CMS releases guide on prior authorization submissions, determinations under WISeR model
The Centers for Medicare & Medicaid Services has released an operational guide for Medicare-enrolled providers and suppliers on the Wasteful and Inappropriate Service Reduction model. It provides an overview of the prior authorization submissions and determinations procedures and details the pre-payment medical review processes for services delivered in states where the WISeR model is being implemented: New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.
Related News Articles
Headline
The Centers for Medicare & Medicaid Services Oct. 21 announced that it has instructed all Medicare Administrative Contractors to lift a hold and begin…
Headline
A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans…
Headline
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…
Headline
The federal government shutdown will continue as the Senate Oct. 3 failed to adopt a government funding deal. The latest attempt to pass the House-passed…
Headline
The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage…