What to Expect When Your Doctor Requests Prior Authorization
Starting January 5, 2026, Medicare patients in Washington state receiving certain procedures have the option to obtain prior authorization before care is scheduled. This is part of a federal program called the WISeR Model, administered in Washington by Virtix Health on behalf of the Centers for Medicare & Medicaid Services. While prior authorization is not required, obtaining it in advance can help ensure a smoother claims process. This guide explains what that means for you — and what to expect at every step.
Prior authorization is optional — but recommended. If your doctor has recommended a procedure covered under the WISeR program, they can request prior authorization on your behalf before scheduling. Doing so helps ensure your claim is reviewed in advance and can avoid payment delays for your provider.
How it Works
Step 1 — Your doctor submits the request
Your doctor or their office submits a prior authorization request that includes your medical history and documentation supporting the recommended procedure.
Step 2 — We review the request
Our team reviews the submitted documentation to confirm that the procedure meets established medical guidelines. Most requests are reviewed within one to three business days.
Many of these guidelines are established Medicare coverage criteria, not standards set by Virtix Health.
Step 3 — Virtix Health notifies your doctor
Once we have completed our review, your doctor will be notified of our determination regardless of the outcome. We also submit our decision to Noridian, Washington’s Medicare Administrative Contractor, to begin the final step. Once Virtix Health has issued its determination and submitted it to Noridian, our work is done. Any remaining steps, including UTN issuance and scheduling, are handled by Noridian and your doctor’s office. If additional information is needed, your doctor will receive clear guidance on next steps.
Step 4 — Noridian issues a Unique Tracking Number (UTN)
Before your procedure can be scheduled, Noridian issues a Unique Tracking Number, or UTN, that confirms Noridian has received and recorded the authorization. Your doctor’s office will contact you to schedule once the UTN has been received.
Scheduling cannot begin until Noridian issues the UTN. If you are waiting to hear about scheduling, your doctor’s office can check UTN status directly with Noridian at 1-877-908-8431.
What if more information is needed?
If the review requires additional documentation, your doctor will be notified and given the opportunity to provide more information or speak directly with one of our physicians. Our team will work with your doctor to gather everything needed — and we welcome your call if you have questions or want an update at any point in the process.
Questions? Know Who to Contact.
Prior Authorization Questions — Virtix Health
Phone: 833-943-2209
Email: wiser.support@virtixhealth.com
Claim or Payment Questions — Noridian
Phone: 1-877-908-8431
Email: PartApriorauth@noridian.com
WISeR Program Questions — CMS
WISeR Model Overview: cms.gov/priorities/innovation/innovation-models/wiser
WISeR Program FAQs: cms.gov/priorities/innovation/files/document/wiser-model-frequently-asked-questions
Virtix Health administers the WISeR prior authorization program in Washington state on behalf of the Centers for Medicare & Medicaid Services (CMS).
