When can I begin submitting Medicare authorizations for WISeR patients?
When can I begin submitting Medicare authorizations for WISeR patients?
Cohere Health® will manage select prior authorizations in partnership with Novitas, the Medicare Administrative Contractor for Texas.
Beginning January 5, 2026, select prior authorizations should be submitted through the Cohere Health portal for services rendered January 15 and later. Starting January 15, all dates of services will be accepted.
Where can I find out which WISeR codes I should submit through Cohere?
Where can I find out which WISeR codes I should submit through Cohere?
You can view the prior authorization list (PAL) codes under management for WISeR prior authorizations here.
Is “Member ID” the same as “Medicare Beneficiary ID” when searching for a patient in the portal?
Is “Member ID” the same as “Medicare Beneficiary ID” when searching for a patient in the portal?
Yes. When searching for a patient, the portal will ask for and display Member ID. For WISeR submissions, you should enter the Medicare Beneficiary ID in the Member ID field.
Is a provider TIN required for WISeR submissions?
Is a provider TIN required for WISeR submissions?
WISeR Medicare submissions do not require you to enter a TIN in the provider details section.
When are PTAN and/or CCN fields required to include when completing provider details?
When are PTAN and/or CCN fields required to include when completing provider details?
For WISeR submissions, the ordering and performing provider fields will always require a PTAN.
Whether a PTAN or CCN is required for the Provider Facility field will vary by place of service:
Provider Facility Field | Place of Service | Required |
Provider Facility | On/Off campus - outpatient hospital | CCN required |
Provider Facility | Ambulatory Surgical Center | PTAN required |
Provider Facility | Home or Office | Neither required |
Is the language “approved” and “denied” the same as “affirmed” and “non-affirmed” in the portal?
Is the language “approved” and “denied” the same as “affirmed” and “non-affirmed” in the portal?
Yes. When filtering requests on the dashboard, you will see the options Approved and Denied. These labels are used only to help you filter and locate authorization requests.
For WISeR Medicare authorizations only, the actual determination language shown on the authorization itself will display as Affirmed or Non-affirmed.
Why am I still receiving paper notifications for WISeR authorizations even though I opted out of paper notifications?
Why am I still receiving paper notifications for WISeR authorizations even though I opted out of paper notifications?
For WISeR authorizations, notifications are required to be sent through the same channel in which the authorization request was submitted. If your WISeR request was submitted via paper, notifications must also be delivered by paper, even if you have opted out of mailed notifications for other submissions.
When “home” is selected for the Place of Service field, what provider facility do I include?
When “home” is selected for the Place of Service field, what provider facility do I include?
When the Place of Service = Home, the Provider Facility field represents the agency performing the service.
How long is an affirmed authorization valid?
How long is an affirmed authorization valid?
An affirmed authorization is valid for 120 days from the date that the decision was made to perform the service and submit the claim to Medicare (Novitas).
Services that are affirmed but not performed before the 120-day window expires will require a new prior authorization request.
What is a Unique Tracking ID (UTN) and where can I find it?
What is a Unique Tracking ID (UTN) and where can I find it?
A unique, 14-digit tracking number (UTN) is assigned for billing and provided in the decision letter. If you are requesting a resubmission on a non-affirmed authorization, please provide the UTN in your resubmission request.
What does “Pre-Payment: Pending Review” mean, and how do I find my request?
What does “Pre-Payment: Pending Review” mean, and how do I find my request?
If a request is under Pre-Payment Review, you will see a status of “Pre-Payment: Pending Review” on your request in the Cohere portal. This means that your claim was submitted without a prior authorization, so we have sent you an ADR letter outlining the specific clinical documentation needed to review your claim. The ADR letter that was sent to you can also be found attached to your request in the Cohere portal.
Please note: The only identifier that can be used to search for a request pending for pre payment review in the Cohere portal is the Cohere ID. This ID can be found in the ADR letter.
Why was my WISeR authorization dismissed before a UTN was created?
Why was my WISeR authorization dismissed before a UTN was created?
Some WISeR Medicare prior authorizations may be dismissed - even after an affirmation or non-affirmation determination is made - if a Unique Tracking Number (UTN) cannot be generated. These dismissals are administrative, not clinical, and are typically caused by provider or facility enrollment information that does not align correctly with Medicare’s enrollment information (PECOS).
To help prevent UTN dismissals, please verify the following before submitting:
Facility CCN accuracy:
For Part A authorizations, confirm that you have entered the correct CMS Certification Number (CCN) for the Facility based on its NPI
PTAN Accuracy
For Part B authorizations, confirm that you have entered the correct PTAN for the ASC Facility or the Ordering Provider based on its NPI.
Correct Medicare Administrative Contractor (MAC)
Verify that you are within Texas and are a part of Novitas's JH jurisdiction. If you are in another jurisdiction, please submit to the appropriate vendor: https://www.cms.gov/priorities/innovation/innovation-models/wiser
Facility type matches place of service
Confirm the facility selected reflects where the service is actually performed. If the service is being performed in an ASC, please ensure that the ASC is listed as the Facility (with its appropriate PTAN).
If your request was dismissed, we recommend verifying PECOS enrollment details before resubmitting to help avoid repeat dismissals and delays in processing.
How many procedure codes can I include in my Medicare - Novitas request?
How many procedure codes can I include in my Medicare - Novitas request?
Medicare - Novitas authorization requests are limited to no more than five (5) procedure codes per submission.
If the date of service (DOS) changes, do I need to submit a new authorization?
If the date of service (DOS) changes, do I need to submit a new authorization?
A Medicare - Novitas authorization is valid for the full date range listed on your affirmed authorization.
If the date of service changes, you do not need to submit a new authorization as long as the updated date falls within the approved date range on the affirmed authorization.
If the new DOS falls outside of the approved date range, you will need to submit a new authorization request.