- Avoid Processing Delays by Following Proper Submission Guidelines
- Medicare Beneficiary Eligibility Checklist
- Acceptable Electronic Signatures Reminder
- Capable Recipients for the Advance Beneficiary Notice of Noncoverage
- Hospital-Issued Notices of Noncoverage
- Medicare Advance Written Notices of Noncoverage Booklet
- Primary Care Exception Guidelines
- Ordering DMEPOS Items
- Appropriate Use Criteria Program
- Assistant at Surgery Billing Documentation Reminder
- Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process
- Checking Eligibility and Knowing Your Point of Contact
- Cloned Documentation Could Result in Medicare Denials for Payment
- Documentation Reminder: Psychiatry and Psychology Services
- Documentation Required for Home Visits
- Electrical Stimulation Therapy: Important Coverage and Documentation Reminders
- Go Paperless Today - Protect Your Bottom Line
- Hospital Acquired Conditions and Present on Admission Resource for Physicians
- MDS Calendar
- Medicare Home Health Collaboration with Other Provider Types
- Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information
- Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device
- Referring, Monitoring and Certifying Home Health Services
- Scribing Medical Record Documentation
- Skilled Nursing Facility Medicare Part A Benefit Quick Reference Fact Sheet
- Submit Medical Record Documentation Electronically
- Submitting Electronic Medical Records via CD or Thumb Drive
- Paperwork Segment – PWK
Paperwork Segment – PWK
PWK is a segment in the 837 electronic claim transaction. It links an electronic claim with the supporting documentation submitted by the provider.
PWK indicators on the electronic claim notify NGS that documentation will be submitted to support the claim's service(s) or procedure(s). This allows providers to submit unsolicited documentation during initial claim processing supporting medical necessity and potentially reducing processing time while eliminating the need for NGS to issue an ADR.
Providers should use the claim's comment field to explain unique situations, document invoice pricing, and detail dosing for drugs/biologicals. If the comment field is not sufficient, the PWK segment can be used to notify NGS that additional documentation is being sent to support the services. Claims with a PWK segment that do not need extra documentation will be processed without further review.
PWK Segment Use Examples – This is not an all-inclusive list
- Surgical and nonsurgical NOC CPT/HCPCS codes
- If the comment section cannot adequately describe the service/procedure or an operative report is required.
- Drugs and Biologicals NOC CPT/HCPCS Codes
- Use the comment section to report the drug name, dose, route of administration and invoice price.
- Only use PWK if additional information is required.
- Modifier 22
- Use the comment section to explain the unusual services.
- If you feel there is not enough space to sufficiently describe the reason, an operative report is required with a concise statement about how the service differs from the usual.
- Modifier 53
- If unable to properly explain the reason for discontinuing the service or procedure in the comments section submit additional documentation.
- Modifier 62
- An operative report is necessary to establish medical necessity for two surgeons when the cosurgery indicator on the Medicare Physician Fee Schedule is marked as 1, meaning cosurgeons could be paid but supporting documentation is required. The operative report may be submitted as either two individually signed reports from each surgeon or as a single report signed by both surgeons.
- Modifier 66
- An operative report is always required for team surgeries.
- Modifier GM
- This is a multiple patient ambulance trip.
- Documentation must include the total number of patients transported at same time and the MBI for each beneficiary.
- CPT codes requiring medically necessary documentation
- 21031, 21032, 21110, 30120, 30400, 30410, 30420, 30430, 30435, 30450, and 69300.
- Modifiers AS, 80, 81 and 82
- Must have documentation to establish the medical necessity of an assistant at surgery when the Medicare Physician Fee Schedule has an assistant surgery indicator of zero.
- Claims submitted with greater than five surgeries on the date of service
Requirements for Reporting in the PWK Segment
Here are the key points regarding the submission of documentation for claims. Adhere to these guidelines to avoid delays in processing your claims.
Timing of Submission
- Submit the documentation once the claim has been assigned an ICN.
Prompt Submission
- Ensure timely submission of your documentation. Delays may lead to potential requests for additional documents.
Time Frames
The claim is placed in a hold location to give the provider time to submit their additional documentation. Hold time depends on how the documentation is being sent.
- Electronically transmitted (esMD) or faxed documentation must be received within seven calendar days from the claim receipt date.
- Documentation that is mailed must be received within ten calendar days from the claim receipt date.
Billers/vendors must enter the two-character code that defines the method of delivery of the documentation.
- Use Loops 2300 or 2400, Segment PWK02 to enter the delivery method code:
- EL or FT ‒ electronic (esMD)
- BM ‒ mail
- FX ‒ fax
Cover Sheet Required
Fill out all fields on the coversheet and submit it as the first page for all PWK documentation submissions.
- Incomplete or incorrect cover sheets will be returned.
- The ACN is a unique identifier created by the provider using letters, numbers and/or special characters.
- In addition to being in the first field on the cover sheet, the ACN must also be entered into Segment PWK06.
- The ACN is used to pair the claim with the documentation.
- Use the correct Cover Sheet
- JK Providers: Medicare JK Part B PWK Fax/Mail/esMD Cover Sheet
- J6 Providers: Medicare Part B PWK Fax/Mail/esMD Cover Sheet
Revised 5/15/2025