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

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