Check Your WISeR Gold Card Exemption Status Today

The Wasteful and Inappropriate Service Reduction (WISeR) Gold Card Exemption Program is underway, offering eligible healthcare providers relief from some prior authorization requirements.

Earlier this year, CMS announced an automatic exemption process to reduce administrative burden for providers participating in the WISeR program. To qualify, providers must submit at least 10 prior authorization requests for WISeR-select items and services during the assessment period and achieve the required affirmation threshold. An affirmation means the request met Medicare requirements and was approved. Gold card status is made at the individual provider level and apply to all services and items subject to the WISeR program. Providers are evaluated on a quarterly basis; those who achieve exemption status will maintain that status for one year from the effective date of their exemption.

Providers with an average affirmation rate of 80% or higher should have received a notification from their designated WISeR participant, CMS-contracted health technology companies that manage prior authorization and prepayment reviews for the program.

Virtix Health LLC, the WISeR participant serving Washington state, shared a Gold Card Factsheet and posted the following key dates:

• Exemption period: Through July 5, 2027
• Claims Review period: Jan. 5 through April 30, 2026
• Next eligibility evaluation: Oct. 1

ACR^® encourages providers to contact their designated WISeR participant to confirm their Gold Card exemption status and discuss any questions about the program.

Not sure who your WISeR participant is? 

Providers should review any exemption notification received from their WISeR participant or visit the CMS WISeR Model webpage to identify the participant serving their state. 

For more information, contact Alicia Blakey, ACR Manager of Economic Policy.