CMS Pub. 100-04, ch. 24, § 50.10.2.1

Providers that wish to utilize the PWK process to submit their additional documentation

will be required to use a specially designed cover sheet which will be provided to them

by their servicing A/B MACs, or DME MACs. Contact your servicing A/B MACs or

DME MACs for details on how/where to obtain the cover sheet. These cover sheets will

be required to be completely and accurately filled out or they will be manually returned.

It is important to note that the A/B MACs or DME MACs is not required to return your

additional documentation along with the cover sheet. In the instance where the coversheet

is returned due to inaccurate or incomplete information, the claim will be adjudicated

according to the normal CMS business policies and procedures without regard for the

additional documentation received.

When submitting an electronic claim, the submitter must indicate in the body of the

electronic claim their intention to submit additional documentation (at the claim level,

line level, or both) along with their claim. This is done by indicating the following in the

electronic claim: the PWK elements PWK01 (attachment type), PWK02 (transmission

method), PWK05 (the value AC), and PWK06 (a 1-50 byte attachment control number

[ACN] of the provider/claim submitter’s choosing). PWK data submitted at the claim

level will apply to the whole claim, unless overridden at the detail line level. Line level

PWK data will only apply to that particular detail line of the claim. Electronic claims

submitted with an improperly formatted PWK segment will be rejected back to the

submitter via either an ASC X12 277CA claim acknowledgment or an ASC X12 999

implementation acknowledgment depending on the nature and location of the error.

Although the ASC X12 837 claim transaction allows for up to 10 iterations of the PWK

at both the claim and line level, only the first iteration of the PWK segment will be

utilized for claim adjudication. Additional iterations of the PWK segment beyond one

will be stored by the claims processing contractor to which the claim was submitted.

Once the electronic claim has been submitted with the PWK, provider/claim submitters

are expected to submit their additional documentation as soon as possible. Providers will

be required to either fax or mail their additional documentation to the A/B MACs or

DME MACs. The only exception will be for those A/B MACs or DME MACs which are

part of an approved CMS electronic attachment pilot. In that case, your A/B MACs or

DME MACs will notify you of other acceptable methods for submitting your additional

documentation. As a rule, the provider/claim submitter is required to provide the

additional documentation within 7 calendar days, if utilizing fax, or within 10 calendar

days, if utilizing mail. After the 7/10 day waiting period expires, the claim will be

adjudicated according to the normal CMS business procedures and policies in place at the

time. Documentation submitted late will not be considered for adjudication but will be

imaged and sent off for storage as per normal CMS correspondence retention

requirements.