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Drug Utilization Review (DUR)

Change Healthcare DUR system utilizes claims history, provider and reference data to assist in the DUR function. This provides all required notifications to providers in a timely manner, allowing providers to adequately counsel clients regarding potential problems associated with their prescription. It accepts and employs only criteria specifically approved by the Department for ProDUR activities and can easily accommodate changes in those criteria.

Optimize patient outcomes and contain costs.
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Notify Pharmacists

The DUR module has the capability to identify the severity level of criteria applied to ProDUR edits. These features range from fatal edits resulting in claim rejection, DUR override interactions submitted by the provider and “soft” messaging that provides information to the pharmacy so they may intervene and alert the prescriber of any issues.

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Promote Healthy Outcomes

Comprised of doctors and pharmacists, our “clinical-data” teams work with analysts, administrators and developers to achieve patient health and safety. A review of pharmacy and medical profiles identify recipients with real or potential drug therapy concerns and assists with interventions as necessary.

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Deny Claims As Needed

Deny claims that exceed the established limitations set by the state drug utilization review board or rely on the Change Healthcare helpdesk to override denial in cases where medical necessity has been determined.