Novitas Solutions Electronic Billing Guide: Submitting Medical Documentation & Attachments (PWK) for Part A/B Claims

Understanding the complexities of electronic claim attachments is crucial for healthcare providers. This comprehensive Novitas Solutions Electronic Billing Guide details the process for submitting medical documentation and attachments (PWK) for Medicare Part A/B electronic claims. We’ll cover essential rules, Novitas documentation submission PWK guidelines, and specific PWK segment details to ensure compliant and efficient processing. 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. Our improved imaging system streamlines the process for accepting medical documentation. 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 essential guidelines:

• Maintain the appropriate medical documentation on file for electronic (and paper) claims.
• Completing Novitas Fax/Mail Cover Sheets: You must complete the Medicare Part A Fax/Mail Cover Sheet or the Medicare Part B Fax/Mail Cover Sheet form. Ensure all requested information is entered in capital letters and avoids contact with the edge of the boxes for accurate processing. *These forms are mandatory and cannot be modified.*
• When to Submit Attachments for Unusual Procedures/Services: Only send medical documentation when absolutely necessary for the adjudication of procedures/services that are unusual or require such documentation on a pre-payment basis. Examples might include:
  • Experimental or investigational procedures.
  • Services requiring prior authorization where documentation supports medical necessity.
  • Complex surgical procedures or extended inpatient stays that fall outside standard length-of-stay guidelines.
  • Billing for unlisted procedures (CPT code ending in 99) that need detailed operative reports.
  • Documentation for services exceeding frequency limitations.
• Utilizing the Claim Narrative Field: The narrative field on the claim should be utilized when sufficient information for the documentation of a procedure/modifier can be provided without sending medical records. If additional information cannot be contained in the narrative of the claim, supplementary documentation (medical records) may be submitted via mail or fax.
• One Patient Per Cover Sheet: Only fax documentation for one patient per cover sheet. The cover sheet is for Part A or B electronic claims.
• Required Information on Cover Sheet: 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 requested items will result in documentation being returned and could delay claim processing.
• First Iteration of PWK: Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.
• Submit All PWK Data Simultaneously: Submitters must send ALL relevant PWK data at the same time for the same claim.
• Locating the ICN/DCN: After submitting the electronic claim, locate the ICN/DCN number on the 277CA claims acknowledgment report. The ICN/DCN is located in the 2200D REF segment.
• Faxing Documentation to Novitas Solutions: 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 Mailing Addresses & Fax

Novitas Solutions strongly recommends faxing your medical documentation to (877) 439-5479. If you are unable to fax, 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 the appropriate P.O. Box listed below. These Novitas Solutions PO Box addresses are critical for correct routing.

Jurisdiction L (Delaware, Maryland, New Jersey, Pennsylvania, District of Columbia)

• Part A: Novitas Solutions, PO Box 3385 Mechanicsburg, PA 17055-1840
• Part B: Novitas Solutions, PO Box 3065 Mechanicsburg, PA 17055-1807

Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas)

• Part A (Arkansas, Louisiana, Mississippi): Medical Review JH Part A, Novitas Solutions, PO Box 3103 Mechanicsburg, PA 17055-1819
• Part A (Colorado, New Mexico, Texas): Medical Review JH Part A, Novitas Solutions, P.O. Box 3113 Mechanicsburg, PA 17055-1828
• Part A (Oklahoma): Medical Review JH Part A, Novitas Solutions, P.O. Box 3114 Mechanicsburg, PA 17055-1829
• Part B: Novitas Solutions, PO Box 3094 Mechanicsburg, PA 17055-1812

Understanding the Claim Supplemental Information Segment (PWK)

The Claim Supplemental Information Segment (PWK) is vital for electronically submitted claims requiring additional documentation. Here’s how to correctly report the PWK segment details in your electronic claim:

• Attachment Report Type Codes (PWK01): Select the appropriate Report Type Code for the medical documentation. These codes inform the MAC about the type of attachment being sent. Common attachment report type codes include:
  • A4: Medical Record
  • AS: Admission Summary
  • B3: Baseline
  • BT: Related to Bill
  • CB: Confinement (Inpatient)
  • CT: Certification (General)
  • DA: Dental Attachments
  • HC: Health Certificate
  • IR: Internal Records (e.g., lab results, imaging reports)
  • P4: Prior Authorization
  • PN: Progress Notes
  • RR: Referral Report
  • RT: Report (General)
  • SG: Surgical Report
  • XR: X-Ray
• Attachment Transmission Code (PWK02): Use the “By Fax” or “By Mail” option.
• Identification Code Qualifier (PWK05): Enter “AC”.
• Attachment Control Number (PWK06): Report the Attachment Control Number. This number may be assigned by your software or can be any number you choose, such as the patient account number or other identifying number, to link the attachment to the electronic claim.

PWK Data Elements Explained (Technical Reference)

For technical reference, 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

Frequently Asked Questions (FAQ) about Novitas Electronic Attachments

• Q: What are the attachment report type codes for Novitas electronic claims?
  A: Common attachment report type codes (PWK01) include A4 (Medical Record), AS (Admission Summary), HC (Health Certificate), P4 (Prior Authorization), SG (Surgical Report), and many others. These codes specify the type of documentation being submitted with your electronic claim. Refer to the “Attachment Report Type Codes (PWK01)” section above for a more comprehensive list.
• Q: Where is the ICN/DCN located on the 277CA report?
  A: The Internal Control Number (ICN) or Document Control Number (DCN) is located in the 2200D REF segment on your 277CA claims acknowledgment report. This number is crucial for tracking your electronic claim submission.
• Q: What is the fax number for Novitas Solutions medical documentation submission?
  A: You can fax your medical documentation and cover sheets to 877-439-5479. This fax line is available 24 hours a day, 7 days a week.

Important Disclaimer

Disclaimer: This guide provides information specific to Novitas Solutions’ guidelines for electronic claim attachments. While this information is updated regularly, billing rules and regulations can vary significantly by Medicare Administrative Contractor (MAC) jurisdiction and are subject to change. Providers should always verify the most current guidelines directly with their specific MAC to ensure compliance and avoid claim processing delays.