Medicare picks tech firms to run prior authorization pilot

The Centers for Medicare and Medicaid Services has selected the six technology companies that will administer artificial intelligence-powered prior authorization programs for Medicare, STAT has learned.

The pilot, called the Wasteful and Inappropriate Services Reduction (WISeR) model, is a CMS effort to reduce waste and abuse within the taxpayer funded health insurance program that spent more than a trillion dollars in 2024. The new prior authorization program will launch in January and run until 2031 in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.

CMS’ decision to test the use of AI technology for prior authorizations comes at a time when large private insurers — including UnitedHealthcare and Humana — are facing class action lawsuits and congressional scrutiny ov