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Back  RFI # 1074: PWK Repeat Claim & Line Level

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Submitter

Keni McMurtry

Description

In the process of coding for 5010, we have come across the PWK at both claim and line level. Unlike most other segments which have repeats at line-level, its appearance at line level is not necessarily to override claim-level information. Both instances contain the same requirement notes, so it appears that if we output at claim level, we must also output at line level, regardless if it is the exact same information. There is no note specifying that the line-level is only necessary when it differs from claim-level. And there is no note at line-level specifying not to output claim-level when outputting at line-level.

If we do not repeat at line level, we will not be outputting pursuant to the TR3's instructions. Is this analysis correct or can you point us to additional notes regarding the use of these two PWK's? Thank you very much for your time.

Response

By virtue of the segment names Claim Supplemental Information and Line Supplemental Information, the PWK at the Claim Level is used when the supplemental information is related to the entire claim, and the PWK at the Line Level is only used when the supplemental information is related to a particular line. The PWK at the line level does not override the PWK at the claim level, it is additional information pertaining specifically to that line. When the Line Level Supplemental Information is the same as the Claim Level Supplement Information it is consistent with the Guides not to send the Line Level Information. The Work Group will consider adding clarification to the PWK segment notes in a future version of the Guides.
Submission 6/11/2010
Status Date 7/30/2010
Status F - Final
Primary References
Document 005010X222
SectionNA
PageNA
Set IDNA
Loop2300
Segment Position1
Segment ID1
Industry NamePWK