Indiana Code 12-15-35-39. Retrospective DUR requisites
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Sec. 39. Retrospective DUR must:
(2) use the mechanized drug claims processing and information retrieval system to analyze claims data to do the following:
(1) be based on the guidelines established by the board; and
Terms Used In Indiana Code 12-15-35-39
- board: refers to the drug utilization review board created under this chapter. See Indiana Code 12-15-35-2
- compendia: means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources:
Indiana Code 12-15-35-3
- DUR: means the program designed to measure and assess on a retrospective and a prospective basis the proper use of outpatient drugs in the Medicaid program. See Indiana Code 12-15-35-8
- Fraud: Intentional deception resulting in injury to another.
- standards: means the acceptable range of deviation from the criteria that reflects local medical practice and that is tested on the Medicaid recipient database. See Indiana Code 12-15-35-15
(A) Identify patterns of fraud, abuse, gross overuse, and inappropriate or medically unnecessary care.
(B) Assess data on drug use against explicit predetermined standards that are based on the compendia and other sources to monitor the following:
(i) Therapeutic appropriateness.
(ii) Overutilization or underutilization.
(iii) Therapeutic duplication.
(iv) Drug-disease contraindications.
(v) Drug-drug interactions.
(vi) Incorrect drug dosage or duration of drug treatment.
(vii) Clinical abuse and misuse.
As added by P.L.75-1992, SEC.19.