Intake
Capture the furnishing location, beneficiary program, anticipated date, service and code, setting, ordering information, and urgency claimed—then validate each item.
State guide
CMS WISeR in New Jersey
Build a repeatable intake-to-notice process while keeping official CMS and participant instructions authoritative.
WISeRly is independent, not affiliated with or endorsed by CMS, and is not an official WISeR participant. It does not issue determinations or guarantee authorization or payment. CMS and official participant instructions control.
New Jersey operating checklist
Route
Determine from current official materials whether prior authorization, pre-payment review, an exclusion, or other handling applies. Never infer a route from a similar case.
Close the loop
Retain the official confirmation and notice, record the actual official outcome, and route any next step to qualified staff.
Documentation quality controls
- Include only records relevant to the selected service and current requirement.
- Reconcile dates, laterality, service description, and identifiers across documents.
- Do not manufacture missing evidence or overwrite the source record.
- Track requests for additional information using the deadline in the official notice.
AI boundary: enhanced technology/AI-assisted review can support information processing; it is not the human clinical determination. WISeRly only organizes preparation and makes no official decision.
Official sources
CMS WISeR model page · Provider and Supplier Guide v7.0 (PDF)
Synthetic/no-PHI boundary: do not submit patient names, identifiers, clinical documentation, claims, or other PHI to public WISeRly pages or demos.