Yes. Effective October
1, 2012, First Coast Service Options Inc. (First Coast) implemented the PWK
(paperwork) segment of the X12N version 5010. PWK allows for voluntary
submission of supporting documentation with a 5010 version electronic claim.
PWK is a segment
within the 2300/2400 Loop of the 837 Professional and Institutional electronic
transactions that provides the link between electronic claims and additional
documentation. PWK allows providers to submit electronic claims that require
additional documentation and, through the dedicated PWK process, have the
documentation imaged to be available during the claims adjudication.
Eliminating the need for costly development and allowing providers and Medicare
contractors to utilize efficient, cost-effective Electronic Data Interchange or
EDI technology will create a significant cost savings.
Although PWK ultimately
will allow electronic submission of additional documentation, the October
implementation only allows for submission of additional documentation via mail
and fax (PWK 02 segment, BM [by mail] and FX [by fax] qualifier, respectively).
First Coast has made
available a fax/mail coversheet that providers or trading partners shall use to
submit the unsolicited additional documentation. The First Coast fax/mail
coversheet is an interactive form posted to our website. Providers or trading
partners may complete required data elements and are then able to print a
hardcopy of the form to mail or fax with their documentation. Modifications to
the fax/mail coversheet are not permitted. Separate forms are provided for Part
A and B for Florida, Puerto Rico, and the U.S. Virgin Islands. First Coast has
also provided secure faxination numbers for those providers or trading partners
who elect to fax the additional documentation.
First Coast is
requiring the following section of the form to be completed with valid information
to ensure the paperwork documentation is appended to the pending claim in our
system: ACN (Attachment Control Number (submitted in the PWK06 segment)), DCN
(document control number [Part A]), ICN (internal control number [Part B]), the
beneficiary's health insurance claim number (HICN)/Medicare number, Billing
provider's name and NPI (national provider identifier).
First Coast will
return PWK coversheets with missing or inaccurate data. The coversheet will be
returned based on how it was received (fax or mail).
• Note: First Coast will not return any paperwork documentation that
accompanies a rejected PWK coversheet; nor will the documentation be used for
adjudication of the claim.
PWK documentation may
not be submitted prior to submission of a claim. Submitters must send all
relevant PWK data at the same time for the same claim. Thus, if the claim was
submitted with multiple PWK iterations, all PWK data for the claim must be
submitted together under one coversheet.
If the PWK segment is
completed and additional documentation is needed for adjudication, First Coast
will allow seven calendar "waiting" days (from the claim date of receipt) for the
paperwork documentation to be faxed or ten calendar waiting days to be mailed. The seven and ten day waiting periods apply
to claims for both Part A and Part B.
If the PWK data is not
received within the waiting timeframe and additional documentation is needed, a
development request will be sent. If documentation is received after the
timeframe has elapsed, the documentation will not be used for adjudication of
the claim. Thus, the paperwork will need to then accompany our request for
additional documentation to prevent possible claim denials.
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
seven or ten day waiting period.
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