10A N.C. Admin. Code 23A .0103 - QUALITY ASSURANCE

(a) County department of social services eligibility actions on active and negative cases, as defined by 42 C.F.R. 431.804, which is incorporated by reference including subsequent amendments and editions, and available free of charge at https://www.ecfr.gov/, shall be subject to review under State and federal quality control (QC) procedures by the Division's Office of Compliance and Program Integrity (OCPI). A statistical sample shall be selected from both active and negative case actions.

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

(1) Ineligibility;

(2) Recipient liability understated or overstated by the client or county;

(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 county agency for corrective action.

(d) If the county agency has verification, as defined by Rule .0102 of this Subchapter, that disputes a QC finding of error, it may submit the verification to OCPI for review. OCPI shall determine whether the error shall be coded client-responsible, county-responsible, or State-responsible. Upon its review, OCPI shall notify the county agency of its decision regarding responsibility for the error.

Notes

10A N.C. Admin. Code 23A .0103

Authority G.S. 108A-54; 108A-54.1B; 42 C.F.R. 431, Subpart P;
Eff. September 1, 1984;
Amended Eff. August 1, 1990;
Transferred from 10A NCAC 21A .0501 Eff. May 1, 2012;
Readopted Eff. June 1, 2019.

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. Readopted by North Carolina Register Volume 34, Issue 01, July 1, 2019 effective 6/1/2019.