Medicare names six tech vendors to run AI prior authorization pilot in six states
CMS named the six companies that will run prior authorization reviews under its WISeR (Wasteful and Inappropriate Service Reduction) model in traditional Medicare: Cohere Health (Texas), Genzeon (New Jersey), Humata Health (Oklahoma), Innovaccer (Ohio), Virtix Health (Washington) and Zyter (Arizona). The vendors use AI and machine learning to review medical necessity for a short list of services CMS considers prone to waste, such as skin substitutes, electrical nerve stimulators and knee arthroscopy for osteoarthritis. Vendors are paid based on the Medicare savings they produce, adjusted for performance measures such as provider experience. Democrats in the House introduced a bill to block the pilot, but the model launched as planned on January 1, 2026, and runs through 2031.
Why it's notable: This brings prior authorization, run by AI vendors paid according to savings, into traditional Medicare for the first time. Clinicians in the six states now need prior approval for services that used to go through without it.