What is PWK?
PWK is a segment within the 837 Professional and Institutional electronic transactions. The PWK segment provides the ‘linkage' between electronic claims and additional documentation which is needed for claims adjudication.
PWK is voluntary and the absence or presence of the PWK does not mean that the claim will be reviewed. PWK was developed to allow providers to submit additional documentation to support services billed with or at time of claim submission. PWK indicators are submitted directly on the electronic claim. They are designed to notify Noridian that additional documentation will be submitted to support the billing/services of the claims. PWK documentation is the corresponding support documentation for the claim submitted.
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 PWK submission can be used with, but is not required, for Medical or Non-Medical Review ADRs.
How is PWK used?
When submitting PWK claims and documentation follow the steps below. These steps will assist in getting claims processed quickly and efficiently.
- Submit electronic claim with te appropriate PWK indicator.
- Apply correct PWK indicator to claim (claims/line level).
- If there are multiple PWK indicators, see EDISS documents for submission directive and coding. EDISS companion documents can be located at: http://www.edissweb.com/cgp/vendors/index.html.
- Complete PWK Coversheet [PDF]
- Fully complete coversheet to ensure proper receipt and processing of documentation. Incomplete coversheets may be rejected.
- Note: Only one (1) coversheet will be accepted for each submitted claim.
- Complete coversheet electronically, prior to printing. This will assist in ensuring legibility and processing.
- Immediately Fax or mail PWK coversheet and documentation to Noridian. Fax number and Mailing address are located directly on coversheet.
- Transmission of PWK documentation must be consistent with PWK02 transmission code submitted on claim, as well as be received within timeframe
- Include all supporting documentation
- Note: If any part of documentation appears to be missing (or past allotted timeframe), documentation will not be used for claim processing. Noridian will suspend the electronic claim and request all supporting documentation through normal ADR process, regardless is partial information was previously submitted using PWK.
PWK Submission Timeframes
Once a claim has been submitted with PWK indicator(s) and has been identified for potential ADR, the claims processing system will suspend the claim to a holding location. In order for the PWK coversheet and documentation to be reviewed, providers must be aware of the timeframes indicated below.
|Submission Type||Claim Suspend/Holding Timeframe*|
|Fax||7 calendar days|
|10 calendar days|
*Noridian encourages providers to send documentation immediately after claim submission as the above timeframes are designated by CMS and accounts for providers mailing time and all processing time. If the documentation is identified beyond the deadline, the claim will process as if the documentation had not been received. Once a claim has been released for normal processing, Contractors are not required to search for the delayed documentation.
Note: Claims submitted with a PWK segment 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.
If you have questions, call the Provider Contact Center.
- Implementation of the PWK (Paperwork) Segment for X12N Version 5010, CMS Change Request (CR) 7041, Transmittal 874
- Modifications to the Implementation of the Paperwork (PWK) Segment for X12N Version 5010, CR 7306, Transmittal 908
- Medical Review of PWK (paperwork), CR 7330, Transmittal 396
Last Updated May 21, 2018