Additional documentation can be submitted when required for claims adjudication as indicated below.

eServices
By utilizing our online eServices portal, providers can upload a variety of documents such as operative reports, invoices, etc. based on pre-selected criteria. The form includes drop-down menus of the valid CPT/HCPCS codes and modifiers allowed for additional documentation submission. This gives providers the ability to submit the documentation needed to support specific claim submission scenarios and prevent submission of unnecessary documentation. Also, this ensures the exact information needed for correct processing of the claim has been sent. eServices saves users time and money, and more importantly – ensures the timely delivery of documentation to Palmetto GBA. Uploading documents is as easy as attaching a document to an email.

Fax

  • When submitting a paper attachment via a Fax, the Claims Processing PWK Fax Cover Sheet must be completed. This form can be located under the Claims section of the Forms application on the Palmetto GBA website.
  • Send all relevant PWK documentation for the claim at the same time
  • Fax number and address is listed on the cover sheet

Whether you are submitting your additional documentation via eServices or Fax, the following PWK data elements must be completed.

Loop 2300

PWK01 (Attachment Report Type Code)

Use the values indicated in the TR3 to identify the type of attachment
Examples:

  • M1 (Medical record attachment)
  • OD (Orders and treatments document)
  • P5 (Patient medical history document)
  • PY (Physician's report)

PWK02 (Attachment Transmission Code)

  • Indicates a code identifying how the attachment will be sent
  • PWK02 = BM (Mail) FX (Fax) or EL (electronically)

PWK05 (Identification Code Qualifier)

  • Required when PWK02 = BM, FX or EL
  • PWK05= AC

PWK06 (Attachment Control Number)

    • A value assigned by the provider/software vendor to uniquely identify the attachment
    • Must be 2-50 characters
    • Can be all numeric, all alphabetical, and/or a combination
    • ACN submitted on the claim must match the ACN entered on the PWK coversheet/form

Additional Documentation Not Needed:

  • As a reminder, Palmetto does not require the submission of additional documentation for:

Additional Documentation Required - Modifiers:
Palmetto does require the submission of additional documentation for some modifiers. Please refer to the Modifier Lookup tool to determine if additional documentation is required.

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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