DUR Rejection Codes

(Drug Utilization Review) DUR Rejection Codes

The topic of this particular page on the website is DUR Rejection Codes.  What are these codes?  DUR Codes are used to override specific insurance rejections; however, they MUST always be documented on the original paper or digital copy of the prescription and MUST be used appropriately. 

These targeted override codes are used in order to sort of "make the prescription insurance company" cover the medication, and therefore, provide the pharmacy with eventual reimbursement for supplying the patient with the drug, by billing, filling, and dispensing the medical provider prescribed product.

There are four parts, or fields, of the DUR Rejection Code.

The first field is the Conflict Code.

The second field is the Code for Professional Service.

The third field is the Code for Result of Service.

And, last but not least, the fourth and final code is the Code for Level of Effort.

Each specific, individual code taken together may be just the thing that unlocks reimbursement for a soon-to-be dispensed medical treatment.

Let's take a look at each part; each element of what makes up DUR Rejection Codes, shall we?

What are Conflict Codes? 

This element is an override for what the HMO or insurance organization has a "conflict" with.  

Let me explain.  Lets say that the insurance rejects a prescription for a reason. 

This reason could be because of one of the following:

There is an Adverse Drug Reaction = Override with Conflict Code "AR"

Or Prescription Authentication is Needed = Override with CC: "AN"

Or maybe this Drug is Interaction with Another Drug = Override with "DD"

Possibly there is a Food to Drug Interaction = Override with "DF"

The Company is Alerting us that there may be a Drug Allergy = "DA"

Perhaps the Company wants the pharmacy to call them = "CH" for Call Help Desk.

Potentially there is a kind of "stacked" or "cumulative" toxicity involving this and another drug = "AT" for Added Toxicity.

Insurance may be holding up the filling of an RX due to the fact that there is a real or potential Drug to Disease Complication = "DC" Drug Disease Inferred Precaution.

Maybe the "All Knowing" Prescription Plan prefers that a certain medication must be tried before this particular medication = "AD" Additional Drug Needed.

Patient Complaint/Symptom = "CS"

Quite possible the (again) "All Knowing" & "god-like" insurance thinks that there is misuse = "DM" Apparent Drug Misuse,

or Overuse = "ER" Precaution for Overuse,

or Dosing that is Too High = "HD" for High Dose,

or how about an excessive amount of medication = "EX" for Excessive Quantity,

or maybe specific chemical component of a product has already been prescribed (and may be already filled) and is the cause for the problem = "ID" Ingredient Duplication,

Perhaps this Drug and a Cocurrent Tobacco Use and/or Addiction is present and is causing the red flag= "DS" for Precautionary Use with Tobacco,


Premium PharmTech Package

Grab this Collection of OVER

25 E-Books/Reports!

Volume #1

Volume #2

Exclusively from 
Pharmacy-Tech-Resources.com ONLY

So, you've found this page and you're wondering "What is the Premium PharmTech Package and Why Am I Going to Invest in it "STAT"?"

Clearly you need to know how this Premium Collection of e-Books and e-Reports has the potential to impact your life, improve your career, your job satisfaction, your workplace relationships, and maybe even your income. Can an collection of digital downloads do that? Read on...

I'd like to get this collection into the hands of as many Techs as possible, so we have lowered the price: Normally $24.99, but NOW, only $19.99 for a LIMITED TIME ONLY.

Add to Cart View Cart
Buy Now

This Fantastic Collection of 25 e-Books and e-Reports is Hand-picked just for you.  You see, I'm pretty sure I know something about you...

  • Have you made your share of mistakes? (Don't worry, we're all human. Everyone of us has.)  Coping with Pharmacy Errors, an e-Book resource I wrote that even I turn back to now and then; is included in this package.
  • are you tired of the head honcho pharmacist getting in your face and micromanaging every little detail of your job?  (Enter my Best Practices for the Assertive PharmTech  e-Book, with proven techniques to help you manage your workplace relationships, included.)
  • are you confused/lost when it comes to the minutia of how to override every last insurance rejection?  (Theres an easier way. Enter Resolving Insurance Rejections (now with Every DUR Code) a quite Handy e-Book, included.

What would you pay to learn...

  • The exact steps to follow to stack the deck in your favor in order to get yourself a raise.  (See Keys to PharmTech Career Success e-Book, included.

Imagine, just for a moment, what work would look like for you, after you invest in yourself and get this VALUABLE, JAM-PACKED e-Book Package... and apply what you've learned...

  1. You now recover and learn from your mistakes a little bit faster.
  2. You are now more assertive and know how to better handle coworker and customer relationships.
  3. You understand how to quickly resolve more Insurance Rejections 
  4. Maybe you've even earned a well-deserved raise! (Congrats!)

These examples are just the "tip of the iceberg" on all the stellar content you will soon be reading and applying.  

While you're sitting there reading this page, you begin to understand why you can't afford to waste any more time getting less than everything you deserve in your pharmacy tech career.

As you think about what you need in your career, you begin to realize that you have only one choice to make, and that is to invest in yourself and grab this Premium PharmTech Package.

Scroll down to see all of the resources (PDF digital downloads) included in this UNBELIEVABLE Deal...

Premium PharmTech Package

Powerful and Invaluable Knowledge from an

Experienced Pharmacy Insider is YOURS:

Take Months off your Learning Curve!

Let this Premium E-Book Package

help you, so you won't have to reinvent the wheel!

Invest in yourself and your career!

You are clicking on the "Buy It Now" button ;)

and Checking Out Now

(before this SPECIAL OFFER goes AWAY for Good)

I've made it easy for you: You can even use Paypal!

Normally $24.99, but NOW, only $19.99 for a LIMITED TIME ONLY.

 
Buy Now

Back to Home

New! Comments

Have your say about what you just read! Leave me a comment in the box below.
[?]Subscribe To This Site
  • XML RSS
  • follow us in feedly
  • Add to My Yahoo!


Didn't find what you were looking for? Use the box below to search this entire site.

Custom Search



Recent Articles

  1. What is day supply take 1 tab on tues and thurs with 30 tabs

    Dec 04, 18 09:06 PM

    What is day supply if I take 1 tablet on Tuesday and Thursday with a quantity of 30 tabs?

    Read More

  2. DUR Rejection Codes

    Nov 27, 18 11:16 PM

    DUR Rejection Codes - Conflict Codes, Professional Service Codes, Result of Service Code, & Level of Effort Field

    Read More

  3. How Does Nalexone Nasal Spray Help an Overdose Victim?

    Nov 23, 18 08:43 PM

    This page discusses, "How Does Nalexone Nasal Spray Help an Overdose Victim?"

    Read More

  4. Medicare Part D

    Jul 31, 18 10:26 PM

    This page answers questions about Medicare Part D, the prescription drug benefit offered by Medicare. Topics include: Who is eligible? What are some of the Costs? Factors to Consider when choosing a p…

    Read More

  5. What are some strategies the FDA has implemented, which help prevent medication errors in the pharmacy?

    Jul 29, 18 06:23 PM

    It seems like some of the errors that have been recently made by our pharmacy techs are actually really preventable. Does the FDA do anything about

    Read More

  6. Osmolarity/Hospital Potassium Infusion problem (3 Part Question)

    Jul 29, 18 05:24 PM

    At 3:00 P.M., a pharmacist received an order to add 30 mEq/L of potassium chloride to the already running intravenous fluid for a patient. After checking

    Read More

  7. HOW MANY DAYS EARLY CAN I GET MY XANAX PRESCRIPTION REFILLED ?

    Jul 29, 18 05:12 PM

    My pharmacy tells me I can get it 3 days early but then they wont fill it but 2 days early. Is the law on Xanax 2 or 3 days ?

    Read More

  8. pharmacy technician exam

    Jul 13, 18 10:36 PM

    I am looking for a tutor to help me prepare for the pharmacy technician certification exam. I live in area code 85373. Can anyone recommend a tutor?

    Read More

  9. Bromfenac(bromday) 0.09% When can I get a refill?

    Jul 13, 18 10:25 PM

    I am to instill 3 drops into both eyes 3 times a day. Received prescription, of 3 bottles/vials, on 16 Mar 18 and need to know how to figure how long

    Read More

  10. Is Publicly mentioning the name of the drug the patient is on a HIPPA violation?

    Jul 13, 18 10:17 PM

    If the name of the drug is mentioned in order to further assist the patient with getting them the medication, is this a violation of hipaa?

    Read More

  11. What is a "Root Cause Analysis"? And how does a pharmacy create "healthy safety culture"?

    Jul 13, 18 09:56 PM

    Recently there was a wrong-drug mistake at the pharmacy I'm employed at as a technician. One of my tech friends (who works at a different pharmacy) asked

    Read More

  12. What is the Correct Dosage for Protamine Sulfate After Receiving 3,000 units of Heparin?

    Jun 28, 18 11:01 PM

    The intern sent the following orders down: Mr. Brown, 50 mg protamine sulfate STAT. You check Mr. Brown’s chart, and he received 3,000 units of heparin.

    Read More

  13. Prior Authorization Rejection

    Apr 10, 18 11:13 PM

    This page covers what a Prior Authorization is and why it happens.

    Read More

  14. My 10 yr olds prescription -- Is The Following Situation a HIPPA Violation?

    Apr 10, 18 10:00 PM

    I know someone who is a pharmacy tech. My 10yr.olds medication was called into the pharmacy she works at. Her daughter and my daughters have an on-off

    Read More

  15. My Pharmacy told my mom that I didn't pick up my meds. Is this a Hippa Violation?

    Apr 10, 18 09:26 PM

    My pharmacy told my mom I didn't pick up my meds. Yes, I do have same last name but I have a different address; for all they know, that wasn't my mom.

    Read More