The EFF obtained roughly 1,000 pages of CMS records showing that the WISeR AI prior authorization pilot generated thousands of denials, long response delays and technical issues after its January 2026 launch. Two vendors denied 5,944 requests in the first three months and one vendor, Virtix, denied more than it approved and faced corrective action. Records document delays beyond CMS's 72-hour target (one case reached 83 days), provider reports of patients left in pain, and payment rules that may financially reward denials despite modest quality penalties (5–10%).
CMS WISeR AI Prior Authorization Pilot Sparks Thousands Of Denials, Long Delays And Technical Failures
Medicare WISeR AI prior authorization pilot: high denial rates 2026
Newly released records obtained by the Electronic Frontier Foundation (EFF) reveal widespread denials, lengthy delays and technical problems in the Centers for Medicare & Medicaid Services' AI-driven prior authorization pilot, known as WISeR, which launched in January 2026.
Key Findings From the Records
The EFF obtained roughly 1,000 pages of documents via a Freedom of Information Act lawsuit focused on WISeR (Wasteful and Inappropriate Service Reduction). The program requires providers in six states — New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington — to request prior approval for certain procedures and products. Private contractors using AI systems evaluate those requests.
Two vendors denied 5,944 prior authorization requests during the program's first three months. One vendor, Virtix, denied more requests than it approved and was required to submit a corrective action plan to CMS.
Long Delays and Patient Harm
Although CMS publicly directs vendors to respond to prior authorization requests within 72 hours, the internal records document widespread delays. An internal status report shows one request remained unanswered for 83 days. Providers reported patients left in pain while awaiting approvals.
"We have patients calling our offices crying in pain because their procedures are being delayed while awaiting approvals or guidance tied to this model," one provider wrote. Another added: "I HAVE HAD TO WATCH 3 PATIENTS CRY AT BEDSIDE FOR NOT HEARING BACK ON THEIR PRIOR AUTH FOR KYPHOPLASTY/VERTEBRAL AUGMENTATION PROCEDURE. THESE PATIENTS ARE IN DEEP PAIN."
Payment Incentives And Quality Controls
The documents indicate WISeR's payment structure creates troubling incentives: vendors are paid for requests they deny, while denials overturned on appeal are not paid. CMS ties payment levels to quality scores intended to discourage inappropriate denials, but the released WISeR Data Reporting Guide shows quality penalties reduce payments by only 5–10%, a relatively small deterrent against excessive denials.
Rushed Rollout And Ongoing Technical Gaps
Records show the rollout was rushed. About a month before the January launch, vendor Innovaccer warned CMS it planned to go live with software that lacked full functionality and had not completed end-to-end testing. CMS declined to delay the start; Innovaccer said it would auto-affirm requests until development was finished. An April 2026 status report indicates some features still had not been completed months after launch.
Outlook And Possible Expansion
WISeR launched just six months after it was announced and is scheduled to run through 2031. A planning document reviewed by the EFF shows CMS has considered broadening WISeR in future years to include more time-sensitive services such as air ambulance transport, cancer treatment and MRI scans — services where delays could cause serious harm.
Bottom line: The records paint a picture of an AI-powered authorization pilot that, in its initial months, produced thousands of denials, frequent and sometimes extreme delays, and operational weaknesses that raised concerns about patient harm and misaligned financial incentives.
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