Isophoric News · Tuesday, November 3, 2026
Records released by EFF describe delays, denial questions and an unready portal in Medicare's AI prior authorization model
Records the Electronic Frontier Foundation obtained in a Freedom of Information Act lawsuit against the Centers for Medicare & Medicaid Services show the agency raised problems with at least four of the six vendors in the first months of its WISeR prior authorization model, according to EFF, which published more than 800 new pages. CMS describes WISeR as a voluntary model that uses technologies such as artificial intelligence, along with human clinical review, for a set of Medicare services in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington from Jan. 1, 2026, to Dec. 31, 2031. EFF, a digital rights group, said the rollout was rushed and called on Congress to limit automated decision-making in Medicare. According to EFF, a March 17 CMS letter to the vendor Virtix cited turnaround times beyond guidelines and "denials that appear inaccurate or inconsistent" with criteria, and MedCity News reported that Virtix rejected 53% of more than 6,000 requests over three months, which the company blamed on an influx of claims. CMS told Zyter it "may lack adequate processes" for provider concerns and issued Innovaccer a notice of noncompliance over its provider portal, EFF said; Innovaccer said it had warned CMS before launch that the portal might not be ready. MedCity News reported that one request to the vendor Genzeon went unanswered for 83 days. CMS says on its WISeR page that denials require review by a human clinician; EFF said the records give limited insight into how that review works.