This article explain how we can attach supporting documents with EDI 837 5010 Electronic Claims. This can be implemented using PWK (paperwork) segment of the X12N version 5010.
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.
There are two steps in this process. Specify the document list to be attached as part the claim in the EDI File and in some transmission mode, send the actual attachment to the payer. Either you can send the document via FTP, FAX, Email directly to payer or via clearing house. All the clearing house have this feature implemented and documented the process of sending the document to the payer.
Here is an example of EDI 837 with PWK Segment.
EDI 837 Professional. Version 005010X222A1
Example 2: Outpatient Visit supporting document
1) Patient is same person as subscriber.
2) Payer is commercial health insurance Company
3) Contains information about 3 attachment in the PWK Segment.
EDI File
ISA*00* *00* *ZZ*123123 *01*241232 *210423*1021*^*00501*232221190*1*T*:
GS*HC*123123*241232*20210423*1021*23222119*X*005010X222A1
ST*837*0001*005010X222A1
BHT*0019*00*0001*20210423*1021*CH
NM1*41*2*ABC Submitter*****46*123123
PER*IC*John Mike*TE*1214151617
NM1*40*2*241232*****46*241232
HL*1**20*1
PRV*BI*PXC*208500000X
NM1*85*2*Get Well Family Clinic LLC*****XX*1740713692
N3*3937 Kenwood Place
N4*Orlando*FL*32801
REF*EI*81-3777631
HL*2*1*22*0
SBR*P*18*92291223*AED12342*****ZZ
NM1*IL*1*BAKER*Alyssa****MI*723223232
N3*197800 Atascocita Shores Dr*302 12 N. Mcgraw St
N4*HOUSTON*TX*77833
DMG*D8*20201204*M
NM1*PR*2*CIGNA*****PI*81400
N3*PO BOX 660044
N4*DALLAS*TX*75266
CLM*10421*100.00***11:B:1*Y*A*Y*Y*P
PWK*AM*FT***AC*X12451232
PWK*PN*FT***AC*524123123
PWK*OB*FT***AC*7342343
HI*ABK:R1013*ABF:E860
NM1*82*1*Nelson*Romer****XX*1023555349
NM1*77*2*Clinic For Pain And Anxiety *****XX*1396885059
N3*6100 W CREEK RD SUITE 35
N4*Independence*OH*44131
LX*1
SV1*HC:99213*50.00*UN*1.00*11**1:2
DTP*472*RD8*20201204-20201204
REF*6R*6001
LX*2
SV1*HC:87070*50.00*UN*1.00*11**1:2
DTP*472*RD8*20201204-20201204
REF*6R*6002
SE*38*0001
GE*1*23222119
IEA*1*232221190
HTML Version
Submitter Information
| Transaction Date | 04/23/2021 |
| Transaction Time (HHMM) | 10:21 |
| EDI Version | 005010X222A1 |
| EDI Transaction set | 837 |
| Submitter Entity | Organization |
| Organization Name | ABC Submitter |
| Contact Name | John Mike |
| Contact Phone | 1214151617 |
| Submitter ID | 123123 |
| Receiver ID | 241232 |
| AuthorizationQualifier | 00 |
| Control Number | 232221190 |
| Usage Indicator | T |
| Acknowledgement Requested | 1 |
Billing Provider
| Entity Type | 2 |
| Last or Organization Name | Get Well Family Clinic LLC |
| Address1 | 3937 Kenwood Place |
| City | Orlando |
| State | FL |
| Zip | 32801 |
| NPI | 1740713692 |
| Tax ID | 81-3777631 |
| Taxonomy Code | 208500000X |
Subscriber information
| Payer Responsbility | P |
| Insured Relationship | 18 |
| Group Number | 92291223 |
| Group Name | AED12342 |
| Claim Filling Indicator | ZZ |
Subscriber Name
| Entity Type | 1 |
| Last or Organization Name | BAKER |
| First Name | Alyssa |
| DOB | 12/04/2020 |
| Gender | M |
| Policy No | 723223232 |
| Address1 | 197800 Atascocita Shores Dr |
| Address2 | 302 12 N. Mcgraw St |
| City | HOUSTON |
| State | TX |
| Zip | 77833 |
Claim Information
| Claim No | 10421 |
| Billed Amount | 100.00 |
| Claim Type | 1 |
| Provider Sign Indicator | Y |
| Provider Accept Assignment Code | A |
| Benefits Assignment Indicator | Y |
| Release of information | Y |
ICD Information
| ICD Code 1 | R1013 |
| ICD Code 2 | E860 |
Claim Attachment 1
| Report Type Code | AM |
| Transmission Code | FT |
| Control Number | X12451232 |
Claim Attachment 2
| Report Type Code | PN |
| Transmission Code | FT |
| Control Number | 524123123 |
Claim Attachment 3
| Report Type Code | OB |
| Transmission Code | FT |
| Control Number | 7342343 |
Rendering Provider
| Entity Type | 1 |
| Last or Organization Name | Nelson |
| First Name | Romer |
| NPI | 1023555349 |
Facility
| Name | Clinic For Pain And Anxiety |
| Address1 | 6100 W CREEK RD SUITE 35 |
| City | Independence |
| State | OH |
| Zip | 44131 |
| NPI | 1396885059 |
| POS | 11 |
Line Item : 1
| Line Item ID | 6001 |
| Procedure Code | 99213 |
| Units Code | UN |
| Units | 1.00 |
| Charges | 50.00 |
| ICD Pointers | 1,2 |
| Service From Date | 12/04/2020 |
| Service To Date | 12/04/2020 |
| POS | 11 |
Line Item : 2
| Line Item ID | 6002 |
| Procedure Code | 87070 |
| Units Code | UN |
| Units | 1.00 |
| Charges | 50.00 |
| ICD Pointers | 1,2 |
| Service From Date | 12/04/2020 |
| Service To Date | 12/04/2020 |
| POS | 11 |
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