The federal government's experiment to deploy artificial intelligence in Medicare prior authorization is encountering significant operational challenges, according to internal documents that reveal technical failures, vendor unpreparedness, and patient care delays.

Approximately 1,000 pages of records obtained by the Electronic Frontier Foundation through FOIA litigation show that the CMS WISeR Model—launched January 1, 2026, across six states—has generated thousands of authorization delays exceeding its three-day target, with several hundred requests remaining unanswered as of late March 2026. One authorization request had been pending for 83 days, according to the documents.

Vendor Implementation Crisis and System Breakdowns

The records expose particularly acute problems with Innovaccer, one of six contracted technology vendors processing prior authorization requests for Ohio. According to the documents, Innovaccer notified CMS before the January 1 launch that it needed additional time to implement its systems. The vendor continued experiencing feature development delays and request backlogs through early April 2026.

Multiple reports document system downtime that delayed approval responses across the pilot program. The records also reveal miscommunication between vendors and Medicare Administrative Contractors (MACs) that caused process breakdowns and mis-categorization of requests.

The WISeR Model currently operates in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, and is scheduled to run through December 2031. It initially covers 13 service categories, with CMS documents outlining expansion plans to add air ambulance transport, MRI scans, and high-cost Part B medications.

Patient Impact and Payment Structure Concerns

Provider complaints documented in the records describe cases of patients "crying in pain" while awaiting approval for procedures like kyphoplasty and vertebral augmentation—interventions typically used for severe spinal conditions.

The documents also reveal a payment structure that critics say may incentivize denials. According to the records, CMS's methodology imposes only limited payment reductions based on aggregate quality scores, which critics argue could potentially reward vendors financially for restrictive authorization practices.

Political and Regulatory Opposition

The troubled rollout has intensified existing opposition from major healthcare organizations. The American Hospital Association, American Medical Association, and Democratic lawmakers have opposed the program. The Senate rejected legislation to roll back WISeR on a party-line 46-50 vote in July 2026.

The U.S. Government Accountability Office determined that the model is subject to the Congressional Review Act and should have been submitted to Congress before implementation—a finding that raises questions about the pilot's regulatory foundation.

Ongoing Document Release

The Electronic Frontier Foundation filed its FOIA lawsuit in March 2026, and document production remains ongoing. Records obtained so far run through April 2026, suggesting additional information may emerge as the organization receives further materials.

For the healthcare AI industry, the WISeR pilot's challenges represent a significant test case for whether artificial intelligence can successfully manage prior authorization at federal scale in systems where delays directly affect patient care.

Sources

  1. Delays, tech failures abound in CMS' WISeR AI prior auth pilot, documents show — Fierce Healthcare