Medicare’s WISeR AI Prior-Authorization Pilot Is Delaying and Denying Care, Records Show
Medicare’s WISeR pilot — which uses AI to approve or deny prior-authorization requests in traditional Medicare — has produced widespread denials, long delays, and technical failures since its January 2026 launch, according to roughly 1,000 pages of records the Electronic Frontier Foundation obtained through a Freedom of Information Act lawsuit. One contracted vendor denied more requests than it approved, and a single request went unanswered for 83 days despite CMS’s stated 72-hour standard. The six-state pilot (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) targets services such as skin substitutes and epidural steroid injections and runs through 2031. Records also show a vendor warned CMS that a working product was unrealistic by the launch date.
For providers in the six pilot states, WISeR reintroduces prior authorization into traditional Medicare — adding approval delays, administrative burden, and cash-flow risk to service lines that were previously unmanaged. Its denial-linked vendor payment structure signals how AI-driven utilization management could reshape reimbursement well beyond this experiment.
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Which services and states does Medicare’s WISeR prior-authorization pilot cover?
WISeR (Wasteful and Inappropriate Service Reduction) is a CMS Innovation Center pilot that uses AI to review prior-authorization requests in traditional Medicare. It runs from January 2026 through 2031 across six states — Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington — targeting about a dozen services considered vulnerable to waste, including skin and tissue substitutes and epidural steroid injections.
How badly has the WISeR AI pilot delayed care?
Newly released records show widespread delays beyond CMS’s stated 72-hour response standard, including one request that went unanswered for 83 days. An earlier report from 16 Washington hospitals found procedure completion times ran two to four times longer, with some urgent authorizations stretching from one day to 15–20 days.
Why are providers concerned about how WISeR vendors are paid?
WISeR’s third-party administrators can receive a share of the dollar value of denied claims that are not overturned, which providers and lawmakers warn creates a financial incentive to deny care. Combined with limited transparency into the AI algorithms, that structure is the basis of the Electronic Frontier Foundation’s FOIA lawsuit against CMS.