How to Prepare Your Wound Care Clinic for WISeR: A Six-Month Readiness Checklist

The WISeR model goes live January 2026 in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. This is a practical readiness checklist for wound care clinics — not an explainer of the policy, but the operational work you need to finish in the months before go-live.

Step 1: Inventory your exposure

Pull last year's Part B billing and flag every claim tied to a WISeR-affected service. Skin substitutes are the highest-value line for most wound clinics. Sort by CPT/HCPCS, volume, and payer to see where a non-affirmation would hurt most.

Step 2: Map each service to its coverage criteria

For every affected code, print the applicable NCD and LCD. Reduce each policy to a checklist: wound type, measurements, duration, conservative care tried, vascular status, comorbidities. This becomes your documentation template.

Step 3: Rebuild your intake and visit workflow

• Add a prior-auth checkpoint to scheduling so affected services never get delivered without a decision
• Require wound measurements and photos at every visit
• Capture conservative care history at the first visit, not retroactively
• Assign a single owner per prior auth request

Step 4: Standardize patient-specific documentation

Reviewers reject templated notes. Every note on an affected service should name the wound, its exact dimensions, weeks present, treatments tried, and vascular status in the patient's own clinical context. AI SOAP notes for wound care and AI-powered wound imaging are designed to produce this kind of note by default.

Step 5: Submit a test batch and measure

Run 10–15 prior auth requests through the new workflow before January. Track affirmations, non-affirmations, and the specific reason cited on each denial. Fix the workflow, not just the individual claim.

Step 6: Track toward Gold Card

A sustained 90% affirmation rate across at least ten prior-auth requests earns a Gold Card exemption starting June 2026. Build a weekly dashboard that shows your rolling affirmation rate by service and by clinician.

For the full policy background, see the WoundScribe WISeR Program overview and the WISeR-compliant prior auth submission guide.