Prepare the request. Respond to the decision. Protect the record.
Enter facts about the service only — no names, Medicare numbers, birth dates, or patient notes.
Which WISeR service are you working on?
About the service
Your state helps us check whether WISeR applies where the service will be performed.
The setting where the service will be performed.
WISeR prior authorization applies to dates of service on or after January 15, 2026.
WISeR applies to Original Medicare. Medicare Advantage plans handle prior authorization separately.
About the decision
WISeR decision notices usually cite a CMS reason code beginning with “WM”.
About this report
TinyDocx WAC is one evidence tool with two workflows: preparing a prior-authorization request, and responding to a non-affirmation or denied claim. Checklist content comes from the cited Medicare documents.
In the print window, turn off “Headers and footers” for a clean page.
Fill in when CMS gives the information. Optional; this prototype does not save it.