| Data Review | Utilization Manager

MHI Drug Exclude = Y

MHI Drug Exclude will have a Y indicator when the following Qualification Rules are active to disqualify dispenses. 

Rules listed by number:

#1    C2 – C5 are NOT Eligible for 340B

#2    C2 are NOT Eligible for 340B

#5    Revenue < or = to $X is NOT eligible for 340B

#7    Generics are NOT eligible for 340B

#12    All scripts are NOT eligible for 340B

#21    Specified NDCs only qualify for 340B

#31    Excluded patient list NOT eligible for 340B

MHI Other Match = Y

MHI Other Match will have a Y indicator when the following Qualification Rules are active to qualify dispenses.

Rules listed by number:

#10    Approved patient list qualifies for 340B

#11    Approved patient list AND (diagnosis code OR standard/extended DEA) qualifies for 340B**

#17    Script qualifies if date written is same as encounter date

#18    Script qualifies if date written is between ADT admit and discharge date

#22    Specified NDCs AND (Dx Code OR (Standard/Extended) DEA) qualifies for 340B**

#23    Specified NDCs OR Diagnosis Code OR DEA qualifies for 340B

#27    Primary Payor is Eligible for 340B (Enter Payor in notes field)

#28    Extended DEA AND Date Written within X days of encounter date eligible for 340B**

#34    EXT DEA and Date: Script qualifies if date written is between the ADT Admit and discharge date**

#36    Extended DEA AND Date Written X days after encounter date eligible for 340B

**Indicates additional test criteria must be met.