Page 755

755 Chapter 3:Processes and procedures • Section 5: Program integrity (07/2026) • Any changes made on the case after the branch is notified the case is to be reviewed may affect future benefits but will not affect the benefits under review. QC review process The QC review process focuses on verification of all factors of eligibility, benefit amount and type. The QC reviewer obtains verification through case record review and field investigation. Case record review includes all relevant agency computer screens. Field investigation includes a personal interview (for SNAP) with the individual and any collateral contacts needed to obtain verification. The QC reviewer looks at eligibility and the amount of benefits for a point in time. The reviewers make a determination about eligibility for the sampled month. If eligible, the reviewer determines if the correct benefit amount and type was authorized. If the review is of a denied, suspended or terminated case, the QC reviewer determines if the decision to deny, suspend, or terminate was correct. QC relationship with local offices QC uses information from ODHS|OHA records and may use certain local store front office resources for gaining additional information. The review itself must be completely independent of the local store front office, with one exception. The exception is to gather additional medical information needed to prove eligibility. The reviewer may ask the local store front office to request medical information or a report. QC staff is responsible for evaluating the information and making an eligibility determination. Distribution of QC findings QC shares individual case review decisions with branch/agency staff when the review is completed. The local office has five working days to agree or disagree with the QC findings. If the branch does not respond by agreeing or disagreeing within the five-day time frame, the reviewer’s findings and conclusions are considered final. To disagree with the review findings, ODHS|OHA staff must present factual evidence and documentation about why the review finding is in error. QC must receive the facts supporting the disagreement within the five working day period. In addition, when they disagree with the QC decision, local offices can ask QC to expand the review and make further contacts or look at different policies. However, the final decision on the review is with QC alone. QC and the agency must resolve the disagreement before the QC completion deadline. Program or other appropriate staff may help resolve the disagreement. Data analysis The Program Integrity Unit analyzes QC data to give management a clear picture of QC findings. The analysis includes the following: • Findings of which error rates are increasing or decreasing. • Estimated caseload dollar loss associated with the error rate and different types of errors. • Identification of errors that corrective action can specifically address.