US · guidance
CMS Pub. 100-04, ch. 24, § 50.10.1
PWK Background
In the current CMS claims processing environment, providers have to wait to receive
requests for additional information, called automated development request letters, in
order to provide additional documentation necessary for the adjudication of their claims.
This “solicited” method of requesting documentation adds unnecessary extra days to
claims processing. Beginning with the 5010 version of the ASC X12 837 institutional,
professional and dental (electronic healthcare claim transaction), electronic billers can
utilize a new methodology for providing CMS with their additional documentation which
is required for claims adjudication. This new methodology involves submission of the
PWK segment (paperwork) in the ASC X12 837 claim to indicate “unsolicited” claim-related documentation is forthcoming.
History
(Rev. 13105; Issued- 04-10-25; Effective: 05-12-25; Implementation: 05-12-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a151502fa3fb7189485a6cf4506da173ba3fa111ab2017fc198584cd05ca8538
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