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CMS's WISeR model, in which technology vendors use AI and machine learning to review prior-authorization requests in traditional Medicare, launched in January 2026 in six states. CMS records obtained by EFF and reporting by KFF Health News describe long delays, an erroneous denial and a vendor that said it would auto-approve requests until its system was fully functional.
Update pending. A scheduled fact-check found newer information on this topic. The entry is being reviewed for an update. How fact-checks work.
TierA supporting function (prior authorization and payment) was delayed or erroneous while clinical systems stayed up. How tiers are assigned.
WISeR is a CMS Innovation Center model running from 1 January 2026 to 31 December 2031 in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It uses 'enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML)', and CMS states that 'All recommendations for non-payment are determined by appropriately licensed clinicians.' Participants receive 'a percentage of the expenditures associated with averted wasteful, inappropriate care.' In June 2026 KFF Health News reported that CMS says decisions come back within 72 hours. It also reported claims payment delays of six to eight weeks described by an Oklahoma radiologist and a denial that cited thoracic procedures when the patient needed a neck injection. Citing an April report from Senator Maria Cantwell's office, it said nearly 100 University of Washington patients were waiting for epidurals. In September 2026 EFF published records obtained from CMS through a Freedom of Information Act lawsuit. According to EFF, one status report cites 'a prior authorization request that went unanswered for 83 days', and two companies denied 5,944 requests in the first three months, a figure EFF corrected from an earlier version. EFF reports that CMS required the vendor Virtix to submit a corrective action plan. Before launch, the vendor Innovaccer said it would auto-affirm all requests until it had full functionality: 'Given CMS's decision not to delay the model start date, auto-affirming is the only path available.' EFF quotes provider complaints in the records, including 'We have patients calling our offices crying in pain because their procedures are being delayed.' EFF notes that reported turnaround times 'are not solely controlled by WISeR vendors.' STAT reported that one vendor told CMS it was 'unrealistic to expect a working product' by the planned launch. CMMI director Abe Sutton told KFF Health News that 'The model aims to reduce inappropriate care without delaying appropriate care.' Vendors told KFF that humans make the final decisions.[1,2,3,4]
No physical harm established by an official finding. Provider complaints in CMS records describe patients in pain and surgeries cancelled during waits (EFF), and nearly 100 patients at one health system waited for epidurals (KFF Health News, citing Sen. Cantwell's office).
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