Fantastic! I got my DME exemption effective July 1st. I will have to look for this. I haven’t had very many denials that stood up through p2p with wiser.
I got a WISER exemption too
Hello!
We are pleased to inform you that you have been identified as a high-performing provider under the CMS Wasteful and Inappropriate Service Reduction (WISeR) Model. Based on your prior authorization history during the program’s initial assessment period, you have met the criteria for exemption under the WISeR Exemption Program.
What This Means for You
Effective July 6, 2026, you are exempt from prior authorization requirements and pre-payment review for all WISeR Select Items and Services. You do not need to submit prior authorization requests or obtain a Unique Tracking Number (UTN) before providing covered services. Simply continue submitting claims through your normal process.
Your Eligibility
Exemption status was awarded based on review of your authorization submissions from February 1 through May 4, 2026. To qualify, providers were required to meet all of the following criteria:
At least 10 prior authorization submissions for WISeR Select Items and Services
A prior authorization affirmation rate of 90% or higher
No active exclusion under the CMS Medicare Exclusion List or the OIG List of Excluded Individuals/Entities
Duration of Exemption Status
Your exemption is effective for a minimum of one year beginning July 6, 2026. Exemption status will be evaluated on an ongoing basis. If your status changes at any future evaluation, you will receive written notice at least 60 days before any change takes effect.
What to Expect During Your Exemption Period
As a standard CMS program requirement, Cohere may send you up to 10 Additional Documentation Requests (ADRs) as part of a routine post-payment compliance review during your exemption year. This is not a reflection of any concern about your billing practices—it is a standard element of the WISeR program that applies to all exempt providers. You will receive further information about this process later in 2026.
No Action Required
You do not need to contact us or take any steps to activate your exemption. It will take effect automatically on July 6, 2026. If you have questions, please contact Cohere Health’s Provider Support team at (855) 430-6299 or via email
[email protected].
Thank you for your commitment to delivering high-quality, medically appropriate care to Medicare beneficiaries in Texas. This recognition reflects the standard of practice you have consistently demonstrated.
Sincerely,
The Provider Success Team
Cohere Health
This notice is issued pursuant to requirements of the CMS Wasteful and Inappropriate Service Reduction (WISeR) Model under the Center for Medicare and Medicaid Innovation (CMMI). Cohere Health is a WISeR Model Participant authorized to administer exemptions on behalf of CMS.
