Submitting Paperwork (PWK) Electronically
(09/24/2013)
End User Agreement
for Providers
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aware that much of the Provider
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This includes items such as CPT codes and CDT codes.
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Medicare Part B
Submitting Paperwork (PWK) Electronically
Effective October 1, 2012, Noridian implemented the PWK (paperwork) segment of the X12N version 5010. PWK allows for voluntary submission of supporting documentation with a 5010 version electronic claim via fax or mail and notifies Noridian of forthcoming documentation. Since implementation of the PWK process, we have encountered several issues regarding claim and documentation submission.
PWK
segments are not necessary on all electronic claims submitted since not
all claims suspend for an Additional Development System (ADS) letter. It
should only be used when a provider recognizes the submitted claim may
suspend for an ADS letter. The submission can be used with,
but not required, for Medical or Non-Medical Review ADS letters.
When supporting documentation with a 5010 electronic claim is needed, follow
these required steps:
· In Loop 2300 or 2400 of the PWK segment, use the following data elements to identify that a paper attachment is forthcoming:
o PWK01 (Attachment Report Type Code) - Use the values indicated in the Implementation Guide to identify the type of attachment.
o PWK02 (Attachment Transmission Code) - Indicates how the document will be sent. PWK02 = BM (by mail) or FX (by fax) are the only values Medicare utilizes.
o PWK05 (Identification Code Qualifier) - AC is the value needed in this segment. It is required when PWK02 = BM or FX.
o PWK06 (Attachment Control Number) - A value assigned by the provider to uniquely identify the attachment. This value will be used on the PWK interactive coversheet to match the documentation to the submitted electronic claim.
· Complete and submit the PWK interactive coversheet at https://www.noridianmedicare.com/partb/forms/mr_forms/pwk_coversheet.pdf. Incomplete PWK cover sheets and attached information will be returned to the provider.
Key Points
· To avoid delayed claims processing and review, submit documentation immediately following claim submission.
· Include all supporting documentation. If any documentation appears to be missing, the claim will continue to suspend and documentation will be requested through normal ADS process.
· Noridian allows seven calendar "waiting" days from the date of receipt of the electronic claim for additional information to be faxed or ten calendar "waiting" days for additional information to be mailed. If the additional documentation is not received within the seven calendar waiting days (fax) or ten calendar waiting days for mailed submissions, Noridian will begin normal processing procedures on the claim.
For questions, contact the
Provide Contact Center at 1-877-908-8431.
Sources: CMS Change Request (CR) 7041, Transmittal 874; CR 7306, Transmittal
908; CR 7330, Transmittal 396
Posted: 9/23/2013
CPT codes, descriptors and other data only are copyright 2009 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply.
© 2013 Noridian Administrative Services, LLC.
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