On June 27, CMS’s innovation arm (CMMI) announced a new pilot: the Wasteful and Inappropriate Service Reduction (WiSeR) Model, a six-year program launching January 2026. The model aims to reduce the administrative burden of prior authorization, limit the use of medically unnecessary care, and curb fraudulent claims by leveraging AI and machine learning. This opens both a competitive opportunity and a compliance imperative.  The model: 

• Automates and streamlines prior authorization  

• Targets fraud and overutilization in Medicare  

• Invites industry partnerships to co-develop tech infrastructure  

Why It Matters for Industry  

• CMMI is actively encouraging industry participation: Especially for companies that already streamline prior authorization processes, there are straightforward avenues to seamlessly partner with health systems.   

• WiSeR pushes providers to modernize their prior auth pipelines: Tools that help providers bridge the gap between current-state workflows and AI-enhanced expectations will be in high demand.  

Key Questions to Ask  

• Is your tech WiSeR-compatible, both functionally and from a federal compliance standpoint?  

• Can your teams speak to revenue cycle savings or FTE reduction tied to AI-enhanced prior auth?  

• Are you positioned to partner with payers or health systems pursuing WiSeR funding?