PWK Background

50.10.1 - PWK Background (Rev. 13105; Issued- 04-10-25; Effective: 05-12-25; Implementation: 05-12-25) In the current CMS claims processing environment, providers have to wait to receive requests for additional information, called automated development request letters, in order to provide additional documentation necessary for the adjudication of their claims. This “solicited” method of requesting documentation adds unnecessary extra days to claims processing. Beginning with the 5010 version of the ASC X12 837 institutional, professional and dental (electronic healthcare claim transaction), electronic billers can utilize a new methodology for providing CMS with their additional documentation which is required for claims adjudication. This new methodology involves submission of the PWK segment (paperwork) in the ASC X12 837 claim to indicate “unsolicited” claim- related documentation is forthcoming.