Applicability
Work through geography, Medicare program, service, setting, timing, and exclusions without assuming a case is in scope.
Check WISeR applicability factors →Independent CMS WISeR education
The WISeR resource hub
A practical, source-linked guide to where the model applies, which services are selected, how the two review paths differ, and what providers and suppliers should prepare.
Authority and independence. Current CMS publications and instructions from the assigned official WISeR participant control if this site conflicts with them. WISeRly is independent, not CMS-affiliated or CMS-endorsed, and is not an official WISeR participant. It does not issue determinations or guarantee authorization, coverage, payment, timing, or outcomes.
Start with the official record
This cluster summarizes operational concepts; it is not a substitute for the controlling material. Verify the service, code, date of service, state, setting, beneficiary status, exemptions, and assigned participant using current official instructions.
- CMS WISeR model page — model overview, official updates, materials, and contacts.
- CMS WISeR Provider and Supplier Guide (PDF) — Version 7.0, updated July 24, 2026.
Technology is not the decision-maker. Enhanced technology, including AI-assisted review, can help surface information or support review. It is distinct from human clinical determinations. Follow official participant channels; qualified human reviewers remain responsible for determinations under CMS requirements.
Core WISeR guides
Selected services
Understand why the current official service list and code-level participant instructions must be checked for each case.
Review selected-service guidance →Documentation readiness
Build a consistent, legible evidence packet tied to the service and applicable Medicare requirements.
Use the readiness checklist →Prior authorization vs. pre-payment
Compare the two routes, their timing, and the operational consequences of performing a service before review.
Compare review pathways →Timelines
Plan from the deadline communicated by the official participant, not from a generic or assumed turnaround.
Build a timeline plan →Outcomes and next steps
Route affirmation, non-affirmation, and other notices according to their exact official wording.
Understand outcome handling →Exemptions and exceptions
Verify rather than infer whether an exemption, exclusion, or special handling rule applies.
Review exemption controls →Participant handoff
Prepare a clean operational handoff while preserving the official participant as the submission and status authority.
Prepare a participant handoff →State-specific starting points
State pages organize the same federal model questions around location. They do not identify a participant for a particular case; confirm current assignments and instructions on official channels.
Arizona
WISeR in Arizona →New Jersey
WISeR in New Jersey →Ohio
WISeR in Ohio →Oklahoma
WISeR in Oklahoma →Texas
WISeR in Texas →Washington
WISeR in Washington →A safe preparation sequence
- Confirm applicability against current CMS and official participant instructions.
- Confirm the selected service and code details for the relevant date.
- Identify whether prior authorization or pre-payment review is the applicable path.
- Assemble relevant documentation; do not add unsupported facts or alter the clinical record.
- Submit and obtain status only through the official participant’s stated channel.
- Record the official notice verbatim, preserve provenance, and route next actions to qualified staff.
Synthetic/no-PHI boundary: public WISeRly demos and resource workflows are for synthetic demonstration information only. Do not place names, identifiers, clinical records, claims, or other PHI in public forms or ungated product areas.
Frequently asked questions
Is WISeRly part of CMS or an official participant?
No. WISeRly is an independent preparation platform. CMS and official participant instructions control.
Does a readiness result predict approval?
No. A preparation result only identifies organizational considerations. It is not a coverage or payment decision and carries no outcome guarantee.
Can AI make a WISeR clinical determination?
WISeRly does not make any determination. Enhanced technology or AI assistance must not be confused with the human clinical determination made through official review processes.
Explore a synthetic preparation workflow
See how WISeRly organizes sources, gaps, and handoff steps without sending a case to CMS or a participant.
View the synthetic platform demoContact WISeRly without PHI