allows documentation to be submitted with an initial claim

Effective October 1, 2012, First
Coast Service Options Inc. (First Coast) implemented the PWK (paperwork)
segment of the X12N version 5010. PWK allows for voluntary submission of
supporting documentation with a 5010 version electronic claim.

PWK is a segment within the
2300/2400 Loop of the 837 Professional and Institutional electronic
transactions that provides the link between electronic claims and additional
documentation. PWK allows providers to submit electronic claims that require
additional documentation and, through the dedicated PWK process, have the
documentation imaged to be available during the claims adjudication.
Eliminating the need for costly development and allowing providers and Medicare
contractors to utilize efficient, cost-effective Electronic Data Interchange or
EDI technology will create a significant cost savings.

Although PWK ultimately will allow
electronic submission of additional documentation, the October implementation
only allows for submission of additional documentation via mail and fax (PWK 02
segment, BM [by mail] and FX [by fax] qualifier, respectively).

First Coast has made available a
fax/mail coversheet that providers or trading partners shall use to submit the
unsolicited additional documentation. The First Coast fax/mail coversheet is an
interactive form posted to our website. Providers or trading partners may
complete required data elements and are then able to print a hardcopy of the
form to mail or fax with their documentation. Modifications to the fax/mail
coversheet are not permitted. Separate forms are provided for Part A and B for
Florida, Puerto Rico, and the U.S. Virgin Islands. First Coast has also
provided secure faxination numbers for those providers or trading partners who
elect to fax the additional documentation.

Fax/mail coversheets

First Coast is requiring the
following section of the form to be completed with valid information to ensure
the paperwork documentation is appended to the pending claim in our system: ACN
(Attachment Control Number (submitted in the PWK06 segment)), DCN (document
control number [Part A]), ICN (internal control number [Part B]), the
beneficiary’s health insurance claim number (HICN)/Medicare number, Billing
provider’s name and NPI (national provider identifier).
First Coast will return PWK
coversheets with missing or inaccurate data. The coversheet will be returned
based on how it was received (fax or mail).

• Note: First Coast will not return
any paperwork documentation that accompanies a rejected PWK coversheet; nor
will the documentation be used for adjudication of the claim.
PWK documentation may not be
submitted prior to submission of a claim. Submitters must send all relevant PWK
data at the same time for the same claim. Thus, if the claim was submitted with
multiple PWK iterations, all PWK data for the claim must be submitted together
under one coversheet.

If the PWK segment is completed and
additional documentation is needed for adjudication, First Coast will allow seven
calendar “waiting” days (from the claim date of receipt) for the
paperwork documentation to be faxed or ten calendar waiting days to be mailed.
The seven and ten day waiting periods apply to claims for both Part A and Part

If the PWK data is not received
within the waiting timeframe and additional documentation is needed, a
development request will be sent. If documentation is received after the
timeframe has elapsed, the documentation will not be used for adjudication of
the claim. Thus, the paperwork will need to then accompany our request for
additional documentation to prevent possible claim denials.

Claims submitted with a PWK segment,
that would not otherwise suspend for review and/or require additional
development, will process routinely and will not be held for the seven or ten
day waiting period.

First Coast has provided designated
faxination lines to expedite receipt of the PWK coversheets/attachments,
depending on the provider’s line of business and location (Part A or Part B;
Florida, Puerto Rico, or the U.S. Virgin Islands.

fax/mail coversheet includes the appropriate First Coast return mailing address
and faxination number, based on the provider’s selection.