Instructions for Completing the Medicare PWK Fax Cover Sheet When Submitting Additional Documentation. Claims Processing PWK Fax Cover Sheet. ALLfields areREQUIRED.
This instruction provides guidance on implementing medical review processes, procedures, and requirements for reviewing claims with a PWK segment and additional unsolicited documentation.
Complete ONE (1) Medicare Fax, Mail or Electronic Submission of Medical Documentation (esMD) Cover Sheet for each electronic claim for which documentation is being submitted. This form should …
Complete ONE (1) Medicare Fax/Mail/esMD Cover Sheet for each electronic claim for which documentation is being submitted. This form should not be submitted prior to filing the claim. Please …
Complete ONE (1) Medicare PWK Fax/Mail/esMD Cover Sheet for each electronic claim for which documentation is being submitted. This form should not be submitted prior to filing the claim.
Complete ONE (1) Medicare Fax/Mail/esMD Cover Sheet for each electronic claim for which documentation is being submitted. This form should not be submitted prior to filing the claim.
If you wish to send supporting documentation when the claim is submitted, indicate in the PWK (Claim Supplemental Information) segment of Loop 2300 of the electronic claim that the documentation will …
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