Federal test of AI prior authorization delays care for seniors, report says

A CMS program piloting AI for prior authorization decisions, the WISE-R pilot, is reportedly causing significant delays in care for Medicare beneficiaries in Washington state. Hospitals report the automated system is more restrictive and slower than human review, prompting Senator Patty Murray to call for a pause and investigation. The program is a test case for broader AI integration into Medicare Advantage review processes. Billing managers should monitor this issue closely; widespread adoption of restrictive AI models could increase appeal volumes and create new bottlenecks.