PWK (Paperwork)

The PWK (Paperwork) segment provides the ‘linkage' between electronic claims and additional documentation which is needed for claims adjudication. PWK is a segment within the 837 Professional and Institutional electronic transactions.

With the implementation of HIPAA version 5010, CMS is now moving forward with an implementation of the PWK segment for the 837 5010 transactions. They have required that Noridian develop a PWK process that will allow providers to attach documentation to their 5010 claims at the time of submission.

Note: PWK segments are not necessary on all electronic claims submitted, since not all claims suspend for Additional Documentation Request (ADR). It should only be used when a provider recognizes that the submitted claim may indeed suspend for an ADR. The submission can be used with, but is not required, for Medical or Non-Medical Review ADRs.

Purpose of PWK and PWK Indicators

PWK is completely voluntary and the absence or presence of the PWK does not mean that the claim will be reviewed. It was developed to allow providers to submit additional documentation to support services billed at time of claim submission. These indicators notify Noridian of this forthcoming documentation.

Submitting PWK

To assist in getting claims paid quickly and efficiently, follow the required steps below.

  1. Submit the claim with the appropriate PWK indicator.
    • For submission directive and coding, see the Common Electronic Data Interchange (CEDI) companion documents
  2. Complete the Noridian PWK Coversheet [PDF].
    • This coversheet allows providers to complete the form prior to printing.
    • To ensure proper receipt and processing of the documentation, fully complete the form
    • Only one coversheet will be accepted for each submitted claim.
  3. Submit the completed Noridian Interactive PWK Coversheet with documentation.
    • Transmission of the PWK documentation must be consistent with the PWK02 transmission code submitted on the claim and must be received by Noridian within the timeframes indicated in the table below.
    • To avoid delayed claims processing and review, Noridian encourages providers to submit their documentation immediately following the claim submission.
    • Be sure to include all supporting documentation.
      • If any documentation appears to be missing, Noridian will continue to suspend and request all documentation through our normal ADR process, regardless if partial information was previously submitted using the PWK process.

PWK Timeframe(s)

Once a claim has been submitted with PWK indicator(s) and has been identified for a potential ADR, the Medicare claims processing system will suspend/hold the claim. In order for the PWK coversheet and documentation to be reviewed, it must be received by Noridian within the allotted timeframe indicated below with respect to the date the claim was submitted.If the documentation is obtained beyond the deadline, the claim will be subject to development for additional documentation.

  • Fax Submission: Seven calendar days
  • Mail Submission: 10 calendar days

Noridian encourages providers to send documentation immediately after claim submission as the above timeframes are designated by CMS and need to account for mailing time and processing time by Noridian.

Noridian is not required to search for the documentation received beyond the allotted timeframe. Receipt of a letter requesting additional documentation indicates that the PWK documentation was either not received in time or was insufficient.

Note: Claims submitted with PWK information that would not otherwise suspend for review and/or require additional development, will process routinely and will not be held for the 7 or 10 day period.

Resources

 

Last Updated Tue, 12 Oct 2021 13:31:59 +0000