Medicare’s prior authorization pilot program is delivering on its promise for gold-card exemptions, as Texas physicians meeting certain criteria will be able to bypass the preapproval process starting on Monday, July 6.
The Wasteful and Inappropriate Service Reduction (WISeR) Model program, administered in Texas by Cohere Health through the end of 2031, is designed to reduce what the Centers for Medicare & Medicaid Services (CMS) identifies as “unnecessary or inappropriate services with little to no clinical benefit,” per its fact sheet.
Section 5 of the WISeR Model Provider and Supplier Operational Guide outlines the criteria for exemptions from the mandatory prior authorization process, more commonly known as “gold carding.”
Cohere recently informed the Texas Medical Association how it plans to implement the process for Texas physicians. It has provided an updated FAQ page.
“Gold carding is a TMA initiative and became a law in Texas,” said TMA Immediate Past President Jayesh “Jay” Shah, MD, referring to TMA-backed legislation passed in 2021 and amended in 2025, directed at alleviating prior auth burden for physicians in certain state-regulated plans. “We are hoping that this WISeR gold carding would be something that would be really helpful to decrease the hassle [for physicians].”
Cohere informed TMA that to meet the gold card criteria, physicians must:
- Have submitted at least 10 WISeR prior authorization submissions (not counting pre-payment reviews);
- Have an approval rate of at least 90%; and
- Not appear on the CMS Exclusion List or the Office of Inspector General List of Excluded Individuals/Entities.
“Physicians and their teams are contacted via email and notified via portal” of their gold-card status approval, a Cohere spokesperson said, adding that determinations are based on data that Cohere maintains. It does not have an application process available for physicians who believe they might be eligible.
Physicians receiving gold-card status will retain it for one year from the date obtained before being subject to a performance review to determine renewal.
Cohere also told TMA that physicians will be evaluated for gold-card eligibility on a quarterly basis, with the vendor coordinating with the Center for Medicare and Medicaid Innovation on a specific evaluation dates.
The spokesperson added that physicians with gold-card status will not need to submit prior authorization requests for any WISeR Select Items and Services for the duration of their status, and Cohere’s system will automatically identify and approve requests or claims coming from a gold-carded physician and push them through.
Learn more about WISeR by visiting TMA’s WISeR webpage.
Last Updated On
June 26, 2026
Originally Published On
June 26, 2026
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.