Sunknowledge Inc. Emerges As The Strategic Pillar For Providers Navigating The New CMS Wiser Model

(MENAFN- EIN Presswire) EINPresswire/ -- The healthcare landscape is bracing for one of the most significant shifts in Medicare history. With the recent announcement of the Wasteful and Inappropriate Service Reduction (WISeR) Model, the Centers for Medicare & Medicaid Services (CMS) is introducing AI-driven prior authorization to traditional Fee-for-Service Medicare. For providers in trial states like Ohio, Texas, and Arizona it is a new administrative hurdle. In view of this, SunKnowledge Inc., a global leader in Revenue Cycle Management (RCM), has announced a comprehensive suite of services designed to turn this regulatory challenge into an operational advantage.

The WISeR Model, scheduled to run from January 1, 2026, through 2031, leverages Artificial Intelligence (AI) and Machine Learning (ML) to scrutinize services historically vulnerable to waste, fraud, and abuse. For the first time, traditional Medicare providers will face rigorous, tech-driven prior authorization requirements for procedures ranging from spinal injections and nerve stimulators to orthopedic surgeries. And SunKnowledge is poised to provide the support these providers need.

SunKnowledge - Bridging the Gap between AI and Patient Care

While the WISeR Model aims to protect taxpayers and ensure evidence-based care, it introduces a "denial-centric" risk into the provider workflow. Technology companies participating in the model are incentivized to reduce Medicare spending, often leading to increased administrative friction for medical practices.

"At SunKnowledge, we don't just see this as a compliance hurdle; we see it as an opportunity for providers to fortify their revenue cycles. Our role is to ensure that while Medicare uses AI to evaluate claims, providers have a human-expert powerhouse ensuring every submission is clinically sound, accurately coded, and positioned for immediate approval," stated Ronnie Hastings, the spokesperson of SunKnowledge about the WISeR model.

Unmatched Expertise Across 30+ Specialties

SunKnowledge distinguishes itself as a premier solution by offering specialized prior authorization services for over 30 medical specialties; starting from DME, HME, cardiology, dental, infusion and many more. Whether it is Cardiology, Durable Medical Equipment (DME), Orthopedics, Pain Management, or Home Health, SunKnowledge employs dedicated subject matter experts who understand the nuanced clinical guidelines of each field.

In the context of the WISeR Model, which targets specific high-value services like percutaneous vertebral augmentation and knee arthroscopy, SunKnowledge's deep expertise not only ensures that the "medical necessity" required by CMS AI systems is clearly demonstrated in the initial documentation, but further ensures faster PA approvals.

The SunKnowledge Advantage

Being in the industry for close to two decades and widely regarded as a provider of best-in-class solutions, the SunKnowledge value proposition is built on three pillars:

High Accuracy and Low Denials: With a proven 97% authorization approval rate, SunKnowledge experts eliminate the guesswork. The team conducts a meticulous "pre-submission" audit, ensuring that ICD-10 and CPT codes are aligned perfectly with the latest Medicare National and Local Coverage Determinations (NCDs/LCDs).

Unbeatable Cost-Efficiency: In an era of rising overhead, SunKnowledge offers its legendary prior authorization support at just $7 per hour. This rate allows practices to scale their administrative capacity in a highly economical and sustainable manner, without the burden of hiring and training in-house staff.

Real-Time Turnaround: The WISeR Model requires rapid responses to avoid care delays. SunKnowledge guarantees 100% same-day submission and proactive follow-ups with payers, effectively neutralizing the risk of treatment abandonment.

Solving the "Gold Card" Challenge

The WISeR Model includes provisions for a "gold card" exemption for providers who demonstrate consistent compliance. SunKnowledge's rigorous documentation standards are designed to help practices achieve this elite status, exempting them from future reviews and significantly reducing long-term administrative stress. Known for their efficient revenue cycle management solutions, SunKnowledge today is among the best-known names in business process outsourcing for all kinds of prior authorization challenges and struggles.

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