Manitoba Health DUR Claims

A DUR claim is a non-financial Manitoba Health (DPIN) claim submitted solely for drug utilization review. Manitoba Health does not pay for DUR claims, but they are added to the patient's DPIN profile.

There are two ways to submit DUR claims:

Using the Group ID 'DU' in the Third Party Information

For Pharmacare patients (Manitoba Health Carrier ID 01), enter the Group ID DU in the patient's Manitoba Health third party information.

The Manitoba Health DU billing code in PharmaClik Rx is for patients who don't adjudicate financially to Manitoba Health (i.e. Manitoba Health doesn't pay for their prescriptions), but require that the DPIN profile be updated - this is called 'DUR Only'. DU is sent in the Group ID for 'DUR Only' patients.

Manitoba Health claims submitted with a DU Group ID automatically use the next third party in the prescription's billing code to determine the prescription's price. For example, if the billing code is DU/VO/VA and the patient's Manitoba Health Group ID is DU, pricing will be based on the VO pricing rules.

Using the DU Intervention Code

Before filling the prescription, add the intervention code DU to the Manitoba Health claim. When submitting a DU intervention code, the claim will be considered a DUR claim and a prompt asks if you want to recalculate pricing (the options are Yes or No). Pressing Yes allows you to price the prescription using the next third party in the prescription's billing code. For example, if the billing code is DP/AS/CA and the DU intervention code is entered for the DP claim, the prescription's price will be based on the AS pricing rules.

When the DU intervention code is entered for a Manitoba Health claim, it will be retained on refill.