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Medicare’s new AI authorization program pays contractors to deny claims

Ellsworth Toohey
Sep 24, 2025
∙ Paid

MargJohnsonVA/shutterstock.com

A controversial new Medicare pilot program will introduce AI-driven prior authorization, with contractors paid to deny claims. Starting January 2026, the Wasteful and Inappropriate Services Reduction (WISeR) model will require providers in six states to obtain pre-approval for certain services, using AI to screen requests.

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