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Last Modified: 2/26/2017 Location: FL, PR, USVI Business: Part A, Part B

First Coast redesigns PWK form to improve provider claim processing

To improve claims processing and improve readability success rates with its optical character recognition (OCR) systems, First Coast Service Options Inc. (First Coast) has redesigned its PWK fax and mail cover forms for providers who submit unsolicited additional documentation with their claims.
The fax cover sheet form is designed for providers or trading partners to supply required data elements such as beneficiary names and Medicare numbers using optimized fonts and then submit the form with their documentation. Using the new forms will increase the success rate of submitted documents, effectively reducing the amount of time to process claims for providers.

Where to download new PWK forms

Providers must use the new First Coast coversheet to submit unsolicited additional documentation related to filed claims. Older forms will no longer be accepted on or after Monday, December 5, 2016. New forms will be available on the First Coast provider site at that time.
First Coast provides separate forms for Part A and Part B for providers in Florida, Puerto Rico, and the U.S. Virgin Islands. First Coast also has provided secure fax numbers for providers or trading partners who chose this method to submit additional documentation.
PWK is the process whereby filed electronic claim transactions link with submitted unsolicited additional documentation needed to adjudicate medical claims for services provided to Medicare beneficiaries.
PWK Fax Cover Sheet Part B
PWK Fax Cover Sheet Part A
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.