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WISeR

Virtix Health is Partnering with CMS on a Pilot Program in Washington state.

Washington providers and suppliers may login or request access to the WISeR Provider Portal.

For any additional inquiries, please contact our support team directly.

Access the WISeR Provider Portal
Contact Washington WISeR Support

To save time, web portal submission and electronic document upload will allow you to track the status of your request and receive a quicker response.

WISeR Intake Form for Print
Download Form
Manual Non-Portal Submission
Download the WISeR intake form for Washington State requests.
  1. You may fill this interactive form in a PDF Reader/viewer, (like Adobe Acrobat Reader, or a built-in browser viewers that let you open, read, print, and fill forms). 
  2. After filling the form, save in this format :WISeR-Intake-Form_Date_Name.pdf
  3. Then print
  4. Include form with supporting medical record documents for review.
  5. Send via mail or fax to:
Fax: (972) 823-9415
Mail:  6509 Windcrest Drive,
Suite 165
Plano, TX 75024

 

This request document and medical record documentation is required and may be submitted via fax, mail or electronic portal. All fields are REQUIRED unless otherwise noted. Incomplete or illegible handwritten requests will be non-affirmed.

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