Send an email to: wiser.support@virtixhealth.com

Subject Line: Requesting Portal Access

Include:

• Name
• Email
• Phone Number
• Facility Name and Address
• Facility PTAN
• Facility NPI
• Tax ID

Once processed, you will receive a welcome email with login credentials.

Before submitting requests or using the WISeR Portal, it is important to understand how WISeR is structured.  WISeR is designed around two distinct review pathways, each with its own purpose and workflow.

2.1  The Two WISeR Pathways

You have two options for WISeR procedures:

• Prior Authorization
  • Prior Authorization is a review that occurs before a service is provided.
  • This pathway supports appropriate access to care by confirming that requests meet CMS coverage criteria in advance.

OR

• Pre-payment Claim Review
  • Prepayment Claim Review is a review that occurs after a service has been provided but before claim payment is issued.
  • This pathway focuses on validating documentation related to submitted claims.

These two pathways are distinct and follow different workflows.

2.2 How the WISeR Process Works

WISeR follows the following structure:

• Prior Authorization
  • Initial Prior Authorization Request
  • Resubmission of a Prior Authorization Request
    • Peer-to-Peer (when requested)

OR

• Prepayment Claim Review
  • Additional Documentation Request

Each pathway has its own documentation requirements, review steps, and outcomes.

2.3 When to use Expedited Requests

Expedited is a processing priority, not a request type.

Expedited processing may apply to:

• Initial Prior Authorization Requests
• Resubmitted Prior Authorization Requests

 Expedited requests must include supporting documentation that delay in performing the procedure could seriously jeopardize the WISeR beneficiary’s life, health, or ability to regain maximum function.

2.4 When to use a Peer-to-Peer

A Peer-to-Peer discussion is a sub-process of Resubmission.

When resubmitting a request, the requester will have the opportunity to request peer-to-peer clinical review to inform the new determination. Under peer-to-peer review, the WISeR provider or WISeR supplier will be connected with a clinician(s) with specialty expertise on the condition under review.

2.5 WISeR Glossary (Canonical Terminology)

This glossary establishes the official terminology used across the Virtix Health WISeR Program, the WISeR Portal, training materials, and support communications.

• Additional Documentation Request (ADR) means a request for additional clinical documentation during Prepayment Claim Review.
• Beneficiary means an individual who is entitled to Medicare FFS benefits under Part A or enrolled under Part B.
• Case Status means the current stage of a Case within the WISeR review process.
• Case means a unique submission record created in the Virtix Health WISeR Portal.
• Digital Intake Form (Cover Sheet) means the digital submission form in the Prior Authorization Management section of the Virtix Health WISeR Provider portal used to create a Case and submit all required information and supporting documentation.
• Enhanced Technology means the WISeR Participant’s technology that is intended to improve the accuracy and efficiency of the Prior Authorization Process and Pre-Payment Review.
• Expedited Processing Priority means the handling of a Case based on urgent medical necessity.
• Expedited means a priority processing request applied to any Prior Authorization or resubmission when a delay in performing the procedure would result in seriously jeopardizing the WISeR beneficiary’s life, health, or ability to regain maximum function.
• Initial Prior Authorization Request means the communication to the WISeR Provider or WISeR Supplier detailing the Prior Authorization Affirmation or Prior Authorization Non-Affirmation for an initial Prior Authorization submission.
• LCDs stands for Local Coverage Determinations and has the meaning set forth in Section 1869(f)(2)(B) of the Social Security Act (42 U.S.C. 1395ff(f)(2)(B)).
• Medical Review means the collection and clinical review of medical records and related information to ensure that Medicare payment is made only for services that meet all Medicare Coverage Criteria.
• Medically Necessary means reasonable and necessary as determined in accordance with Section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)).
• Medicare Coverage Criteria means the existing Medicare coverage criteria as set forth in statute, regulation, NCD, or LCD.
• Model Participant means a technology company that has signed an agreement with CMS to participate in WISeR and is not the WISeR Participant.
• NCDs stands for National Coverage Determinations and has the meaning set forth in Section 1869(f)(1)(B) of the Social Security Act (42 U.S.C. 1395ff(f)(1)(B).
• Noridian is the Medicare Administrative Contractor (MAC) responsible for claims processing in the State of Washington.
• Peer-to-Peer (P2P) means the clinical discussion requested as part of a Resubmission between the requesting provider and a reviewing physician.
• Pre-payment Claim Review (PPR) means the review by the WISeR Participant to verify consistency with Medicare Coverage Criteria for a claim for one or more Select Items and Services furnished in the MAC Jurisdiction that is submitted to Medicare without requesting Prior Authorization, consistent with 42 C.F.R. § 405.903.
• Prior Authorization (PA) is a request by the WISeR Provider or WISeR Supplier for provisional affirmation of Medicare Coverage Criteria for one of the Select Items and Services prior to furnishing such items and services to the WISeR Beneficiary and before the claim is submitted for processing.
• Prior Authorization Non-Affirmation means a WISeR Provider or WISeR Supplier prior authorization request that is not accepted by the WISeR Participant as meeting the Medicare Coverage Criteria for the Select Item or Service.
• Prior Authorization Provisional Affirmation means a WISeR Provider or WISeR Supplier prior authorization request that is accepted by the WISeR Participant as meeting the Medicare Coverage Criteria for the Select Item or Service.
• Requestor (synonymous with User) means an authorized user who submits and tracks Cases on behalf of a facility. Additionally adds the facility and the provider if they do not already exist in the portal.
• Resubmission means a Prior Authorization submitted to the WISeR Participant within 120 Days of an Initial Prior Authorization Determination for a Prior Authorization previously submitted by the same WISeR Provider or WISeR Supplier for the same WISeR Beneficiary and same Select Item or Service.
• Supporting Documents means the pertinent Clinical records, imaging, test lab results, and other documentation uploaded to support a Case.
• User (synonymous with Requestor) means an authorized user who submits and tracks Cases on behalf of a facility. Additionally adds the facility and the provider if they do not already exist in the portal.
• View Cases means the portal function used to search, filter, and monitor the status of submitted Cases.
• Virtix Health is the CMS-selected WISeR Participant for the State of Washington, providing the WISeR Portal, review workflows, and provider support.
• WISeR (Wasteful and Inappropriate Service Reduction) is the CMS Innovation Model designed to reduce unnecessary, low-value, or potentially harmful outpatient services while supporting timely access to care.
• WISeR Participant means the technology company that meets the requirements set forth in Article III and has signed this Agreement with CMS to participate in the Model.
• WISeR Portal means the secure Virtix Health application used to submit, track, and manage WISeR Cases.
• WISeR Provider means a provider, as that term is defined in 42 C.F.R. § 400.202, that is in the WISeR Participant’s designated WISeR Jurisdiction that furnishes items and services to WISeR Beneficiaries, consistent with Section 3.5.
• WISeR Supplier means a supplier, as that term is defined in 42 C.F.R. § 400.202, that is in the WISeR Participant’s designated WISeR Jurisdiction and who furnishes items and services to WISeR Beneficiaries, consistent with Section 3.5.

This section explains who uses the WISeR Portal, how access is managed, and how to sign in.

3.1 WISeR User Roles

Each role has specific responsibilities within the WISeR program.

3.2 How to Request Portal Access

To request access to the Virtix Health WISeR Portal, send an email to: wiser.support@virtixhealth.com

Subject Line: Requesting Portal Access

Include:

• Name
• Email
• Phone Number
• Facility Name and Address
• Facility PTAN
• Facility NPI
• Tax ID

 Once processed, you will receive a welcome email with login credentials.

3.3  Account Setup & Multi-Factor Authentication

To request access to the Virtix Health WISeR Portal, email: wiser.support@virtixhealth.com

All new users receive an automated welcome email with:

• Username
• Temporary password
• Application URL
• Password requirements

Multi-Factor Authentication (MFA) is required for all users.

Before logging in, download an authenticator app such as:

• Google Authenticator
• Microsoft Authenticator

3.4 Logging in for the first time

Navigate to the application URL provided in your welcome email, then:

• Enter your username and temporary password
• Create a new password
• Set up MFA by scanning the QR code with your authenticator app
• Enter the 6-digit code to complete setup
• For future logins, you will need:
• Your username
• Your password
• Your current authenticator code

This section explains how Requestor/Users set up facilities, providers, and maintain portal permissions within the Virtix Health WISeR Portal.

4.1 Prior Authorization Management Dashboard Overview

The Prior Authorization Management Dashboard provides a centralized view of:

• Pending Active Requests
• User management tools

 Requestor/Users use this dashboard to add facilities and providers, as well as maintain access across their organization.

4.2 Adding Facilities

Requestor/Users are responsible for registering facilities within the WISeR Portal.

To add a facility:

1. Log into the Virtix Health WISeR Portal
2. Navigate to Prior Authorization Management Dashboard
3. Scroll down to Place of Service / Facility Information
4. Enter the facility NPI
5. Following the pop-up window, select OK to add a new facility
6. Enter facility identifying information
7. Save the request, then a pop-up window will appear
8. Review the facility details
9. If correct, agree and confirm to add the facility
10. Once confirmed, the facility becomes available for case assignment

Once a Requestor/User has entered the facility NPI, the system will auto-populate details if the facility already exists for future case assignments.

4.3 Adding Providers

Providers are clinicians associated with WISeR cases.

To add a Provider:

1. Log into the Virtix Health WISeR Portal
2. Navigate to Prior Authorization Management Dashboard
3. Scroll down to Attending / Rendering Provider Information
4. Enter the provider NPI
5. Following the pop-up window, select OK to add a new provider
6. Enter provider identifying information
7. Save the request, then a pop-up window will appear
8. Review the provider details
9. If correct, agree and confirm to add the provider
10. Once confirmed, the provider becomes available for case assignment

Once a Requestor/User has entered the provider NPI, the system will auto-populate details if the provider already exists for future case assignments.

This section explains how to submit Prior Authorization requests in the Virtix Health WISeR Portal. Prior Authorization is a review that occurs before a service is provided and is designed to support timely, appropriate access to care.

5.1 Prior Authorization Overview

Providers may choose to submit Prior Authorization for certain WISeR-applicable services.

Submitting Prior Authorization before care is delivered can help:

• Reduce downstream documentation requests
• Improve timeliness of determinations
• Minimize rework
• Support appropriate patient access

If Prior Authorization is not obtained, documentation may be requested later through Pre-payment Claim Review.

5.2 Initial Prior Authorization Requests

5.2.1  When to Use Initial Requests

Use an Initial Prior Authorization Request when you are submitting an initial request for that beneficiary for that procedure for that date of service.

5.2.2 Step-by-Step Submission

1. Log in to the Virtix Health WISeR Portal
2. Complete user profile
3. Choose Prior Authorization
4. Complete user profile
5. Select Initial Request
6. Complete the Intake Form
7. Upload required supporting documentation
8. Submit the request

5.2.3 Completing the Intake Form

The Intake Form captures required service, beneficiary, and provider information. All required fields must be completed to avoid processing delays and/or rejection of the request.

5.2.4 Attaching Supporting Documentation

Upload clinical documentation that supports medical necessity, including:

• Office visit notes
• Imaging reports
• Procedure notes
• Relevant lab results
• Any documentation referenced in the coverage guidelines

5.2.5 Submitting & Tracking Status

After submission, the Case status can be monitored under View Cases

5.3 Resubmitting a Prior Authorization Request

5.3.1 When Resubmission is Required

Resubmission is required after an Initial Request is returned or non-affirmed and additional documentation or clarification is submitted.

5.3.2 What Documentation to Include

Include all additional clinical documentation requested in the determination notice.

5.3.3 Step-by-Step Resubmission Process

1. Log into the WISeR Portal
2. Select the applicable Case
3. Choose Resubmission
4. Upload additional documentation
5. Submit

5.4  Peer-to-Peer Requests (Sub-Workflow)

5.4.1 What Peer-to-Peer Means

Peer-to-Peer is a clinical discussion between the requesting provider and a reviewing physician after a non-affirmation is received by the provider.

5.4.2  When to Request It

Peer-to-Peer may be requested as part of a Resubmission when desired by the treating physician wants to discuss the case with the reviewing physician.

5.4.3 Submitting a Peer-to-Peer Request

1. Open the applicable Case
2. Select Request Peer-to-Peer
3. Provide availability and contact information
4. Submit

5.4.4 What Happens Next

A Virtix Health associate will contact the requestor to schedule a time for a reviewing physician to contact the requesting provider to discuss the case.

5.5  Expedited Requests

5.5.1 What Qualifies as Expedited

Expedited requests are used when a delay in care could seriously jeopardize the beneficiary’s life, health, or ability to regain maximum function.

5.5.2 How to Mark a Request as Expedited

Expedited status can be applied to:

• Initial Prior Authorization Requests
• Resubmissions

Select Expedited within the Intake Form and provide supporting documentation.

5.5.3 Documentation Requirements

Supporting documentation must demonstrate a procedure is needed urgently to prevent loss of life, health or the ability to regain maximum function.

1.5.4 Turnaround Time Expectations

 When approved for expedited processing, determinations are communicated within two business days of receipt.

This section explains what happens when a claim enters Pre-Payment Claim Review and how to respond to an Additional Documentation Request (ADR). Pre-Payment Claim Review occurs after a service has been provided but before Medicare issue payment.

6.1 Pre-Payment Claim Review Overview

Pre-Payment Claim Review may occur when:

• A claim is submitted for a WISeR-applicable service
• The service has already been delivered

This review protects providers by validating documentation before payment is issued and helps prevent future audits, recoupments, and appeals.

When your claim enters Pre-Payment Claim Review, you will receive an Additional Documentation Request (ADR).

An ADR will be sent to the Provider, who will have 45-days to return before the medical review may commence. A determination will be issued within 3 days of receiving all necessary documentation.

6.2  Responding to an Additional Documentation Request (ADR)

1. Log in to the Virtix Health WISeR Portal
2. Navigate to View Cases
3. Look for:
   1. Case Type: Pre-Payment Claim Review
   2. Status: ADR Response Pending

6.2.1 Uploading Supporting Documentation

Upload all documentation requested in the ADR within 45 days of the request.

Documentation may include:

• Office visit notes
• Imaging reports
• Lab results
• Procedure notes
• Any other requested clinical documentation

6.2.2 Submitting the ADR Response

After uploading documents:

1. Confirm that documentation is complete
2. Select Submit

This confirms that your ADR response has been received.

6.2.3 What Happens After Submission

Virtix Health clinical reviewers validate submitted documentation against CMS coverage criteria. Once review is complete:

• The determination is returned to Noridian for claim processing.

This section explains how to view, monitor, and manage Cases submitted through the Virtix Health WISeR Portal.

7.1 Viewing Case Status and Determinations

To view your submitted Cases:

1. Log into the Virtix Health WISeR Portal
2. Select View Cases from the main menu

This screen displays all Cases associated with your account and assigned facilities.

7.2 Understanding Status Messages and Determinations

Each Case displays a status or determination indicating where it is in the review process. Common status messages and determinations include:

7.3 Searching & Filtering Cases

Use search and filter tools to:

• Locate specific Cases
• Filter by Case Type
• Filter by Status
• Sort by submission date

These tools help manage volume efficiently and keep workflows organized.

This section provides guidance for common portal issues and how to get help when needed.

8.1 Password Reset

If you forget your password:

1. Navigate to the WISeR Portal login page
2. Select Forgot Password
3. Enter your registered email address
4. Follow the password reset instructions sent to your email

8.2 Common Portal Issues

8.3 Document Upload Issues

File upload criteria:

• Maximum file size: 4 MB
• Maximum number of files per case: 10
• Naming convention: file names must not include any space or special characters

If documents fail to upload:

• Confirm file size and format meet portal requirements
• Try uploading one file at a time
• Verify internet connectivity
• Refresh the browser and retry

8.4 Contacting Support

For WISeR Portal support, contact:

• Email: wiser.support@virtixhealth.com
• Phone: 833-943-2209

Support representatives are available to assist with access, technical issues, and general portal questions Monday – Friday 8am – 4pm EST.

The following best practices can help ensure timely, accurate review and reduce delays or additional documentation requests.

9.1  Best Practices for Submissions

• Verify beneficiary eligibility before submitting
• Confirm the service is WISeR-applicable
• Select the correct Case type (Initial, Resubmission, or Pre-Payment Claim Review)

9.2 Documentation Tips

• Include recent and relevant clinical notes
• Attach imaging and lab reports that support medical necessity
• Ensure documentation aligns with CMS coverage guidelines
• Upload legible, complete records
• Avoid submitting duplicate or incomplete files

9.3 Reducing Delays and Denials

• Submit Prior Authorization before care when appropriate
• Respond promptly to ADRs
• Review determination notices carefully
• Maintain accurate portal user access
• Keep facility and provider records current

This section provides helpful references and support contacts for the WISeR Program.

10.1 CMS WISeR Program Information

For official CMS information about the WISeR Innovation Model, including program updates and coverage policies, visit:

• WISeR (Wasteful and Inappropriate Service Reduction) Model | CMS

10.2 Noridian Information

Noridian is the Medicare Administrative Contractor (MAC) for the State of Washington. Noridian provides official Medicare claims processing guidance and coverage information. For additional Noridian resources, visit:

• WISeR Model – Arizona and Washington Providers and Suppliers – JF Part B – Noridian

10.3 Virtix Health WISeR Support

Virtix Health provides onboarding, training, and portal support for WISeR in the State of Washington.

• Email: wiser.support@virtixhealth.com
• Phone: 833-943-2209
• Portal: wiser.support@virtixhealth.com

10.4 Additional Resources

Additional training materials, FAQs, and portal updates will be provided as the WISeR program evolves.