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đŸ’ŗ 3rd Party Reference

Insurance Plans & Billing Codes

📋

Patient Insurance Information Form

Print or email this form to patients who need to provide their insurance billing numbers (BIN, PCN, Member ID, Rx Group)

📄 Open Patient Form
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Indiana Medicaid

IN
💊

IN Medicaid Formulary

Search Indiana Medicaid drug list with filters for tier, prior authorization, quantity limits, and step therapy

🔍 Search Formulary
✓ Contracted Plans
Plan Name Code Group Number Actions
✗ Not Contracted Plans
Plan Name Code Group Number Actions
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Illinois Medicaid

IL
✓ Contracted Plans
Plan Name Code Group Number Actions
✗ Not Contracted Plans
Plan Name Code Group Number Actions
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Commercial Insurance

COMM
✓ Contracted Plans
Plan Name Code Group Number Actions
✗ Not Contracted Plans
Plan Name Code Group Number Actions
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🏷ī¸ Rugby/Major OTC Drug Lookup

OTC
ℹī¸ About Rugby/Major OTC Products
Search our comprehensive database of Rugby and Major brand OTC medications by NDC, product name, description, or therapeutic category.
🔍
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DAW Codes

DAW 0–9

⚠ī¸ Common Source of Claim Rejections

An incorrect DAW code is one of the most frequent reasons a claim rejects. See also: Insurance Rejections Guide (Part 1), Part 2, Part 3.
Code Meaning When to Use Notes
0 No product selection indicated Default — prescriber allows generic substitution Use for most Rx unless a specific reason applies
1 Substitution not allowed by prescriber Rx written "brand only," "DAW," or "dispense as written" Brand billed — patient typically pays brand cost share
2 Substitution allowed — patient requested brand Generic permitted by Rx, patient specifically wants brand Patient pays any brand-vs-generic cost difference
3 Substitution allowed — pharmacist selected brand Pharmacist chooses brand for clinical/therapeutic reason Rare — document rationale in profile notes
4 Substitution allowed — generic not in stock Generic temporarily out of stock; dispensing brand Revert to DAW 0 once generic is restocked
5 Substitution allowed — brand dispensed as generic price Brand billed at generic rate (authorized generic situation) Less common; plan-specific — verify before using
6 Override State-specific override scenario Rarely used; check plan requirements first
7 Substitution not allowed — brand mandated by law State law requires brand be dispensed Document applicable legal requirement
8 Substitution allowed — generic not available in marketplace No generic exists for this drug at any wholesaler Common for newly launched brand-only medications
9 Other Plan-defined — use only when directed by the payer Check plan specifications before using

Quick Decision Guide

  • Dispensing generic (normal): DAW 0
  • Rx says "brand medically necessary" / "DAW" / "dispense as written": DAW 1
  • Patient refuses generic: DAW 2
  • Shortage — only brand in stock: DAW 4
  • Brand-only drug (no generic exists): DAW 8
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Utility Codes

UTIL
Description Code Usage Actions
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Quick References

REF
Title Content Actions
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CGM (Continuous Glucose Monitoring)

CGM
⚠ī¸ CRITICAL: CGM Billing (as of 12/9/24)
Walgreens can process Medicare Part B for: Freestyle Libre 2 Plus, Freestyle Libre 3 Plus, Dexcom G6, Dexcom G7

📞 CGM Support Contacts

Walgreens CGM Helpdesk: 877-378-9787
AR Central (Chart Notes Fax): 866-353-7514
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Medicare Part B

MED-B

📋 Medicare Part B Overview

Covers medically necessary services, supplies, and durable medical equipment (DME). Requires Standard Written Order (SWO) for most items.

📞 Key Contact Numbers
☎ī¸

Walgreens Medicare Support Center

888-281-0590 - General Medicare Part B issues

📋

Supplemental Medicare Part B Support

888-380-4798 - Supplemental insurance issues

💉 Diabetic Testing Supplies

⚠ī¸ Important Rules

  • Cannot be mailed/delivered to patients (except CGM receiver & supplies)
  • Proof of Delivery required - Patient or representative signature with relationship documented
  • SWO Required - Standard Written Order with ICD-10 code for diabetes
  • 5-Day Rule - If not available within 5 business days, must contact prescriber for alternate product
Item Usual Utilizer (Non-Insulin) Usual Utilizer (Insulin) High Utilizer Frequency
Test Strips & Lancets 100 per 3 months (1x daily) 300 per 3 months (3x daily) >1x daily (non-insulin)
>3x daily (insulin)
Lancet Device 1 per 6 months 1 per 6 months Same
Blood Glucose Monitor 1 per 5 years
đŸĸ Comm 📋 IN 📋 IL đŸ’ŗ Med-B 📊 CGM 💊 DAW 🔧 Util 📚 Ref 🏠 Home
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