Wasteful and inappropriate service reduction (WISeR) model participant - Cohere Health

Who is Cohere?

Cohere Health is a clinical intelligence company with experience in improving health care decision-making for health plans and at-risk providers. Cohere Health will manage WISeR Program prior authorization (PA) requests in partnership with Novitas for the CMS WISeR Model for providers rendering select Medicare covered services in the state of Texas. The goal of this partnership is to streamline the prior authorization process for select services and enhance the quality of care through evidence-based care paths that support a patient's care journey.

Provider PA request submission options

Providers or suppliers in a designated state for the model who choose to submit a prior authorization request for covered services will send all relevant information to support Medicare coverage of the selected services either directly to the WISeR model participant for that state or to their MAC (Novitas), which will then route it to the model participant.

Novitas and Cohere Health will begin accepting submissions starting January 5, 2026, for dates of service January 15, 2026, and forward.

Cohere Health submission options - Portal

Cohere Health is offering a dedicated portal to Texas providers for PA request submission. Registering for the Cohere provider portal is the quickest and easiest way to submit and track requests.

The Cohere Health portal is a separate and distinct platform from Novitasphere.

Key benefits for providers:

Immediate confirmation of submission

Real-time status tracking

Faster turnaround times

Built-in alerts for missing documentation

Fewer delays

Reduced administrative burden

Direct routing to Cohere

Portal registration:

Registration is optional; however, it is available now to Texas providers rendering services applicable to the WISeR model. Before January 5, 2026, register with Cohere Health to access the web-based application for submitting prior authorizations.

Note: If you already use the Cohere Health portal for other health plans, you can continue logging in as usual.

Cohere Health Portal Registration link:

https://next.coherehealth.com/organization_onboarding

Access the portal:

Beginning January 5, 2026, you will be able to use the Cohere Health platform for submitting prior authorizations for dates of services January 15, 2026, and forward.

Cohere Health submission option - Fax

When faxing, utilize the fax coversheet and submit to (404) 835-8325. Cohere Health will begin accepting submissions starting January 5, 2026, for dates of services January 15, 2026, and forward.