14. Checklists without case or claims examiner identifiers may be provided to management at any time for training and quality control measures. Other than outlined in this bulletin, the checklists completed by the SrCE may not be used in establishing the rating record for the CE’s they are mentoring.

15. The checklists will be used for new actions subsequent to the date of this bulletin. Training on the bulletin and the associated checklists will be provided in the District Offices.

16. Analysis of Results

The original completed Quality Control Checklists are maintained by the SrCE or SCE as indicated. On a quarterly basis, the District Offices are required to prepare the Analysis Reports for QC Checklists (Attachments 6-9) for the DO’s Regional Director, and Deputy Director of EEOICPA. This analysis must be completed by the SrCE’s, given that management will not be reviewing the checklists for NIOSH referrals and recommended decisions until after the appraisal period. The reports are then sent via E-mail to the Regional Director and DEEOIC Deputy Director.

Disposition: Retain until incorporated in the Federal (EEOICPA) Procedure Manual.

PETER M. TURCIC

Director, Division of Energy Employees

Occupational Illness Compensation

Distribution: Distribution List No. 1: (Claims Examiners, Supervisory Claims Examiners, Technical Assistants, Customer Service Representatives, Fiscal Officers, FAB District Managers, Operation Chiefs, Hearing Representatives, District Office Mail & File Sections.)