CMMI Updates WISeR Model Provider, Supplier Operational Guide

The Center for Medicare and Medicaid Innovation (CMMI) released Version 4.0 of the WISeR (Wasteful and Inappropriate Service Reduction) Model Provider and Supplier Operational Guide, which features several important updates including refreshed contact information for participants and Medicare Administrative Contractors (MACs). WISeR participants are specialized health technology companies CMS contracts with to manage prior authorization and pre-payment reviews for often overused, high-risk Medicare services.

The revised guide clarifies provisional, partial affirmation and dismissal decision types and provides expanded guidance on exemptions. Appendices are reordered, now listing ICD 10 indications for relevant WISeR items and covering the WISeR Associated Codes List.

CMS and WISeR participants will introduce an automatic exemption process this year to reduce administrative burden for providers. To qualify for Exemption Status, a WISeR provider must submit at least 10 prior authorization requests for WISeR Select Items and Services during an exemption assessment period and meet the required affirmation threshold during that same period.

WISeR participants will publish additional exemption criteria details this spring, and begin issuing exemption status notifications in June.

ACR^® encourages WISeR providers to review the updated guide to ensure compliance with updated requirements and to understand changes that may affect claims processing.

For more information or if you have questions, contact Alicia Blakey, ACR Manager Economic Policy.