The following information is provided by Novitas Solutions.
So much time each day is spent completing paperwork. Wouldn’t it be great if we could reduce the amount of time spent on paperwork? We think so, and have some information that can help do just that! Under the Health Insurance Portability and Accountability Act (HIPAA), claims, even claims with attachments, must be submitted electronically, except where waived, for reimbursement by the Medicare Program. However, providers should only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis that cannot be adequately documented in the Claim Note Segment, also known as the NTE segment or narrative field. Recent analysis at Novitas indicates that many providers are sending unnecessary documentation via the Claim Supplemental Information Segment, also known as the PWK segment, and submitting the additional documentation incorrectly. It is important that additional documentation is only submitted when it is necessary for claim adjudication. Here is some information to help you determine when and how to submit additional documentation to Medicare:
- When additional, supporting information for a procedure code, modifier, etc. is required for claim adjudication and can be reported without sending the medical records, the additional information should be reported in the NTE segment (Loop 2300) of the electronic claim. However, it is important to only report additional information in the NTE segment when necessary for claim adjudication or it could delay claim processing.
- When additional information must be provided for claim adjudication and cannot be reported in the NTE segment, or narrative field, of the electronic claim (i.e., medical records), an indicator must be reported in the PWK segment of the electronic claim to indicate that additional documentation will be submitted via fax or mail after the electronic claim has been submitted to Medicare. The PWK segment allows providers to indicate that additional documentation will be submitted to support the services billed so that Medicare can properly identify and match the additional documentation submitted to the claim for processing upon receipt. However, additional documentation should only be sent when necessary for claim adjudication; therefore, the PWK segment should rarely be used and is NOT necessary on all electronic claims submitted.
Recently, Novitas has been receiving numerous faxes that are submitted incorrectly, precluding us from properly matching the documentation to the claim in question. For example, providers are not submitting a cover sheet to let us know why they are submitting the records or they are submitting records for multiple patients under one cover sheet. If cover sheets are not completed or are completed incorrectly, the medical records will be sent back to the submitter. Oftentimes, the submitter could be the provider’s billing service; therefore, providers may not be aware that their medical records are being returned.
If additional documentation is required for claim adjudication, please use the following guidelines:
- Maintain the appropriate medical documentation on file for electronic (and paper) claims.
- Complete one “Medicare Part A/B Fax/Mail Cover Sheet” form per beneficiary. For accurate processing of your claim(s), please complete all requested information in capital letters and avoid contact with the edge of the boxes. The cover sheet can be found on our website.
- Clearly write the Attachment Control Number (ACN), Internal Control Number (ICN), patient name, Health Insurance Claim (HIC) number, date of service, total claim billed amount, National Provider Identification (NPI) number, contact information, and state where services were provided on the cover sheet. NOTE: The ACN is the number used to identify the documents sent as attachments to an electronic claim. The ACN is entered on the Fax Cover Sheet and in the PWK segment of the electronic claim.
- Report the PWK segment on your electronic claim as follows:
- Select the appropriate Report Type Code for the medical documentation
- Use the By Fax or By Mail option for the Attachment Transmission Code
- Enter AC for the Identification Code Qualifier
- Report the Attachment Control Number
- Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.
439-5479. You may fax documentation any time after claim submission, including the same day. 5. Faxing is available 24 hours a day, 7 days a week.
6. Failure to submit all items requested will result in documentation being returned and could delay claim processing.
7.Again, it is important that additional documentation is only submitted when it is necessary for claim adjudication, which may ultimately reduce the amount of paperwork in your practice. For more information regarding when and how to submit medical documentation for Medicare Part A and Part B electronic claims, please refer to
6. Failure to submit all items requested will result in documentation being returned and could delay claim processing.
7.Again, it is important that additional documentation is only submitted when it is necessary for claim adjudication, which may ultimately reduce the amount of paperwork in your practice. For more information regarding when and how to submit medical documentation for Medicare Part A and Part B electronic claims, please refer to
