Claims Processing
NPI/DEA Crosswalk
ePrescribing
DUR/Reports

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DUR/Reports
Retrospective drug utilization review involves DUR evaluating medicinal therapies after the medications have been provided to the patient. The purpose of this review is to determine patterns of dispensing that may be inappropriate and are in opposition with your policy. HCIdea 3.0 will be able to match the DEA and NPI numbers to the physician in the processed claim. This allows the health plan to identify the physician so they may communicate their treatment protocol.
Improve member satisfaction while reducing costs by identifying inappropriate patterns such as:
| | - Clinical abuse/misuse
- Drug-disease interactions
- Drug-drug interactions
- Erroneous dosage, duration of therapy or choice of therapy
- Over and under utilization
- Therapeutic duplication
- Under utilization of generic substitutes
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