DUR

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Once the claim is transmitted and rejected by the 3rd party carrier for any DUR (Drug Utilization Review) reason, the system will capture and store the DUR reject code. If a user tries to transmit the prescription with the DUR reject, the system will display this DUR screen. You will then need to enter the appropriate Professional Service code and Result of Service code. At present time the last 3 fields on the screen (Level of Effort, Co-Agent ID Qualifier and Co-Agent Id) are not typically used for regular claims.

Upon entering the data you must click on the ‘Save DURs’ to save the data.

To clear any entered information, click the "Clear DURs" button.

If you'd like to delete the DURs displayed on this screen, click the "Delete DURs" button.

Reason for Service Code (Conflict Code): This will automatically be selected when the user transmits a claim.

Professional Service Code (Intervention Code): Enter in the appropriate professional service code or select it using the dropdown box.

Result of Service Code (Outcome Code): Enter in the appropriate result of service code or select it using the dropdown box.

Level of Effort: Enter in the appropriate Level of Effort using the dropdown box, if required by the payor.

Co-Agent ID Qualifier: Enter in the appropriate qualifier number or select it using the dropdown box, if required by the payor.

Co-Agent ID: Enter in the appropriate Co-Agent ID, if required by the payor.

REMINDER: Save the DURs when finished by either clicking the ‘Save DURs’ button or by pressing the "Enter" key when the ‘Save DURs’ button is highlighted.