May 6, 2026
WISeR Model
Your WISeR Questions, Answered
Documentation requirements, portal workflows, and turnaround times have created real friction for Washington physicians and providers — and we are here to help.
Virtix Health will be hosting a physician and provider-focused webinar on Wednesday, May 27. During this session, we’ll walk you through the prior authorization workflow, clarify what documentation is required and why, and take your questions live.
WISeR in Practice: What Washington Physicians and Providers Need to Know
Wednesday, May 27, 2026 at 12:00 PM PST
PRESENTED BY
Virtix Health
Representatives from Noridian, WSHA, and WSMA will be available to answer questions.
Additionally, we’ve received several questions about the program, including how it works, our role, and what physicians and providers need to know. To make things easier, we’re sharing helpful information, key updates, and valuable clinical insights, so you have the information your organization needs, right at your fingertips.
Program Announcements
In coordination with CMS, we plan to debut the WISeR Gold Card Exemption Program on July 6. Under the initiative, physicians and providers who consistently meet coverage criteria by achieving a certain affirmation threshold associated with their prior authorization requests will generally be exempt from any additional prior authorization and pre-payment review processes for the selected items and services in WISeR. See how it works, methodology, and key dates to remember via the Gold Card Exemption Program Fact Sheet.
Technology Updates
We’re excited to announce that we are finalizing a new portal feature that will maintain data security while providing flexibility to portal users and requestors to share or assign cases to others within your organization. We are finalizing testing of the functionality and anticipate this will be made available to all physicians and providers by mid-May.
Clinical Insights
Physicians and providers continue to do an excellent job with ESI documentation, and we’ve appreciated the thoughtful peer-to-peer discussions across cases. This dialog fosters transparency and quality. When gaps do occur, they are often consistent and correctable.
Two of the most common areas we’re seeing relate to conservative therapy:
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Guidelines typically expect at least four weeks of conservative management prior to intervention.
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WISeR guidelines emphasize the importance of an active home exercise program or equivalent, not just a prescription but documentation of patient participation and response.
In your notes, be sure to clearly outline the type of therapy performed, duration, adherence, and clinical response, along with the rationale for escalation to injection. Clear, specific documentation supports medical necessity and helps avoid unnecessary delays.
Next Steps
To support Washington State physicians, providers, and the communities that we serve, we are continuously updating our resource library with FAQs, program statements, patient guides, and much more. Visit the Virtix Health website to access these materials and stay informed.
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.
