Does WISeR change Medicare coverage?

No. WISeR uses existing Medicare coverage policies; it's about how reviews happen, not what is covered.

How do I contact someone with additional questions?

Email wiserhelpdesk@genzeon.one or visit the portal page at portal.hip.one.

Is participation optional for providers?

WISeR is a voluntary model for vendors and MAC operations, but prior authorization is required for included services furnished in pilot states.

How do providers submit prior authorization requests for WISeR model services?

Providers submit PA requests to Genzeon Platforms or Novitas via the Genzeon Platforms portal at portal.hip.one, Novitasphere, by fax at (484) 200-2155, or by mail to Genzeon Corporation, 256 Eagleview Blvd, Suite 509, Exton, PA 19341.

Can a third party submit a prior authorization request on behalf of a provider?

Yes, a third party can submit a prior authorization request on behalf of the provider or facility, provided the third party has access to the necessary information to submit a complete request.

Can multiple CPT codes be submitted on one prior authorization request?

All procedure codes within the same category that require prior authorization for the same beneficiary must be filed on a single claim and listed on the coversheet for review. The categories and codes are available in Appendix A of the CMS WISeR Provider and Supplier Operational Guide.

Where can I find additional FAQs?

A full list of FAQs is maintained on the WISeR portal page at portal.hip.one/blog/faq-wiser-model.

← Back to WISeR Provider Portal

WISeR fax & mail coversheets

Coversheets for fax and mail submissions.

Two coversheets cover the entire WISeR program: Part A for Hospital Outpatient Departments and Part B for ASC, physician’s office, and home settings. Both apply across all WISeR service categories — you do not need a separate coversheet per service category.

BEFORE YOU REACH FOR THE FAX

The portal is faster — and it prevents dismissals.

The HIP One Provider Portal validates required fields at submission, auto-populates the coversheet from your entered data, and reaches a determination faster than fax or mail. Faxed coversheets that are incomplete or illegible are returned undeterminated — the portal catches those errors before they leave your facility.

Open portal.hip.one → Or register an account →

If you must submit by fax or mail

Download one of two coversheets.

Pick by claim type. The coversheet you choose stays the same regardless of which WISeR service category your case falls under.

A

MEDICARE PART A

Hospital Outpatient Department

Use this coversheet for institutional claims billed on UB-04 with bill type 13x. On-campus and off-campus HOPD facilities enter their CCN.

Place of service: HOPD (on-campus or off-campus)
Identifier: Facility CCN
Bill type: 13x

Download Part A coversheet (PDF)

B

MEDICARE PART B

ASC, Physician’s Office, Home

Use this coversheet for professional claims billed on CMS-1500. ASCs, physician’s offices, and home settings enter their PTAN.

Place of service: ASC, office, home
Identifier: PTAN
Claim form: CMS-1500

Download Part B coversheet (PDF)

Alternate channel: If you submit through Novitasphere, use the Novitas WISeR coversheet instead. Novitas-submitted requests are automatically forwarded to Genzeon Platforms for processing. Novitas JL portal →

What’s in scope

WISeR service categories — for reference.

The WISeR Model covers thirteen low-value medical services in four groups. The same Part A or Part B coversheet applies regardless of category — just enter the appropriate procedure code on the form.

Nerve stimulation services

Electrical Nerve Stimulators (SCS, PNS)

Spinal cord and peripheral nerve stimulators
Vagus Nerve Stimulation (VNS)

Implantable VNS
Phrenic Nerve Stimulators

Implantable phrenic nerve stimulation for central sleep apnea
Sacral Nerve Stimulation (SNS)

For urinary incontinence
Hypoglossal Nerve Stimulation (HGNS)

For obstructive sleep apnea
Induced Lesions of Nerve Tracts

Selected nerve-tract ablation procedures

Pain and spine services

Epidural Steroid Injections

For chronic intractable pain management
Percutaneous Vertebral Augmentation

Vertebroplasty and kyphoplasty for VCF
Cervical Fusion

Including with disc removal

Skin and tissue substitutes

Bioengineered Skin Substitutes / CTPs

For lower-extremity chronic wounds

Other services

Incontinence Control Devices

Implanted artificial urinary sphincters and related devices
Diagnosis and Treatment of Impotence

Penile prostheses
Arthroscopic Lavage / Debridement

For osteoarthritic knee

For complete details including CPT/HCPCS codes and NCD/LCD basis, see the Appendix of the CMS WISeR Model Provider Supplier Operational Guide, or download the Portal User Guide (PDF).

If you need help

Where to submit and how to reach us.

HELP DESK

[email protected]

(484) 713-9291

Business hours: Monday-Friday 8 AM-6 PM ET. Submission questions, coversheet format issues, login support.

FAX SUBMISSIONS

(484) 200-2155

Place the Part A or Part B coversheet on top. Include all required clinical documentation per WISeR Provider Guide v5.0 §3.2. One coversheet per request.

MAIL SUBMISSIONS

Genzeon Corporation
256 Eagleview Blvd, Suite 509
Exton, PA 19341

Place the Part A or Part B coversheet as the cover page. Mail may take longer than fax or portal.

NOVITASPHERE

Submitted via Novitas with the Novitas WISeR coversheet. Automatically forwarded to Genzeon Platforms for processing.

Novitas JL portal →

Required-elements note: A WISeR Model prior authorization request requires specific elements to be present on the submission. Incomplete or illegible requests are returned undeterminated. To avoid dismissals due to incomplete or unreadable handwritten coversheets, submitters are highly encouraged to use the Genzeon Platforms portal or the Novitas portal. See Section 3.2 of the WISeR Provider/Supplier Operational Guide.