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February 27, 2018

PWK Segment Process – Avoid Misrouted Documentation and Incomplete Fax Cover Sheets

When you submit a service electronically that requires additional documentation, CGS will accept the documentation via the PWK (paperwork) Segment process via fax or mail. If you choose to use the PWK Segment process, you must identify the documentation using the PWK Segment at the claim level (Loop 2300) or line level (Loop 2400) of the electronic claim. Once received, the documentation will be imaged and matched to the correct pended claim in our processing system. Details on the PWK Segment process is available to you here.

Recently, we have seen an increase in misrouted PWK fax submissions. Before sending documentation to CGS, please be sure the fax is actually for a claim submitted to us (CGS) electronically, and not to one of your other payers (e.g., a Medicare Advantage (MA) plan). Documentation sent to us in error will not be forwarded to other payers, resulting in delays in processing and/or claims denials.

We have also noticed an increase in the number of incomplete PWK fax cover sheets. Using the standard PWK Fax Cover SheetPDF and completing it accurately is vital to the processing of your claims, as it helps us sort the documentation appropriately to match with the correct pended claim.

Before sending documentation, please verify that EACH field of the fax cover sheet is complete, including the field where the patient's Medicare ID is identified. NOTE: Please do not enter the Internal Control Number (ICN) in the Medicare ID field. Enter ONLY the Medicare ID.

Finally, please note that a separate fax cover sheet is required for EACH individual claim. Submitting the documentation for more than one patient in the same fax transmission will cause processing delays and/or denials. Check here for additional tips and reminders.

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