| Table 10: Pharmacist ProDUR Override Codes | |||
| Should SDMCD ever choose to deny (reject) claims because of a prospective drug utilization review alert, The POS/ProDUR system will allow the pharmacist to override the rejection using an NCPDP Outcome Code. Following are the allowable NCPDP Intervention Codes, Outcome Codes and related descriptions. Pharmacists must be able to submit these codes along with the conflict codes in Table 9 in the incoming NCPDP Medicaid Claim: | |||
Intervention Code |
Description | Outcome Code |
Description |
‘M0’ (zero) |
Prescriber consulted | 1A |
Filled, False Positive |
‘P0’ (zero) |
Patient consulted | 1B |
Filled Prescription as is |
‘R0’ (zero) |
Pharmacist consulted other source | 1C |
Filled with different dose |
‘00’ (zero-zero) |
No intervention | 1D |
Filled with different directions |
Blank |
Not specified | 1E |
Filled with different drug |
1F |
Filled with different quantity | ||
1G |
Filled with prescriber approval | ||
2A |
Prescription not filled | ||
2B |
Prescription not filled - directions clarified | ||