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DUR: FAQs

  1. What are the conflict, intervention and outcome codes for responding to a DUR alert?
  2. Why should a pharmacist enter an outcome code showing that a prescription is cancelled? It is much easier and faster to terminate the transaction.
  3. Why doesn't the DUR program provide alerts for all Medi-Cal drugs?
  4. Are there circumstances when all of the drugs for the Medi-Cal system are screened?
  5. Who should I call if I have a question?
  6. Which alerts can I pre-override?
  7. Our pharmacy computer system performs DUR edits. Why should Medi-Cal duplicate this effort?
  1. What are the conflict, intervention and outcome codes for responding to a DUR alert?
    A. A DUR response consists of three components. The conflict code is a two-digit entry that contains the same two letters of the alert that the pharmacist wants to override. The intervention code describes what action the pharmacist took - whether he or she consulted the prescriber (M0), the patient (P0) or another source (R0), including the provider's own knowledge. Finally, the outcome code describes the intended outcome of the claim. This includes a number of codes that show the prescription was filled (1A through 1G) and two codes showing the prescription was not filled (2A and 2B). These are listed below.

    Outcome Codes graphic

  2. Why should a pharmacist enter an outcome code showing that a prescription is cancelled? It is much easier and faster to terminate the transaction.
    A. Responding to alerts may seem time-consuming, but the information returned is valuable for educating pharmacists about new information and problems with therapeutics. Currently, over 100,000 claims a month are cancelled without the necessary override information; therefore, Medi-Cal does not know why these claims were a problem and cannot use the information to assist or inform pharmacists. Entering the override information provides DUR with the knowledge to assist prescribers and pharmacists.
  3. Why doesn't DUR provide alerts for all Medi-Cal drugs?
    A. One of the primary tasks of the DUR Board is to choose the most important alerts to send to pharmacists. Currently, the DUR program generates over 700,000 alerts per month. Medi-Cal is analyzing how to add more drugs to the DUR system without overwhelming pharmacists with unnecessary alerts.
  4. Are there circumstances when all of the drugs of the Medi-Cal system are screened?
    A. Yes. The DUR program will send out an alert for any drug interaction that is considered most severe, or severity level one. In this case, all drugs on the contract drug list are evaluated for their potential to cause severe drug interactions drug list are evaluated for their potential to cause severe drug interactions.
  5. Who should I call if I have a question?
    A. For basic Medi-Cal website issues or additional alert information, call the POS/Internet help desk at 1-800-427-1295.
  6. Which alerts can I pre-override?
    A. For the following Conflict Codes, a pharmacist may override the DUR alert (referred to as a pre-override) by submitting a DUR response with the initial claim transmission.
    Code Description
    HD High dose
    PA Drug-age conflict
    LD Low dose
    PG Drug-pregnancy conflict
    LR Underutilization - late refill
    SX Drug-gender conflict
    DA Drug-allergy conflict
    MX Incorrect duration
    ER Overutilization - early refill, same pharmacy only
    TD Therapeutic duplication, same pharmacy only
    ID Ingredient duplication, same pharmacy only
  7. Our pharmacy computer system performs DUR edits. Why should Medi-Cal duplicate this effort?
    A. Conduent/Medi-Cal has more interlinked recipient data than any single in-store system. This database allows Conduent/Medi-Cal to send drug-disease alerts to pharmacists that link the incoming drug claim to the recipient's history of diagnoses. This database also contains pharmacy records for a recipient from any pharmacy that processed paid fee-for-service Medi-Cal claims. As a result, therapeutic duplication, ingredient duplication, drug-pregnancy, drug-allergy, additive toxicity and drug-drug interaction alerts provide more information than an in-store system does.

    So, some overlap exists between the Conduent/Medi-Cal system and an in-store system. But the Conduent/Medi-Cal system offers important features which provides pharmacists with essential information.