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CMS

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Medicare's AI prior-auth pilot denies 53% of requests in first months

SecurityLead story

Medicare's AI prior-auth pilot denies 53% of requests in first months

The WISeR program pays contractors a share of 'averted expenditures' — a design that ties vendor revenue directly to denials of senior care.

Jaeden SchaferEditor in ChiefSep 255 min read

More tagged CMS

CMS pilots AI-driven prior authorization in six states as doctors warn of more denials

CMS pilots AI-driven prior authorization in six states as doctors warn of more denials

The WISeR program brings machine learning to original Medicare through 2031, while 61% of physicians fear AI will worsen coverage denials.

Jaeden SchaferJul 185 min read

Medicare's new ACCESS payment model opens federal reimbursement to AI care

Medicare's new ACCESS payment model opens federal reimbursement to AI care

CMS picked 150 participants for a 10-year outcomes-based program built around AI agents like Pair Team's Flora.

Jaeden SchaferMay 135 min read