What this means
m21-4:7.7 explains purpose of the QRT. In plain terms, the official guidance says the results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows: It also addresses EP 930s must use the PMC – Correction of National Quality Error claim label and the National Quality Review special issue indicator.
How this may help with a claim
Use m21-4:7.7 as an internal VA audit trail for purpose of the QRT, not as a promise of a particular result. Compare the actions recorded in your claim file or decision notice with this source-specific detail: The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. EP 930s must use the PMC – Correction of National Quality Error claim label and the National Quality Review special issue indicator. If the record does not show the expected action, identify the missing step precisely when asking VA or an accredited representative to review the file.
What to review in your file
- Check the file against this official condition: The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows:
- Confirm that the record or notice addresses this source point: Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is not correct, the claim is marked as incorrect.
- Document how this stated step or exception applies: indicating when re-adjudication is not appropriate, and
Important limits
m21-4:7.7 is primarily internal workflow guidance about purpose of the QRT. It can help identify what VA was expected to document, but it does not by itself create a claimant deadline, a freestanding entitlement, or a guaranteed remedy. The source also states: The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. Follow the steps in the table below for corrective actions of the responsible employee.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Purpose of the QRT
- m21-4:7.7
- Purpose QRT
- 4.a. Availability Review Results
- results national reviews maintained
- STAR accuracy reports published
- distribution error reports provided
- Note Station performance ratings
Original VA guidance
The official VA text of this section
7. 4.a. Availability of Review Results
The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows:
- STAR accuracy reports are published via the VBA intranet in a 12-month rolling cumulative, 3-month rolling cumulative, quarterly, and monthly, and
- distribution of error reports are provided in 12-month rolling cumulative and quarterly formats.
Note: Station performance ratings are generated during September using the most current available data. For STAR reports, the most current data available in September will be the 12-month cumulative report for the period from October through September. This represents the performance year.
7.4.b. BE Categories
BE review categories include
- addressing all issues
- Duty to Assist (DTA) (38 CFR 3.159) and other applicable regulations for complete development, and
- correct
- decisions
- evaluations
- effective dates, and
- payment rates.
Note: The BE accuracy rate is the official measure of claims processing accuracy and is the result used for performance measurement purposes
7.4.c. Decision Documentation/ Notification Categories
Decision documentation/notification categories include review of the decision and the notification sent to the claimant.
Note: Accuracy of these categories is assessed and reported but is not included for station quality performance.
7.4.d. Claim-Based Accuracy
Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is not correct, the claim is marked as incorrect. Claim-based accuracy is calculated as the percentage of cases considered correct out of the total number of cases reviewed.
5. Reporting the Correction of National Error Citations
Introduction
This topic describes procedures for reporting the correction of national error citations, including
- outcome of national reviews
- clearing PMC vs. correcting PMC
- action to take following notification of a national error
- EP 930 establishment requirements
- corrective actions and reporting
- time limit for corrective actions
- indicating when re-adjudication is not appropriate, and
- responsibility for corrective action by the
- clearing PMC's QRT coach
- correcting PMC's QRT coach
- responsible employee, and
- responsible employee’s coach.
Change Date
October 15, 2021
7.5.a. Outcome of National Reviews
PMCs will learn the outcome of a STAR assessment that results in an error via the QMS.
In QMS, the created date shown on the correction record is the date the RO was notified of the error in QMS.
7.5.b. Clearing PMC vs. Correcting PMC
The clearing PMC is the PMC that cleared the EP identified for national quality review.
The correcting PMC
Note: Generally, the clearing and correcting PMC will match for most corrective actions.
- is the PMC that P&F Service has identified as responsible for taking the corrective action(s) documented during the course of a national quality review including those errors caused by a different PMC, and
- will be identified by its RO number at the beginning of each error narrative.
7.5.c. Action to Take Following Notification of a National Error
QMS will route the error correction record(s) to the clearing PMC in all cases. The national error correction record(s) will populate in the clearing PMCs Quality Review Team (QRT) coach's team queue.
The clearing PMCs QRT coach, or designee, will review the national error cited to determine if a reconsideration request will be submitted.
Use the table below to determine what actions to take when a reconsideration request is received.
Scroll sideways to see the full table.
| If a reconsideration request is … | Then follow the... |
|---|---|
| not warranted | corrective action instructions in M21-4, 7.5.h. |
| warranted | reconsideration request instructions in M21-4, 7.6.a - f. |
7.5.d. EP 930 Establishment Requirements
An EP 930 must be established and cleared for any claim with a cited error where the EP has been cleared or cancelled, even those that do not require a rating or award correction. This requirement has been put in place to ensure data integrity. P&F Service will also monitor completion of error corrections using these EPs.
EP 930s must use the PMC – Correction of National Quality Error claim label and the National Quality Review special issue indicator.
Notes:
- The National Quality Review special issue indicator is a Do Not Recall (DNR) indicator that prevents the National Work Queue (NWQ) recall until the special issue is removed in conjunction with an appropriate transaction.
- If the EP associated with the claim reviewed for quality is still pending, which is likely following a local quality review, then an EP 930 is not necessary. Corrective action to include mentoring and entering a Veterans Benefits Management System (VBMS) note should be conducted under the existing EP.
References: For more information on
- the requirement to enter a VBMS note, see M21-4, Appendix B, and
- how to enter a VBMS note, see M21-1, Part II, Subpart ii, 2.A.1.c.
7.5.e. Corrective Actions and Reporting
The identified correcting PMC must take corrective action on all national errors.
All actions to initiate the correction must be done within 30 days of notification of the error. If multiple errors are cited on a case, all actions to initiate the correction of all errors must be executed.
When corrective actions are initiated, the error correction is considered complete for reporting purposes. P&F Service may review claims for accuracy after the record shows complete. If P&F service determines the PMC action did not correct the error, the claim will be returned to the PMC for additional corrective action.
If the corrective action needed is development, rating correction, or award promulgation, once executed, the ERROR CORRECTED box in QMS must be checked and the DNR special issue indicator removed.
If no further action is needed after the corrective action is taken and reviewed by a supervisor for completion, the EP 930 should be cleared.
If the only corrective action is to provide training and/or feedback to the responsible employee, once a supervisor has confirmed the training and/or feedback has occurred, a VBMS note should be entered and the EP 930 should then be cleared.
7.5.f. Time Limit for Corrective Actions
The correcting PMC is required to initiate and report the corrective action taken for each error within 30 days of the error notification.
7.5.g. Indicating When Re-Adjudication Is Not Appropriate
In cases where re-adjudication may be inappropriate, the correcting PMC must indicate why re-adjudication is not appropriate and describe the other action taken, such as training or feedback provided to the responsible employee when updating the error correction record in QMS. The clearing PMC may also indicate that reconsideration has been requested. If the reconsideration request is denied, the corrective action must be taken and appropriately reported.
7.5.h. Responsibility for Corrective Action by the Clearing PMC’s QRT Coach
When upon review by the clearing PMC's QRT coach, or designee, it is determined that a reconsideration request is not warranted, the reviewer must identify the PMC responsible for corrective actions using the RO number annotated at the beginning of the error narrative(s).
When the identified correcting PMC is also the clearing PMC, the clearing PMC will maintain ownership of the correction record(s) and must take corrective actions.
When the identified correcting PMC is a PMC other than the clearing PMC, the clearing PMC's QRT coach must transfer the error correction record(s) to the correcting PMC's QRT coach team by selecting the CHANGE OWNER box for each error correction record that needs to be transferred.
The error will remain in pending notification status, and this action also confirms that the error has been reviewed and accepted by the clearing PMC.
7.5.i. Responsibility for Corrective Action by the Correcting PMC's QRT Coach
Follow the steps in the table below for corrective actions of the correcting PMC’s QRT coach.
Scroll sideways to see the full table.
| Step | Action |
|---|---|
| 1 | Send notification (according to local procedures) of the error correction to the identified responsible employee and ensure that a copy is sent to the employee’s supervisor. When there is no identified responsible employee, use local procedures to determine who at the PMC is responsible for the corrective action. In QMS, mark the error correction record as notified when notification is sent to the employee and accept the error correction(s) by marking the ERROR ACCEPTED box within each associated error correction record. Ensure that an EP 930 is established for any claim with a cited error(s) with the PMC – Correction of National Quality Error claim label, along with the National Quality Review special issue indicator, and is assigned to the appropriate employee in VBMS. |
| 2 | Change ownership of the national error correction record(s) in QMS to the responsible employee’s supervisor for tracking and updating. |
| 3 | The responsible employee has a maximum of five business days to take corrective action. |
7.5.j. Responsibility for Corrective Action by the Responsible Employee
Follow the steps in the table below for corrective actions of the responsible employee.
Scroll sideways to see the full table.
| Step | Action |
|---|---|
| 1 | Take the corrective action and enter mandatory notes in VBMS describing the corrective action taken, date taken, and RO number taking corrective action. |
| 2 | Communicate with supervisor to advise required corrections have been completed. |
| 3 | The responsible employee has a maximum of five business days to take corrective action. |
7.5.k. Responsibility for Corrective Action by the Responsible Employee’s Coach
Follow the steps in the table below for corrective actions of the responsible employee’s coach.
Scroll sideways to see the full table.
| Step | Action |
|---|---|
| 1 | Ensure that the corrective action is completed within the required five business day timeframe and the responsible employee has added the mandatory VBMS note. |
| 2 | Remove the National Quality Review special issue. |
| 3 | Select the CORRECTED box within each associated error correction record in QMS. |
6. Requests for Reconsideration
Introduction
This topic contains information on requests for reconsideration, including
- formally addressing disagreements
- requesting reconsideration
- time limit for reconsideration requests
- misclassified errors
- formal reconsideration requests, and
- secondary reconsideration requests.
Change Date
April 24, 2025
7.6.a. Formally Addressing Disagreements
It is anticipated that occasionally PMCs may receive a review result with which the PMCs disagrees or believes the explanation offered is unclear or inadequate. Any basic disagreement over the correctness of an error citation must be formally addressed.
7.6.b. Requesting Reconsideration
To request a formal reconsideration of an error, the clearing station must submit the request through QMS. The request for reconsideration must be submitted by a PMC Manager (PMCM) or designee no lower than an assistant coach.
7.6.c. Time Limit for Reconsideration Requests
Requests for reconsiderations must be submitted within 10 business days. P&F Service will accept submission of reconsideration requests if the request is received within 10 business days from the created date of the error correction record in QMS. The 10 business days begin the day after the created date.
Requests for reconsideration that are not received within the established time limit will be rejected and returned to the clearing PMC’s QMS Coach Team Queue for action.
Note: Exceptions to the 10-day period may be requested by contacting the P&F Service Quality staff at VAVBAWAS/CO/P&F QUAL OVRST.
7.6.d. Misclassified Errors
P&F Service will not remove BE errors on reconsideration merely because the error was misclassified on the National Pension Quality Review (NPQR) Checklist when a legitimate BE error exists. Removing known errors on cases included in the nationally mandated sample is contrary to sound quality control principles and provides stakeholders with inaccurate data.
Notes:
- In these cases, the error will be upheld, but reclassified in QMS to reflect correct classification.
- This process will not affect the station’s right to ask for an additional reconsideration using the process detailed below.
7.6.e. Formal Reconsideration Requests
A formal reconsideration request must include pertinent information such as
- supporting statutes
- regulations
- CAVC opinions/decisions
- OGC opinions
- manual citations, or
- other appropriate citations.
The reconsideration request will be submitted via QMS. The reconsideration decision will be returned in QMS. When a reconsideration results in a withdrawal or change in the error status, P&F Service will update QMS to reflect the decision. Results of reconsideration requests will be maintained in QMS and monitored to ensure the effectiveness and integrity of the review process.
7.6.f. Secondary Reconsideration Requests
PMCs have the option to seek additional reconsideration from P&F Service on upheld BE errors.
- Secondary reconsideration requests must be sent to P&F utilizing the RECON 2 button in QMS.
- Requests must be submitted within five business days of the date the PMC receives notification that an electronic review has been completed and the request may be submitted via e-mail.
Important: P&F Service reserves the right to alter this timeline at the end of the FY reporting period to ensure timely final quality reports. If P&F Service disagrees with the action taken by the QA Staff, the error will be withdrawn. The case will be returned to the QA Staff to amend the decision as directed, and feedback will be given to ensure that such errors are not cited in the future.
7. QRT Overview
Change Date
March 23, 2018
7.7.a. Purpose of the QRT
The QRT program establishes a team of dedicated Quality Review Specialists (QRSs) to perform all quality reviews in every PMC.
The QRT responsibilities involve evaluating PMCs’ individual employee-level accuracy and performing in-process reviews (IPRs) to eliminate errors at the earliest possible stage in the claims process.