On June 27, CMS’s innovation arm, CMMI, announced the launch of the Wasteful and Inappropriate Service Reduction (WISeR) pilot starting Jan 1, 2026. For a pre-selected set of procedures and services, the model will use AI and machine learning to review and determine appropriateness of service before approval. The pilot will apply only to Medicare. Critics claim that the approach is reminiscent of what commercial payers have already adopted and are concerned about the impact on patient care. While much remains to be seen, it is clear that the challenge of preauthorization is not going away. This opens both a competitive opportunity and a compliance imperative.
Why It Matters for Industry
CMMI is actively encouraging industry participation: Companies already streamlining prior authorization have a clear path to partner with health systems as WiSeR takes shape
WiSeR will accelerate demand for tools that modernize prior auth processes. As health systems prepare for Medicare’s new process, expect growing demand for –
Automated auth submissions and status checks
Time-to-approval tracking
Seamless integration with EHRs and scheduling workflows
Essentially, any solutions that close the gap between today’s workflows and tomorrow’s AI protocols
Shifting front-end workloads will necessitate solutions to lessen the load: If WiSeR functions like commercial payer systems, providers could see new documentation requirements and rework risks. Partners can help reduce that load with AI-powered tools that integrate with EHRs or auth portals.
Changing Denial Patterns = Need for Adaptive Solutions: Even as AI aims to speed approvals, it may introduce new denial patterns tied to opaque algorithms. Partners that can flag WiSeR-specific denials and help tune systems in real time will become essential.
Key Questions to Ask
Is your tech WiSeR-compatible—both functionally and from a federal compliance standpoint?
Can your teams speak to revenue cycle impact from your prior auth tools (e.g. FTE savings, fewer denials)?
Are you positioned to partner with providers or payers pursuing WiSeR-funding or pilots?