Electronic Billing Guide: Submitting Medical Documentation for Part A/B 5010 Electronic Claims Submitting Medical Documentation For Part A/B 5010 Electronic Claims

Under the Health Insurance Portability and Accountability Act (HIPAA), claims for reimbursement by the Medicare Program must be submitted electronically, except where waived, even for claims with attachments. The process for accepting medical documentation and attaching it to the electronic claim has been improved due to our imaging system. The Claim Supplemental Information segment (PWK) is used whenever paper documentation has been sent for an electronic claim. When sending an electronic claim that contains an attachment, follow these rules to submit the attachment for your electronic claim:

Maintain the appropriate medical documentation on file for electronic (and paper) claims.
Complete the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * form. For accurate processing of your claim(s), please complete all requested information in capital letters and avoid contact with the edge of the boxes.
Important tips to keep in mind when faxing medical records for electronic claims:
•    Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis.
•    The narrative field on the claim is to be utilized in situations where sufficient information for the documentation of a procedure/modifier can be provided without sending the medical records. When additional information cannot be contained in the narrative of the claim, additional documentation (medical records) may be submitted via mail or fax.
•    Only fax documentation for one patient per cover sheet. The cover sheet is for Part A or B electronic claims.
•    Clearly write the: Attachment Control Number, Internal Control Number (ICN/DCN), 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.  Failure to submit all items requested will result in documentation being returned and could delay claim processing.
•    The fax/mail cover sheets are not to be modified.
•    Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.
•    Submitters must send ALL relevant PWK data at the same time for the same claim.
•    After submitting the electronic claim, locate the ICN/DCN number on the 277CA claims acknowledgement report.  The ICN/DCN is located in the 2200D REF segment.
•    Fax the cover sheet and medical documentation to (877) 439-5479. You may fax documentation any time after claim submission, including the same day. Faxing is available 24 hours a day, 7 days a week. Faxes should be sent within seven calendar days of your electronic claim submission.
Novitas Solutions strongly recommends faxing your medical documentation. If you are not able to fax your documentation, mail the Medicare Part A Fax/Mail Cover Sheet * or the Medicare Part B Fax/Mail Cover Sheet * and all pertinent medical documentation within ten calendar days of your electronic claim submission to:

In the Claim Supplemental Information Segment (PWK) of the electronic claim:

•    Select the appropriate Report Type Code for the medical documentation. For information on what codes are needed in the PWK segment.
•    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 – This number may be assigned by your software or can be any number you chose including the patient account number or other identifying number.
Note: Only send medical documentation when necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis.

Technically Speaking, Claim Supplemental Information (PWK) is reported as follows:
Data Element    Segment
Attachment Report Type Code    2300 or 2400 – PWK01
Attachment Transmission Code    2300 or 2400 – PWK02
Identification Code Qualifier    2300 or 2400 – PWK05
Attachment Control Number    2300 or 2400 – PWK06