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💳 3rd Party Reference

Insurance Plans & Billing Codes

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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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ICD10 Diagnosis Lookup

Search ICD-10 codes by diagnosis name or find diagnosis descriptions from ICD-10 codes.

🔍 Open ICD10 Lookup
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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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🏷️ Rugby/Major OTC Drug Lookup

OTC
ℹ️ 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

⚠️ 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
⚠️ 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
☎️

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

⚠️ 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
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💊 Medicare GLP‑1 Bridge — Billing Quick Reference

MEDGLP1
ℹ️ Program Overview
Weight‑management GLP‑1s only: Wegovy (inj & tablets), Zepbound KwikPen (pens/vials excluded), Foundayo. Indication routes the claim — not the drug.  |  Demonstration period: Jul 1, 2026 – Dec 31, 2027.
1 · Which plan gets the claim? (by diagnosis)
BILL MEDICARE PART D — Part‑D‑coverable BILL GLP‑1 BRIDGE → IC+ MEDGLP1
  • Type 2 diabetes — E11.-
  • Obstructive sleep apnea (mod‑severe) — G47.33
  • MASH (non‑cirrhotic) — K75.81 (+ K74.0- if fibrosis)
  • CV risk reduction / established CVD — I25.-; prior MI I21.-/I22.- or Z86.711; prior stroke I63.-/Z86.73; PAD I73.9 / I70.2-
  • Already on a Part D GLP‑1 → stay on Part D.
  • Weight management (obesity) — E66 family:
    E66.01 E66.09 E66.1 E66.2 E66.811 E66.812 E66.813 E66.89 E66.9
  • Overweight (BMI 27–29.9) — E66.3
  • + BMI code — Z68.30–Z68.45 (documents tier at initiation)
  • Weight loss is excluded from Part D → the Bridge covers it.
2 · IC+ billing — Plan ID MEDGLP1
  • Add Plan ID MEDGLP1 to the profile: F9 → 3rd Pty Plans (ALT+N).
  • Patient MBI goes in the Cardholder ID field. Not on file? Use FINDMPAB with full or last‑4 SSN to find it.
  • Person Code and Group = blank. Do not mark MEDGLP1 primary in the profile — then reprocess MEDGLP1 as primary.
  • MEDGLP1 can't be billed secondary; nothing bills after it. No COBs · no discount cards · no manufacturer coupons.
3 · Process
  1. Confirm a covered product was prescribed — Wegovy, Zepbound KwikPen, or Foundayo.
  2. Bill the patient's Medicare Part D plan. Accepted → fill as normal.  Denied → go to Step 3.
  3. Cross‑reference the ICD‑10 diagnosis code(s). If not on the eRx image (or hardcopy), contact the prescriber to obtain. Route by code — Part D: E11.- T2DM, G47.33 OSA, K75.81 MASH, I25.- / established CVD  ·  Bridge (MEDGLP1): E66 obesity family + Z68.30–Z68.45 BMI.
  4. 4A. Part D diagnosis → send Rx to CoverMyMeds and manually fax the prescriber; comment "PA initiated." (Enter override 999 if needed to bill Part D.)
  5. 4B. Bridge diagnosis → switch the plan to MEDGLP1 and submit — it will usually return a PA reject. Send Rx to CoverMyMeds and manually fax the prescriber; comment "PA initiated." (If it rejects "PATIENT HAS PREVIOUSLY RECEIVED A GLP‑1 … PER CMS," re‑bill Part D — override 999.)
  6. Zepbound KwikPen only: check for a pen‑needle Rx sent in or on file; if none, contact the prescriber for one. Neither Part D nor the Bridge covers pen needles unless the patient is on insulin.
Notes & Callouts

⚠️ Zepbound — KwikPens Only

Pens/vials reject as invalid product — obtain PBR authorization to switch to KwikPens and annotate the Rx.   If a PA is ultimately denied, inform the patient and check RX Savings Finder for a manufacturer savings card.

💲 $50 Copay — Fixed in Every Phase

Does not apply to the deductible or count toward TrOOP/out‑of‑pocket max. LIS/Extra Help does not reduce it.   Diagnosis codes live in the prescriber's PA / on the Rx (E66 + "SEND TO BRIDGE FOR WEIGHT MANAGEMENT"); not usually transmitted on the POS claim.

⚠️ Disclaimer

For operational use only — not legal, coding, or reimbursement advice. Where this differs from the official CMS payer sheet / program pages or current Walgreens SOP, those control.
Key Identifiers
Field Value
BIN 028918
PCN MEDDGLP1BR
Plan ID MEDGLP1
Pharmacy Help Desk 844-673-0910
🏢 Comm 📋 IN 📋 IL 💳 Med-B 📊 CGM 💊 GLP‑1 💊 DAW 🔧 Util 📚 Ref 🏠 Home
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