WISeR Model 

August WISeR Updates: Only 6 Days Until the Webinar; Plus, Discover All-New Portal Interface and UTN Insights

Are you seeking a better understanding of the WISeR Model and the prior authorization process? Washington State physicians, providers, and staff are invited to our “WISeR in Practice: Advancing Appropriate Care Under the WISeR Model” webinar on Wednesday, August 12 at 11 a.m. PDT, where we will guide you step-by-step, from submitting requests and managing reviews to resolving common issues within the Provider Portal.

Attendees will gain valuable clinical insights and discover best practices to streamline your workflows, monitor case statuses, and address documentation requirements with confidence.

Program Announcements

The Gold Card program is designed to recognize consistent excellence in compliance under the WISeR Model. As the next eligibility evaluation approaches (October 1), providers who are interested in learning more about Gold Card eligibility, review periods, and program requirements are encouraged to visit the Gold Card Fact Sheet. For assistance with Gold Card determination letters or questions about your status, the WISeR support team is ready to support your organization’s continued success in the program.

Technology Updates 

In our previous update, we introduced the Copy feature, allowing you to easily duplicate existing cases with fewer restrictions than the resubmission process. To further support your workflow and enhance your experience with the WISeR Provider Portal, we’re rolling out three new interface improvements:

• Single-page case creation: Start, document, and submit cases all in one place
• Left-hand navigation: Navigate quickly with a new compact sidebar
• Side-by-side sections: View all key details without extra scrolling

Additionally, we will enhance our existing PECOS integration by incorporating additional API calls into the prior authorization form, aiming to strengthen the accuracy of physician and facility validations, reduce dismissals, and streamline Provider Portal workflows.

Visit the WISeR Provider Portal to experience these new features.

Clinical Insights

Efficient claims submissions and prior authorization requests (including resubmissions) rely on following best practices and staying informed about key processes. Below are practical reminders and tips to help streamline your workflow and reduce delays:

• Ensure the Unique Tracking Number (UTN) on your claim matches the correct WISeR request and line of business. As a guideline, Part A UTNs usually have an “A” and Part B UTNs a “B” in the third position. For UTN errors or rejections, promptly contact the WISeR support team for escalation and resolution, as we can coordinate escalation of UTN-related concerns through established processes with the Medicare Administrative Contractor (MAC). Prompt identification and reporting of UTN issues can help support timely resolution and minimize unnecessary claim processing delays.
• Always include all necessary documentation with each resubmission. Submit a complete request that stands independently for review or audit, rather than only new or supplemental records. Use the Provider Portal’s Copy and Resubmission features to carry forward previously submitted documentation while adding any new or updated records, as needed. Including all relevant documentation with each resubmission helps support timely review and determination.

Questions or Support

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

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