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CGS Administrators, LLC

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December 18, 2019 - Updated 12.20.19

PWK Reminder: Missing Form Requirements

It is important that suppliers fill out the entire PWK form when submitting a claim. Any information noted below that is left off the submission will qualify the PWK form for rejection.

The following pieces of information are required when filling out a PWK Form: ACN, CCN, Beneficiary First and Last Name and Medicare ID, Dates of Service, NPI, PTAN, Number of Documentation included. All sender information including Name, Fax, Company and full address also must be filled in.

The "Notes" section is optional and is the only field that can be left blank.

The PWK Cover Sheet (linked here) can be found on the PWK page or the Forms page on at any time.

Please refer to our PWK Segment pagePDF, or Chapter 6, Section 16 of the Supplier ManualPDF for more information on filling out the PWK Segment Form.

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