WISeR Model 

July WISeR Updates: Streamlined Resubmissions, Dismissal Know-How, and Escalation Tips

Three updates this month that will change how you submit, track, and escalate prior authorization requests in WISeR.

Plus, to help you make the most of these changes, save the date for our next WISeR in Practice webinar on Wednesday, August 12 at 12 p.m. PDT, where we’ll explore best practices for advancing appropriate care under the WISeR Model.

Program Announcements  

The WISeR Gold Card Exemption Program is now live.

Providers with an average affirmation rate of 80% or higher were notified of their exemption status on June 1, 2026.

Key dates:

• Exemption period: one year from effective date
• Next eligibility evaluation: October 1, 2026
• Coverage period reviewed: January 1 through July 7, 2026

For more information, review the Gold Card Fact Sheet.

Technology Updates 

 The WISeR Provider Portal now pre-fills your resubmissions, lets you duplicate cases, and shows patient and physician names in the case view.

 The portal now streamlines resubmissions with a new workflow that pre-fills existing case details, eliminating redundant data entry. For added flexibility, the new Copy feature allows you to duplicate a case with fewer restrictions on input changes than the resubmission process. This is particularly helpful when the same patient requires a second procedure on a new date of service or when correcting a dismissed case without rebuilding the form.

 Additionally, based on feedback from our May webinar, the View Cases tab now displays Patient Name and Physician Name columns, with search and sort enabled for both. Users can also search additional fields not shown in the table, such as MBI and NPI.

Visit the WISeR Provider Portal to experience these new features.

Clinical Insights

Every non-affirmation in the WISeR program is reviewed by a board-certified, licensed physician. No request is declined by technology alone.

Below are key terms to help clarify the WISeR process and what each outcome means for physicians and providers:

Affirmation: The request meets Medicare criteria and is approved.

• Non-Affirmation: The request does not meet Medicare criteria and is not approved.
• Dismissal: The request is outside of the WISeR program’s scope and was not formally denied or evaluated for medical necessity. However, other prior authorization requirements may still apply outside of WISeR.
• Make clinical decisions based on patient needs.
• Follow NCD/LCD and standard Medicare guidelines.

A dismissal is not a denial. Here's what to do if your request is dismissed:

If no separate prior authorization requirement exists, the request is handled as if the WISeR Model was not in place.

Questions or Support

Need help? Contact the WISeR support team directly: wiser.support@virtixhealth.com

The support team handles:

• Prior authorization questions
• Documentation requirements
• Portal navigation

If your issue needs additional review, your support contact will escalate internally and track it through resolution. You can also request escalation directly if something remains unclear or unresolved.

For additional information and resources, visit the Virtix Health website.

Your insightful questions and feedback are helping us shape a more responsive, efficient experience for everyone involved. In case you missed it, see the full webinar.