For WISeR participants
The licensed clinician
behind every non-affirmation.
Your platform screens the request. CMS requires that a human clinician with relevant clinical expertise review every non-affirmation, and that no denial be made solely by technology. We supply that clinician — specialty-matched, NPI-verified, named on the record — and the hash-anchored receipt your auditor can check without you.
Pre-go-live pilot. Sandbox for synthetic or de-identified requests; a BAA before any patient data.
The requirement, in CMS's words.
“All recommendations for non-payment are determined by appropriately licensed clinicians who will apply standardized, transparent and evidence-based procedures to their review.”
WISeR model page →“A human clinician with relevant clinical expertise for selected items and services must review every non-affirmation.”
WISeR FAQ →“Non-affirmations will require the review of a human clinician and cannot be performed solely by technology.”
WISeR FAQ →What we supply
- Relevant clinical expertise. Reviewers are matched to the item or service — skin substitutes, nerve stimulators, knee arthroscopy — and verified against the CMS NPPES registry. Outside a covered specialty the gate fails closed and says so.
- A named human on every non-affirmation. Affirm, revise, or decline with a documented rationale. The fee is identical either way, so the review is not paid to say no.
- A receipt for the audit. NPI, timestamp, and document hash, anchored on hashcare.com and countersigned daily. CMS audits participant determinations; this is the record that survives one without your cooperation.
- Capacity you do not have to hire. Volume arrives in waves and by specialty. A per-review fee means you pay for reviews, not for a bench.
The six participants
January 1, 2026 through December 31, 2031. Source: CMS.
| Cohere Health | Texas | JH Novitas |
| Genzeon | New Jersey | JL Novitas |
| Humata Health | Oklahoma | JH Novitas |
| Innovaccer | Ohio | J15 CGS |
| Virtix Health | Washington | JF Noridian |
| Zyter | TruCare | Arizona | JF Noridian |
Listed as published by CMS. Not an endorsement by or of any participant. Model page.
Straight answers
What exactly does CMS require of a WISeR participant on a denial?
CMS states that all recommendations for non-payment are determined by appropriately licensed clinicians, that a human clinician with relevant clinical expertise must review every non-affirmation, and that non-affirmations cannot be performed solely by technology. Determinations on complete standard requests are due within three calendar days.
CMS WISeR FAQ →Can HarnessHealth be that clinician?
HarnessHealth supplies specialty-matched, NPI-verified physicians who review, sign, revise, or decline with a documented rationale, and it produces the receipt. Whether an arrangement satisfies the model’s participation terms is your compliance team’s determination; we supply the reviewer and the record, and the gate fails closed outside a covered specialty.
How a pilot works →What does it cost and how does it start?
A flat fee per review, $12 to $100 by document class, the same whether the physician affirms or declines; the platform fee is flat per completed review and disclosed before you accept. Start in the sandbox with synthetic or de-identified requests today. Real requests wait for a Business Associate Agreement, which is offered to qualifying covered entities and has not yet been executed with anyone.
Run a sample in the sandbox →Run one of your de-identified cases through it.
Two minutes in the sandbox, then a five-field request. The founder reads every one.