SECTION 340:2-23-19. Quality control review process

(a)   Case Selection. The QC process begins when a case is selected from the random sample for review and ends when that case finding and data are entered into the NIQCS, transmitted, subjected to federal sub-sampling, and federally accepted.

(b)   Client contacts. Client contacts are described in this subsection.

(1)   Initial contact. Except in the Medicaid program, clients are notified in writing they have been selected for a QC review. At the initial face-to-face visit, the ARU reviewer seeks to validate the information provided to the Department at the time of application or recertification.

(2)   Obtaining information from clients. Any missing or conflicting information between the record and the interview is researched by the ARU reviewer and required to be resolved. The client may be asked to provide written documentation to clarify areas of concern.

(c)   Collateral contacts. ARU reviewers seek collateral references to substantiate client or case record information.

(1)   Role of collateral contacts in the QC review process. The client may be asked to sign a release of information so phone, face-to-face, or written contact can be made with affiliated persons or businesses. Collateral contacts for QC reviews include, but are not limited to: landlords, utility companies, employers, neighbors, banks, schools, post offices, local businesses, and medical vendors. These sources of collateral contacts are asked to validate information regarding the client and may be asked to assist in locating the household if an ARU reviewer is unable to do so.

(2)   Authority to pursue collateral contacts. If a household refuses to provide collateral contacts or sign a release of information for collateral contacts, the ARU reviewer has the authority, in accordance with Medicaid, and Food Stamp federal policies and TANF and Day Care state policies, to contact any collaterals necessary to verify the correctness of statements made on the application forms for assistance. Application forms denote the Department representative's authority to contact collateral sources necessary to verify the correctness of client statements made at application.

(d)   Quality control review findings. The ARU reviewer records all verification obtained on the sampled person or household in the QC file. The ARU reviewer makes a preliminary finding on the case as to the accuracy of the eligibility determination and payment and other information after through analysis of the information collected during the QC process.

[Source: Added at 15 Ok Reg 1271, eff 4-1-98 (emergency); Added at 16 Ok Reg 1008, eff 4-26-99]