Providing Multiple Benefits

When a claim is being processed for a drug that has the potential to cause problems for the recipient, the prospective DUR system will return an alert message to the pharmacy provider via the fiscal agent to inform the provider of the potential problem. This will offer the following benefits:

· Provides a real-time alert so that pharmacies can immediately respond to the potential problem.

· Reviews not only the prescriptions at an individual pharmacy, but all of the prescriptions reimbursed by Medicaid fee-for-service, giving pharmacy providers access to information that was formerly unavailable to them.

· Uses information from previously paid medical and pharmacy claims to build a recipient profile that links to additional medical information, such as medical diagnoses and inferred diagnoses.

· Allows pharmacy providers to deal with any alerts once they have occurred
Health Information Designs has experience and expertise in creating Pro-DUR edits and assisting fiscal agents in implementing them.


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