CMS AI Prior Authorization Pilot Faces Delays and Technical Failures, Documents Show
Documents obtained by the Electronic Frontier Foundation (EFF) through a Freedom of Information Act (FOIA) lawsuit reveal significant issues in the Centers for Medicare & Medicaid Services (CMS) Wasteful and Inappropriate Service Reduction (WISeR) Model, an AI prior authorization program. The roughly 1,000 pages of records from the program's initial months outline widespread problems including delayed approvals, miscommunication, and provider frustration. Thousands of prior authorization requests exceeded the pilot’s three-day turnaround goal, with some remaining unanswered for up to 83 days. The documents also detail miscommunications between tech vendors and Medicare Administrative Contractors (MACs), system downtime, and numerous complaints from providers about delays and lack of communication, particularly concerning the vendor Innovaccer.
