10a NCAC 25K .0502       SCREENING AND PATTERN ANALYSIS

At least quarterly, the Medicaid drug claims, in conjunction with other Medicaid claims as needed for clinical purposes, shall be subjected to screening against standards approved by the Drug Use Review Board.  The objective of the screening is to identify patterns of behavior involving prescribers and pharmacists,

or patterns associated with specific drugs or groups of drugs.  Health care patterns of individual Medicaid recipients shall be screened.  In addition, individual incidences of screen failure associated with a specific recipient shall be identified for intervention alerts.

 

History Note:        Authority G.S. 108A‑68; Social Security Act Section 1927(g);

Eff. January 4, 1993;

Transferred from 10A NCAC 22M .0302 Eff. May 1, 2012;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. July 23, 2016.