Providers

Frequently Asked Questions

Getting Started & Provider Enrollment

What is WISeR?

WISeR is a Centers for Medicare & Medicaid Services (CMS) Innovation Center model that aims to improve care quality while reducing unnecessary or unsupported services in Medicare Fee-for-Service (FFS) through AI-enabled prior authorization and pre-payment medical review. The model leverages enhanced technology to streamline the prior authorization process for a specific list of items and services, with a goal of promoting high-value, evidence-based care.

Which technology vendor is participating in WISeR for Oklahoma?

Humata Health is the designated WISeR Model Participant for Oklahoma, leading efforts to support Medicare providers with prior authorization and pre-payment medical review. As a physician-led company, Humata Health is solely focused on solving the complexities of prior authorization. By seamlessly connecting payers and providers, we leverage deep clinical expertise and advanced AI to streamline approvals, reduce administrative burden, and ensure patients receive timely care.

When and where will WISeR be implemented?

The WISeR model is set to run for six performance years, spanning from January 1, 2026, to December 31, 2031. It will be implemented in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Providers can begin submitting prior authorizations on January 5, 2026.

Which Medicare beneficiaries does WISeR include?

The WISeR model applies to Medicare fee-for-service beneficiaries who are eligible for Medicare Part A and enrolled in Medicare Part B at the time of the prior authorization request or on the date of service for the claim subject to pre-payment review and:

Aged 18 years or older
Not enrolled in Medicare Advantage
Have Medicare as the primary payer
Not covered under the United Mine Worker Health and Retirement Funds

Do providers need to create an account prior to prior authorization portal submission?

Yes. Provider registration is required to create an account before submitting prior authorization requests through the Humata Health submission portal the WISeR Model. More information will be available on the Humata Health website on December 12th.

Which services are impacted?

A current list of the included services for the WISeR model are available on the CMS WISeR Model Overview web page.

Which places of service are impacted?

The WISeR model applies to providers billing to Part B claims with a place of service (POS) office (11), home (12), off campus-outpatient hospital (19), on campus-outpatient hospital (22), ambulatory surgical center (24), and Part A outpatient claims with type of bill (TOB) 13X.

The model excludes inpatient-only services, emergency services, and services that would pose a substantial risk to patients if delayed. However, a provider or supplier may request an expedited review, if needed.

Will WISeR change Medicare coverage or payment rules?

No. WISeR does not alter existing Medicare FFS coverage, payment, or appeals policies — it enhances review efficiency, transparency, and decision accuracy.

Will there be education sessions?

Yes. Joint provider education sessions with Novitas are planned in December 2025. Dates, registration links, and materials will be posted on the Novitas web page.

Where can I learn more about the WISeR model and the services included?

You can learn more on the Humata Health website starting December 12th, as well as through the CMS WISeR Model Overview and Novitas Solutions WISeR Resources web pages.

Submissions, Authorizations and Workflow

What is the recommended submission channel?

The Humata WISeR Portal (account creation will begin mid December, 2025 and portal submissions will begin January 5th, 2026) is recommended for the best provider experience. The portal will allow prior authorization submissions, relevant criteria visualization with a list of clinical information needed for review, and a dashboard with PA status and determination letters.

Future integrations with providers will enable near-instant decisions for prior authorization with a significant reduction in administrative burden. If you are a provider in Oklahoma impacted by WISeR, let us know if you would be interested in additional discussions around integration opportunities to streamline the process.

How does WISeR impact my workflow?

Option 1 – Prior Authorization (recommended)

Submit through the Humata WISeR Portal (or approved Medicare channels such as Novitas MAC portal, fax, or mail).
Determinations are typically issued within three business days (two if expedited).
Outcomes include Provisional Affirmation (valid 120 days) or Non-Affirmation (with resubmission guidance).

Option 2 – Pre-Payment Medical Review (default if no prior authorization)

Provider submits claim to the MAC post service. The claim will be suspended for clinician review prior to payment, increasing cycle time and administrative effort. The provider has 45 days to respond to the ADR letter request for clinicals.
Standard Medicare claim and appeals processes apply through the MAC.

Decisions, Resubmissions & Appeals

Can I resubmit a prior authorization and how can a provider appeal a decision?

Yes. Providers may resubmit within 120 days of the original decision.

For a “non-affirmed” prior authorization request — meaning that a future service was found not to meet Medicare coverage, coding or payment requirements — the provider/supplier has unlimited opportunities to resubmit a request. A non-affirmed decision does not prevent the provider/supplier from delivering the service and submitting a claim. Submission of such a claim and denial by the MAC will constitute an initial payment determination, which would be subject to the existing administrative appeals processes available to providers, suppliers and people with Medicare.

Is a resubmission considered a new prior authorization request?

An initial prior authorization request is the first submission sent to the WISeR participant for review and decision. If that request is non-affirmed, the provider may submit a subsequent request (also called a resubmission) with additional or updated documentation to address the errors or omissions identified during the initial review.

If the clinical information changes from the original request, it is considered a new prior authorization submission rather than a resubmission.

Who do I contact if I have questions related to the Humata portal or clinical review
process?

For clinical inquiries, please email the following: wiser@humatahealth.com and for general and technical support, please email the following: wiser.support@humatahealth.com.

About Humata Health, Inc. and a word from Jeremy Friese, MD, Founder and CEO

Humata Health is the leader in AI-powered, touchless prior authorizations. A health tech company “Built for Yes,” its mission is to make prior authorization easy and seamless for providers, payers and the patients they serve. With the industry’s largest ecosystem of integrations and proprietary technology that gathers the right clinical information required for fast approval, the Humata platform is the only truly end-to-end prior authorization solution for all services and procedures. Humata is a physician-led company that is backed by a syndicate of strategic healthcare investors including Blue Venture Fund, LRVHealth, 406 Ventures, and Highmark Ventures.

Humata’s core mission is to ensure that every patient receives the right care as quickly as possible. We feel a profound responsibility to prove that this can be done the right way,” said Jeremy Friese, MD, Founder and CEO of Humata Health. “We look forward to partnering with CMS and medical providers across Oklahoma to leverage our technology to help ensure that every patient journey is one of transparency, speed and safety. This is a defining opportunity to set a new standard — one where technology finally brings physicians and payers together — for the good of the patient.

Oklahoma Provider Resources

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Frequently Asked Questions