Wednesday, November 18, 2026 | 1:00-2:00pm EDT
Prior authorization has arrived in Original Medicare. CMS’s WISeR Model, launched January 1, 2026 in six states, requires prior authorization or pre-payment review for selected outpatient services, administered by technology vendors that share in the savings from the services they deny. At the same time, CMS-0057-F imposes new decision deadlines and specific-denial-reason requirements on Medicare Advantage, Medicaid, CHIP, and Exchange plans. This practical webinar equips appeal professionals to navigate WISeR, track payer compliance with the new CMS clock, and build appeals that lead with missed deadlines and nonspecific denial reasons before arguing medical necessity, illustrated through two overturned case studies.
Upon completion of this activity, participants will be able to:
- Explain the WISeR Model’s participating states, covered outpatient services, prior authorization and pre-payment review pathways, and denial process.
- Identify CMS-0057-F prior authorization decision timeframes and specific denial reason requirements, and recognize when a payer has failed to meet them.
- Construct appeals that lead with a missed decision deadline or nonspecific denial reason before presenting the medical necessity argument.