21-611 Avoid Delays: Use the New CCIH Toll-Free Fax Number to Submit Additional Documentation for EDI Claims
Date: 09/15/21
This information applies to Physicians, Hospitals, and Ancillary providers.
The CCIH toll-free fax line for providers has changed to 844-836-7475, effective August 16, 2021
Prison Health Care Provider Network providers submitting Accredited Standards Committee (ASC) X12 837 claims through electronic data interchange (EDI) can submit additional supporting documentation by using the process outlined below and a Paperwork (PWK) Fax Cover Sheet.
The provider must populate the following PWK elements in Loop 2300 of the ASC X12 submission:
Element | Must contain | Purpose |
|---|---|---|
PWK01 (Attachment Report Type Code) | A valid two-character value (e.g., "OZ" = "Support Data for Claim") | Identifies the type of documentation that will be faxed |
PWK02 (Report Transmission Code) | The value "FX" | Indicates that the provider will be faxing supporting documentation associated with the claim |
PWK05 (Identification Code Qualifier) | The value "AC" | Indicates that PWK06 contains an Attachment Control Number (ACN) |
PWK06 (Identification Code) | A 1-50 character ACN assigned by the provider | Enables CorrectCare Integrated Health (CCIH) to match a faxed attachment with its ASC X12 837 claim |
Submit supporting claim documentation with the PWK Fax Cover Sheet as follows:
- Download the PWK Fax Cover Sheet available online at the CCIH provider website, under User Reference.
- Complete the fax cover sheet, place it on top of the supporting documentation and fax all pages to 844-836-7475. Note: If an attachment is required to adjudicate the associated claim, CCIH must receive it within 10 calendar days of the electronic claim’s submission date; otherwise, CCIH may reject the claim.
- Attachments associated with incomplete cover sheets may be discarded.
- Use only one cover sheet for each electronic claim, regardless of the number of attachments.
Additional information
Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library.
If you have questions regarding the information contained in this update, contact the PHCPN Provider Services Center by email within 60 days or by phone at 877-899-0561.