2024 Self-Audit Series #2: DAW Codes
Prescriptions flagged for incorrect or invalid DAW codes is a discrepancy we have seen increase notably on PBM audit results. Pharmacy reimbursement and/or patient copay may be influenced by the DAW code billed providing another reason PBMs scrutinize so closely.
Auditors will look for …
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documentation to support any DAW code billed other than DAW 0. Prescriptions without appropriate documentation may be at risk of full recoupment. Understanding the significance of billing the correct code is something all pharmacy staff should be aware of.
PAAS National®® has created the: DAW Codes Explained chart with the NCPDP list of codes and their description.
PAAS Tips:
- Print and post the DAW Codes Explained chart for easy reference.
- Avoid having pharmacy software default the DAW field, as this may allow an incorrect code to be used.
- Follow state specific laws and Medicaid requirements for DAW 1 format requirements.
- Patients requesting brand name medication must be notated on the prescription or in your electronic notes field. Be sure this information is readily retrievable for audit purposes.
- Do not assume the same DAW billed on past prescriptions is accurate for the current prescription.
- DAW 0 would be appropriate for generics, single-source drug products, brand or reference products (without an available equivalent).
- Follow plan reject messages when brand name is the plan’s formulary choice; use DAW 9 when plan indicates – do not assume.
- Self-audit prescriptions on a weekly/monthly basis using internal software reports to confirm claims were billed with correct DAW codes and have supporting documentation.
- Utilize the PAAS National® Self-Audit Mindset tool when reviewing
- Consider these additional references:
- June 2023 Newsline, Billing guidance: When to Use DAW 0 vs DAW 9
- February 2024 Newsline, Best Practices for DAW Billing in Pharmacies
- PAAS’ on-demand webinar, Understanding Interchangeability with Prescription Biologics.
Analyst at PAAS National®
As a Certified Pharmacy Technician at PAAS, I am here to assist and provide you with pre- and post-audit advice. I can also provide product and billing information.
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
I attended Madison College in nearby Madison, WI (PAAS headquarters are in the Madison suburb of Stoughton). Prior to coming to work at PAAS, I worked as a Certified Pharmacy Technician in a retail setting for 25+ years. Pharmacy has been my life’s work.
Helping our members have a successful audit experience is very rewarding. Celebrating with them, when PAAS often helps generate positive post-audit results, is the best part of my work.
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