The WISeR Model Is Here: What Providers in Select MAC Jurisdictions Need to Know

The WISeR Model Is Here: What Providers Need to
Know
CMS is rolling out the Wasteful and Inappropriate Service Reduction (WISeR) Model, impacting
providers in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Practices in these states
should prepare for increased front-end review of certain Medicare services.
What Is the WISeR Model?
The WISeR Model focuses on reducing improper Medicare payments by shifting review earlier in the
billing process. This may include prior authorization, pre-claim review, and enhanced documentation
requirements.
WISeR Jurisdictions and MAC Coverage
New Jersey (Novitas JL), Ohio (CGS J15), Oklahoma and Texas (Novitas JH), and Arizona and
Washington (Noridian JF) are participating jurisdictions.
Suggested Actions
Review high-risk services, strengthen documentation, educate staff, and prepare workflows for
additional review. Contact Practice Advantage for support at every step.
Frequently Asked Questions
WISeR does not apply to all services, but affected claims may experience delays. Practice Advantage
can help identify risks, improve documentation, and assist with appeals.
Final Takeaway
Preparation is essential. Practice Advantage is ready to help your organization navigate WISeR, protect
revenue, and remain compliant.