Paperwork Segment
These slides cover how to complete the paperwork (PWK) segment of the CMS-1450 and 837I forms.
Loop 2300/PWK (Paperwork) Segment for X12N Version 5010
Beginning with the 5010 version of the ASC X12 837I, electronic billers can use a new method for providing CMS with additional documentation required for claims adjudication. This method involves including the PWK (Paperwork) segment in the 837I transaction to indicate you plan to submit claim-related documentation.
The PWK segment acts as the link between the electronic claim and the accompanying paper documentation. Submit the documentation to the MAC at the same time or as close as possible to the time you submit the electronic claim. If needed, the MAC uses the documentation to adjudicate the claim.
If the claim doesn’t require additional documentation, the MAC will adjudicate the claim without reviewing the submitted paperwork. If the MAC doesn’t get the additional documentation, or if the documentation isn’t useful, the MAC will adjudicate the claim as it normally would without the PWK data. Once you submit the electronic claim with the PWK segment, send your additional documentation as soon as possible.
As a general rule, submit documentation:
- Within 7 calendar days if sending by fax
- Within 10 calendar days if sending by mail
PWK Segment for X12N Version 5010
Providers who use the PWK process to submit additional documentation must include a specially designed cover sheet provided by their MAC. Find your MAC’s website for details on how and where to get the cover sheet.
You must fill out the cover sheet completely and correctly. Otherwise, the MAC will return the documentation.
For more information on the PWK process, refer to the Medicare Claims Processing Manual, Chapter 24.