10A NCAC 23A .0103       QUALITY ASSURANCE

(a)  Case actions taken by the county department of social services are subject to review by state and federal quality control procedures.  A statistical sample is selected from both active and negative case actions.

(b)  The purpose of the QC review is to identify eligibility errors and erroneous payments resulting from:

(1)           Ineligibility;

(2)           Recipient liability understated or overstated;

(3)           Third-party liability; and

(4)           Claims processing errors.

(c)  A report of an error discovered in a QC case shall be sent to the appropriate county agency for corrective action.

(d)  If the county agency has verification that disputes a QC finding of error, it may submit the verification to the Recipient Services Section for review.  The Recipient Services Section cannot overturn a listed error, but shall determine whether the error shall be coded client-responsible, agency-responsible, or state-responsible.  Upon its review, the Recipient Services Section shall notify the county agency of its decision regarding responsibility for the error.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R. 431.800;

Eff. September 1, 1984;

Amended Eff. August 1, 1990;

Transferred from 10A NCAC 21A .0501 Eff. May 1, 2012.