WISeR Model 

September WISeR Updates: UTN Guidance, Portal Enhancements, and ADR Routing Simplified

As the WISeR participant for Washington State, we often hear one common question: How do you determine whether a WISeR request requires a Part A or Part B UTN? The appropriate UTN type is driven by the site of service where the procedure will be performed.

For quick reference, hospital outpatient services billed on a UB-04 require a Part A UTN, while professional services billed on a CMS-1500 form need a Part B UTN. As an added tip: you physicians and providers can check the UTN itself—if the third position is an “A,” it’s for Part A; if it’s a “B,” it’s for Part B.

Technology Updates 

Alongside these guidelines, several recent WISeR Provider Portal enhancements have been introduced to streamline your workflow.

Faster Case Creation, Fewer Errors

The case creation experience is now consolidated onto a single page, which significantly reduces time spent scrolling and clicking. Real-time validation features have also been implemented for key fields (including Member Beneficiary ID, Facility and Provider NPI/PTAN, and Procedure/Diagnosis combinations), so any discrepancies are flagged instantly. The result: fewer cases created with invalid information, and a smoother path toward getting a timely medical necessity determination.

Better Visibility Into Your Case History

In addition to improved case entry, tracking and managing submitted cases is now more efficient. The upgraded case history view offers advanced search capabilities, making it easier to locate specific cases. New data export capabilities also provide greater flexibility for reporting and record-keeping needs. These features are designed to give your team more control and visibility throughout the case management process.

Visit the WISeR Provider Portal to experience these new features.

Clinical Insights

It is also important to address recent questions about ADR correspondence routing. According to Noridian guidance, ADR routing is driven by information contained within Medicare enrollment records as follows:

• The Medical Records Correspondence Address on file is used when available
• If a Medical Records Correspondence Address is not designated, Part B ADRs may be sent to the Pay-To Address on file
• Address information is driven by Medicare enrollment records maintained through PECOS

Ensuring your organization’s Medicare enrollment information is current will help prevent misrouted correspondence.

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.