WISeR Participation and Prior Authorization Process

Who needs to participate in WISeR?

Physicians in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington within specific Medicare Administrative Contractor (“MAC”) jurisdictions (JL, J15, JH, and JF) that provide the identified services. CMS intends to expand the model to more states.

However, it is mandatory for Medicare-enrolled physicians and practices to submit prior authorization requests for selected procedures to a WISeR participant (a technology company or MAC). The WISeR participant companies are:

WISeR Participant (technology company)	State
Cohere Health, Inc.	Texas
Genzeon Corporation	New Jersey
Humata Health, Inc.	Oklahoma
Innovaccer Inc	Ohio
Virtix Health LLC	Washington
Zyter Inc.	Arizona

Where can I find the selected services that require prior authorization?

Access the selected services as well as the pain medicine and associated anesthesia codes here. More details are available at CMS’ Provider and Supplier Information webpage. 

How do I begin the prior authorization process?

Physicians and practices have two options under WISeR to receive coverage determinations: 

1. Submit a prior authorization request to receive a determination prior to administering WISeR select items and services, as described in Sections 3 and 4, or 

2. Furnish WISeR select items and services immediately and wait for the determination through pre-payment review, as described in Section 7.2.

Comprehensive details including data elements to include in authorization requests, process flow, timeline, and where to send requests are found in the WISeR Model Provider and Supplier Operational Guide 3.0

What is the timeline for receiving a determination of coverage?

For non-urgent cases, WISeR vendors or the MAC will typically issue a determination to the requester within 3 days of receiving the initial or resubmitted request. If delays could seriously jeopardize a patient’s life, health, or ability to regain maximum function, an expedited request can be issued a decision to the requester within 2 days of receipt of the request.

Other relevant and up-to-date resources to review include:

• CMS Manual for WISeR including changes to services and start date (PDF)

• WISeR Model Frequently Asked Questions  
  (Updated 12/23/2025)

• WISeR Provider and Supplier Operational Guide (PDF)  
  (Updated 12/23/2025) 

• WISeR Provider Factsheet (PDF) Includes services (page 2) and prior authorization process flow (page 3)

• All other details are available at Provider and Supplier Information