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Medicare starts WISeR, an AI-assisted prior-authorisation pilot in six states

ProgrammeHealthGovernmentUSConfirmed

CMS's Wasteful and Inappropriate Service Reduction (WISeR) Model began on 1 January 2026, running six years to end-2031 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Technology vendors use AI and machine learning to review prior-authorisation requests for selected traditional Medicare services such as skin substitutes, nerve stimulators and knee arthroscopy, and are paid a share of the savings; CMS says any non-payment decision is made by a licensed clinician.

Why it matters

It brings algorithmic prior authorisation, long criticised in private Medicare Advantage plans, into traditional Medicare with vendors paid on savings.

SourceCenters for Medicare & Medicaid ServicesCoverage: Dinsmore & Shohl Checked against the primary source. Independently fact-checked on 7 Oct 2026.
CMSHHS

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