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WISeR Model 

June WISeR Updates: Webinar Recap, Gold Card Launch, and Claims Guidance

At Virtix Health, we’re committed to supporting physicians and providers as you continue to navigate the CMS WISeR (Wasteful and Inappropriate Service Reduction) Model initiative.

Last week we connected with Washington State physicians and providers to discuss the prior authorization process for select Medicare procedures, submission requirements, documentation standards, issue escalation, and the Gold Card program. Noridian experts joined the session and answered questions submitted by providers across the state.

The written Q&A from the session is available now.

Program Announcements  

The WISeR Gold Card Exemption Program launches July 6. Physicians who achieve a 80 percent or higher affirmation rate on prior authorization requests will generally be exempt from additional prior authorization and pre-payment review for WISeR procedures. Review the fact sheet to see if you are eligible: Gold Card Fact Sheet.

Technology Updates 

The WISeR Provider Portal Sharing Center is now available. It allows physicians and staff to share cases with internal colleagues securely — with configurable permissions, expiration settings, and a clear audit trail of who accessed what and when. Visit the WISeR Provider Portal to see the Sharing Center in action.

Clinical Insights – UTN Reminder

A reminder for claims submission: our clinical team has identified cases being submitted without the UTN (Unique Tracking Number) even when a prior authorization request is already on file. Missing the UTN causes delays and may trigger an ADR letter. Including it at submission prevents additional review. 

If a claim is submitted without a UTN and a PAR is on file:

  • If the PAR has been affirmed, Virtix Health will coordinate with Noridian to ensure the claim processes correctly.
  • If the PAR was non-affirmed, the claim will be denied and standard appeal rights will apply.
  • You may also receive an ADR letter requesting additional documentation.

See Section 7 of the WISeR Provider and Supplier Operational Guide for full claim submission guidance. If you encounter issues, contact our WISeR Support team directly.

Questions or Support

Our clinical and regulatory team is available for direct consultation on prior authorizations, documentation requirements, and portal navigation. Contact our support team to request a meeting.

To better support physicians, providers, and the communities that we serve, we continuously update our resource library with FAQs, program statements, patient guides, and much more. Visit the Virtix Health website to access these materials and stay informed.

Additionally, if you know someone who should receive this email and stay informed about WISeR updates, please encourage them to register here to join our mailing list.

 
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