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Preparing for the WISeR Model requires converting CMS’s 61-page manual into clear operational steps. The model introduces defined service lists, documentation expectations, and claims requirements, all of which need to be reflected in internal workflows before the program begins.

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1.    Identify in-scope codes and diagnoses

WISeR applies only to specific combinations ofCPT/HCPCS codes, ICD-10 diagnoses, and approved places of service. Providers can begin by:

●     Reviewing WISeR code appendix

●     Flagging affected services within your EHR

●     Using alerts or internal logic to identify WISeR orders at entry

This ensures services subject to WISeR requirements are recognized early in the process.

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2.    Define your submission pathway

CMS provides two participation options:

●     Opt-in prior authorization -submitting PA before the service may result in an affirmed decision and aUnique Tracking Number (UTN).

●     Pre-payment medical review - if PA is not submitted, claims for WISeR services will be held for review, and documentation may be requested. Providers have 45 days to respond.

 The chosen pathway influences documentation timing, staffing needs, and claim workflows. Organizations benefit from deciding this early so processes can be aligned accordingly.

3.    Integrate billing from dayone

Billing teams play a central role in WISeRreadiness because UTNs must be included on applicable claims in the correctfields. To support this:

●     Define where UTNs are stored

●     Ensure UTNs are transmitted properly to billing

●     Identify who verifies UTN placement on claims

Incorrect or missing UTNs will result in denial.

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4.    Use automation to support documentation and review

WISeR requires documentation that aligns with existing NCD/LCD coverage criteria. Automated tools can help teams:

●     Reference coverage rules

●     Identify missing documentation

●     Monitor affirmation andnon-affirmation trends

These capabilities support consistent preparation and reduce manual workload.

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5.    Educate and test

Training clinical, coding, and billing staff on WISeR processes can reduce errors once the program begins. Running mock submissions and testing documentation workflows can help confirm readiness andhighlight areas that need adjustment before January 2026.

WISeR requires coordination across ordering, documentation, and billing teams. Developing structured workflows now can help organizations prepare for the operational requirements outlined inCMS’s manual.

Next: From Manual to Modern — Leveraging AI for WISeR Compliance.

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