Families and Children. Adult, Recipient is interchangeable with “Enrollee.” Retrospective Drug Utilization Review (RetroDUR) means a process that involves ongoing and periodic examination of pharmacy Claims data to identify patterns of Fraud, Abuse, gross overuse, or medically unnecessary care and implements corrective action when needed, as required by 42 Risk Adjustment is a method for determining adjustments to the PMPM rate that accounts for variation in health risks among participating Contractors when determining Capitation Rates.
Appears in 4 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract