Retrospective DUR definition

Retrospective DUR means that part of the drug utilization review program that assesses or measures drug use based on an historical review of drug use data against predetermined and explicit criteria and standards, on an ongoing basis with professional input.
Retrospective DUR means a retrospective review of Members’ prescription claims to evaluate the appropriateness of each Member’s therapy based upon generally accepted current clinical pharmacy practices and clinical rules that focus on gaps in care and unsafe and clinically inappropriate therapy across widely utilized therapy classes.

Examples of Retrospective DUR in a sentence

  • Retrospective DUR shall utilize telephonic or written interventions with prescribers to determine medical necessity for prescribed medications.

  • Retrospective Utilization Review Retrospective DUR activities are implemented after medications have been dispensed to health plan members.

  • The two components of New York State's DUR Program are Retrospective DUR (RetroDUR) and Prospective DUR (ProDUR).

  • Retrospective DUR involves evaluating patterns of drug therapy either concurrent with therapy or after a Medicaid patient has completed therapy.

  • Retrospective DUR generally involves claim review and may include communication by the PBM with prescribers to coordinate care and verify diagnoses and Medical Necessity.

  • Retrospective DUR examines drug use after the drug has been dispensed.

  • ESI currently does not provide Current DUR Savings or Retrospective DUR reports monthly for PEBP; however, the ESI clinical pharmacist does provide physicians with reporting to encourage increased generic and formulary prescribing.

  • We describe a pilot implementation of Level Three: Improved Retrospective DUR Programming and Clinical Case Management (“Level Three”).

  • When tasks are complex, Programmable Logic Controller (PLC) is adopted.

  • To date, 13 states (26%) for the Prospective DUR and 22 states (44%) for the Retrospective DUR have designed or redesigned their Medicaid Management Information System (MMIS) systems to incorporate Physician Administered Drugs (i.e. drugs paid through the physicians and hospitals programs) into their DUR criteria.

Related to Retrospective DUR

  • Retrospective review means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment.

  • Retroactive Date means the date specified in the Schedule.

  • Premium surcharge means a payment required from a subscriber, in addition to the subscriber's medical premium contribution, due to an enrollee's tobacco use or an enrolled subscriber's spouse or state registered domestic partner choosing not to enroll in their employer- based group medical when:

  • child tax credit means a child tax credit under section 8 of the Tax Credits Act 2002;

  • Special Reimbursement Date means, the special payment date established in connection with a Reimbursement under Special Circumstances as described hereunder “Extraordinary Events and Special Circumstances – Reimbursement Under Special Circumstances and Payment”.

  • Premium Due Date means date specified in the Schedule on which the Instalment Premium will become due.

  • Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.

  • Extra Premium means an additional amount charged by Us, as per Our Underwriting Policy, which is determined on the basis of disclosures made by You in the Proposal Form or any other information received by Us including medical examination report of the Life Insured.

  • Insurance Cost Increase shall not, however, include any premium increases resulting from the nature of the occupancy of any other lessee of the Building. If the parties insert a dollar amount in Paragraph 1.9, such amount shall be considered the "BASE PREMIUM." If a dollar amount has not been inserted in Paragraph 1.9 and if the Building has been previously occupied during the twelve (12) month period immediately preceding the Commencement Date, the "Base Premium" shall be the annual premium applicable to such twelve (12) month period. If the Building was not fully occupied during such twelve (12) month period, the "Base Premium" shall be the lowest annual premium reasonably obtainable for the Required Insurance as of the Commencement Date, assuming the most nominal use possible of the Building. In no event, however, shall Lessee be responsible for any portion of the premium cost attributable to liability insurance coverage in excess of $1,000,000 procured under Paragraph 8.2(b).

  • Inflation means the percentage change in the implicit price

  • Yearly (1/Year) sampling frequency means the sampling shall be done in the month of September, unless specifically identified otherwise in the effluent limitations and monitoring requirements table.

  • Risk Premium means a percentage determined on an Adjustment Day for the Adjustment Period beginning on such Adjustment Day, which indicate the price of the risks taken over by the Issuer. The determination will be made by the Issuer in its reasonable discretion (billiges Ermessen § 315 German Civil Code (BGB)). The respective

  • Cost Reimbursement means a contract which provides for a fee other than a fee based on a percentage of cost and under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms.

  • High Deductible Health Plan means a Health Plan as defined by 26 USC § 223(c)(2)(A) that also is a Qualified Health Plan.

  • Coinsurance means that you pay a percent of the total cost of the drug each time you fill a prescription.

  • Yearly (1/Year) sampling frequency means the sampling shall be done in the month of September, unless specifically identified otherwise in the effluent limitations and monitoring requirements table.

  • Premiums means premiums, considerations, deposits and similar receipts with respect to the Policies or Post-Closing Policies.

  • Material Change in Formula means the occurrence since the Launch Date of a material change in the formula for, or the method of, calculating the Reference Price.

  • Enrollee point-of-service cost-sharing or "cost-sharing" means amounts paid to health carriers directly providing services, health care providers, or health care facilities by enrollees and may include copayments, coinsurance, or deductibles.

  • Loss Factor means the scaling factor determined in accordance with clause 7 and applied by the reconciliation manager to volumes of electricity measured or estimated in respect of ICPs on the Network, in order to reflect the impact of the ICP on Losses within the Network;

  • Rebates means rebates, price reductions and administrative fees and related adjustments charged by or payments to state Medicaid and other federal, state and local governmental programs and their participants, and by health plans, insurance companies, Medicare Part D prescription drug plans, pharmacy benefits managers, mail service pharmacies, long term care providers, specialty pharmacies and other health care providers based upon the utilization and sales of the Product, and service, administrative and inventory management fees due to wholesalers, distributors and group purchasing organizations based on sales of the Product (in each case, other than chargeback claims).

  • R&W Policy means those certain buyer-side representations and warranties insurance policies purchased by Buyer in connection with this Agreement.

  • Input Tax Credit means the credit of input tax;

  • Disciplinary change in placement means a suspension or removal from a student’s current educational placement that is either:

  • Payback Period means the reasonably estimated period of time that it takes for the cost savings resulting from a capital improvement to equal the total cost of the capital improvement. Landlord, by itself or through an affiliate, shall have the right to directly perform, provide and be compensated for any services under this Lease. If Landlord incurs Expenses for the Building or Property together with one or more other buildings or properties, whether pursuant to a reciprocal easement agreement, common area agreement or otherwise, the shared costs and expenses shall be equitably prorated and apportioned between the Building and Property and the other buildings or properties.

  • Indexation means the adjustment of an amount or sum in accordance with paragraph 69 of this Call Off Schedule 3;