Rule
Identify the exact current exemption, exclusion, transition, or special-handling provision and authoritative URL.
Exception control
CMS WISeR exemptions and exclusions
Verify the rule, effective date, and actual case facts. Never extend special handling by analogy.
Only CMS and applicable official participant instructions can establish the controlling treatment. WISeRly is independent, not CMS-affiliated or endorsed, not an official participant, does not issue determinations, and does not guarantee authorization or payment.
Verification record
Facts
Document which required facts are present, who validated them, and which source record supports each fact.
Time
Record effective and expiration dates, case/service date, source retrieval date, and any revalidation requirement.
Guardrails
- Do not treat a participant conversation as a durable exemption unless official instructions support that status.
- Do not reuse an exemption from another location, provider, supplier, beneficiary, code, or date.
- Do not label an uncertain case “exempt”; escalate for official clarification.
- Keep exemption status separate from ultimate coverage and payment requirements.
AI-assisted review may compare facts with a rule, but cannot confer an exemption or replace a human clinical or official determination. WISeRly has no authority over scope.
Full applicability check · Selected-service verification · Official clarification handoff
Official sources
CMS WISeR model page · CMS Provider and Supplier Guide v7.0 (PDF)
Synthetic/no-PHI boundary: use fictional facts in public WISeRly tools. Do not submit patient, clinical, claim, or other protected health information.