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October 1, 2012 – Revised July 17, 2014Reviewed 12.07.22

Submitting Additional Documentation with Electronic Claims: Paperwork (PWK) Segment

When paper documentation or attachments are necessary to support an electronically submitted claim, trading partners should identify the documentation using the PWK Segment at the claim level (Loop 2300) or line level (Loop 2400). The PWK segment allows additional documentation to be submitted with initial claims. The documentation is imaged to be available during the claims adjudication.

Electronic Claim Requirements (Loop 2300 & Loop 2400). Only the first iteration of the PWK, at either the claim level and/or line level, will be considered for adjudication.

In PWK segment claim level (Loop 2300) or line level (Loop 2400), use the following data elements to identify that a paper attachment is forthcoming:

  • PWK 01 (Attachment Report Type Code - Required): please refer to the implementation guide for values
  • PWK 02 (Report Transmission Code - Required) - Only values listed below will be accepted.
BM By Mail
FX By Fax
  • PWK 05 (Identification Code Qualifier - Required with PWK02)- Values are listed below:
AC Attachment Control Number
  • PWK 06 (Identification Code - Required with PWK02) - PWK06 is a value assigned by the provider to uniquely identify the documentation to be mailed or faxed. The maximum field length is 50.

Additional Documentation Information

The PWK Fax/Mail Cover SheetPDFmust accompany your additional documentation transmission. Use this as the first page of your documentation.

  • Submit additional documentation with your claim only if CGS has indicated it may be necessary for that service.
  • Submit your claim first, before transmitting the PWK cover sheet and any additional documentation.
  • Complete all fields on this form. CGS will return PWK cover sheets with missing, illegible, or inaccurate information. Please note, we will not return additional documentation attached to these PWK cover sheets.
  • You may not modify this form, other than completing the required fields.
  • Send all additional documentation in a single transmission for each claim.
  • Separate PWK cover sheets are required for each claim.
  • CGS will allow 7 calendar "waiting" days (from the date we receive your claim) for your documentation to be faxed. If you are mailing documentation, we will allow 10 calendar "waiting" days.

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