Is AI WISeR? CMS Models AI-based Prior Authorization Process in Six States

The Centers for Medicare and Medicaid Services (CMS) is poised to launch a bold, new initiative to reduce waste, fraud and abuse. Starting January 1, 2026, the Wasteful and Inappropriate Service Reduction (WISeR) Model will launch in six states—Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, and run for six years. The program will employ enhanced technologies, such as artificial intelligence (AI) and machine learning (ML) to introduce prior authorization to select services within…
By: Dinsmore & Shohl LLP