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Frequently Asked Questions About Origin Codes

07/14/2021 4:38 PM | Anonymous member (Administrator)

By Trenton Thiede, PharmD, MBA
President, PAAS National®

When processing a prescription, the pharmacy is required to assign an origin code to the claim. PAAS National® continues to see audit results for invalid origin codes. These discrepancies can range from $5 fees to full recoupments. The proper use of the origin code field is to record how the pharmacy originally received the prescription order from the prescriber. Below are two of the most common questions PAAS receives related to origin codes.

1. Does the origin code change if you need to call the prescriber to clarify a prescription and make a clinical note?

Answer: No, NCPDP states that any clarifications or modifications to the original prescription [after receiving it at the pharmacy] do not change the origin code. The origin codes stays the same throughout the life of that prescription.

2. What origin code is used for a standing order or protocol?

Answer: Origin code 5 – Pharmacy (some software systems label as Transfer instead of Pharmacy). A standing order or protocol would be designated as origin code 5 because it is being created by the pharmacy. Two examples of a standing order or protocol commonly used are for administering immunizations and dispensing Narcan.

Here are the NCPDP Definitions:
0 – Not Known
1 – Written – Prescription obtained via paper.
2 – Telephone – Prescription obtained via oral instructions or interactive voice response using a phone.
3 – Electronic – Prescription obtained via SCRIPT or HL7 Standard transactions, or electronically within closed systems.
4 – Facsimile – Prescription obtained via transmission using a fax machine.
5 – Pharmacy – This value is used to cover any situations where a new Rx number needs to be created from an existing valid prescription such as traditional transfers, intrachain transfers, file buys, software upgrades/migrations, and any reason necessary to “give it a new number.” This value is also the appropriate value for “Pharmacy Dispensing” when applicable such as behind the counter (BTC), Plan B, established protocols, pharmacist’s authority to prescriber, etc.

You can find a link to the NCPDP February 2021, Telecommunication Version D and Above Questions, Answers and Editorial Updates document here: ncpdp.org/NCPDP/media/pdf/VersionD-Questions.pdf (see section 3.1.4 on origin codes).

PAAS National® is an expert third-party audit assistance and FWA/HIPAA compliance organization. It is committed to serving community pharmacies and helping keep hard-earned money where it belongs. Learn more at paasnational.com or email info@paasnational.com to see why membership might be right for you.

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