The WISeR Model is a six-year CMS Innovation Center model designed to use enhanced technology, including artificial intelligence and machine learning, together with clinical review to evaluate certain Original Medicare services for medical necessity. The model began January 1, 2026, and operates in six states: Oklahoma, Washington, New Jersey, Ohio, Texas, and Arizona.
For laboratories and...
Anthem and UnitedHealthcare continue to apply detailed laboratory management and reimbursement requirements to molecular pathology and genetic testing claims. For Colorado laboratories, these requirements can affect prior authorization, medical necessity review, test identification, coding, and reimbursement. LBM updates are therefore more than an administrative issue; they can directly affect...
