CMS AI Prior Authorization Pilot Plagued by Delays and Technical Failures, Documents Reveal
Documents obtained through a Freedom of Information Act (FOIA) lawsuit by the Electronic Frontier Foundation (EFF) reveal widespread issues in the Centers for Medicare & Medicaid Services (CMS) Wasteful and Inappropriate Service Reduction (WISeR) Model, an AI-powered prior authorization program. The roughly 1,000 pages of records from the pilot's initial months outline significant problems including thousands of delayed approvals, miscommunications between tech vendors and Medicare Administrative Contractors (MACs), and provider frustration. Many prior authorization requests exceeded the program's three-day goal, with some remaining unanswered for over 80 days. Providers reported patients experiencing severe pain due to delayed procedures. Technical issues, system downtime, and a lack of communication from vendors, particularly Innovaccer in Ohio, were also cited. The WISeR model, launched on January 1, aims to curb improper spending in traditional Medicare by using AI for prior authorization in Arizona, O...