Thousands of Washington state Medicare users could soon have claims denied by AI

Thousands of Washington state Medicare users could soon have claims denied by AI Stephen Howie December 01, 2025 / 6:02 am

Starting Jan. 1, traditional Medicare recipients in Washington state will face a new hurdle to get certain procedures covered — private AI companies that get paid based on how many claims they deny.

Washington is one of six states selected to take part in a federal pilot program called Wasteful and Inappropriate Service Reduction, which aims to reduce fraud and waste by requiring prior authorization for about a dozen outpatient procedures deemed “low-value services.”

Washington state has more than 1.5 million Medicare enrollees, just over half of whom are enrolled in traditional Medicare (51%). Until now, people with traditional Medicare have not been requi