Supporting appropriate care through technology and clinical expertise

The WISeR Model is a CMS program designed to reduce wasteful, inappropriate, or low-value services by introducing enhanced prior authorization and medical review processes for selected procedures. The model evaluates whether services meet existing Medicare medical necessity criteria before payment or service delivery. WISeR does not change Medicare coverage rules.

The model applies only to beneficiaries enrolled in Original Medicare Parts A and B. It does not apply to Medicare Advantage plans.

Zyter|TruCare is a CMS model participant responsible for performing prior authorization and medical review for procedures included in the WISeR model. Providers can submit requests through the Zyter|TruCare ProAuth provider portal, which supports the submission, tracking, and documentation of authorization requests.

Providers may submit prior authorization requests through the Zyter|TruCare ProAuth provider portal, which is the preferred submission method. Requests may also be submitted through the Medicare Administrative Contractor (MAC), if needed.

Affirmed prior authorizations are valid for 120 days for the number of units requested.

Requests should include clinical documentation supporting medical necessity for the requested service. Examples may include:

• Provider clinical notes
• Imaging results
• Diagnostic testing
• Relevant patient history

Complete documentation at the time of submission can help support efficient review.

No. Artificial intelligence tools are used to help organize clinical information and support workflow efficiency. All coverage determinations are made by licensed clinicians applying Medicare coverage criteria.

For detailed operational guidance, program documentation, and Medicare policy resources, providers may reference the following materials: 

• WISeR Provider/Supplier Guide: The best starting point for WISeR implementation details is the CMS Provider/Supplier Guide, which outlines the program requirements and operational processes.
• WISeR Program Overview: General information about WISeR.
• WISeR Model listserv: Subscribe to the WISeR Model listserv to receive email updates on the program directly.
• WISeR program team: You can also reach out to the WISeR program team at WISeR@cms.hhs.gov with specific questions.