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 …

Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!

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.
  • Consider these additional references:

Dana Westberg, CPhT