Medicare’s test of algorithmic coverage decisions went live over its own contractors’ warnings, according to more than a thousand pages of newly released records.
WISeR is the program’s name. It went live in January and is set to continue through 2031. Its scope is narrow but consequential: skin substitutes and epidural pain injections now require advance sign-off, and providers in six states have to comply, Texas and Ohio among them.
The records surfaced through a Freedom of Information Act lawsuit filed by the Electronic Frontier Foundation. One message in the pile comes from a vendor. That contractor told the Centers for Medicare and Medicaid Services the launch deadline left no realistic path to a finished product. Elsewhere the files document testing gaps, backlogs and care that arrived late.
This is the largest attempt yet to automate prior authorization inside traditional fee-for-service Medicare. Backers see algorithmic review as a route to less waste and faster routine approvals. Critics say it hands clinical judgment to software that has never been validated at national scale.
STAT, Medscape and Newsweek describe the same cluster of complaints: denials that arrive without clear reasoning, slow turnaround, and few ways for a clinician to push back on a machine’s decision. Democratic lawmakers have already asked CMS to pause WISeR. The new files give that push harder evidence.
CMS has not said whether it will change course. Hospitals want to know two things: whether denials can be appealed fast enough to keep treatment on schedule, and whether accuracy figures will be published while the multi-year experiment runs.
