Medicare AI Prior Authorization Pilot Plagued by 83-Day Delays and Testing Failures

Medicare AI Pilot Creates Treatment Bottlenecks Across Six States

Medicare's ambitious AI prior authorization pilot is stumbling badly. The Wasteful and Inappropriate Service Reduction (WISeR) pilot program, which launched in January across Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, promised to streamline approvals within 72 hours. Instead, newly released records obtained by the 1

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through a Freedom of Information Act lawsuit reveal one authorization request sat unanswered for 83 days. The roughly 1,000 pages of documents expose widespread technical failures, inappropriate denials, and warnings that contractors issued before the system went live.

Vendors Warned CMS About System Readiness Before Launch

Contractors flagged critical problems weeks before the WISeR pilot program began. Innovaccer, the vendor assigned to Ohio, sent a letter to CMS on December 12, 2025, stating its system lacked full functionality and had not undergone sufficient end-to-end testing. The company warned this "increases the potential for provider abrasion and disruption to beneficiary services." To avoid creating backlogs and testing gaps, Innovaccer temporarily auto-affirmed all prior authorization requests while completing additional functionality within 60 days. Yet documents suggest some features remained unfinished or untested as of April. Lena Cohen, staff technologist at the Electronic Frontier Foundation, questioned why CMS chose not to delay the launch despite these system issues.

Lengthy Treatment Delays and Alarmingly High Denial Rates

The AI prior authorization pilot has generated substantial backlogs at multiple vendors. Virtix Health, serving Washington, and Zyter, serving Arizona, received 1,276 direct prior authorization requests in January. About 30% of these requests were 6-21 days old, far exceeding the promised 72-hour turnaround. Virtix reported its average turnaround time peaked at 8.97 days during initial weeks before improving to 0.51 days by week 11. The two vendors issued more than 20,000 combined non-affirmations during the program's first three months, with Virtix Health denying more requests than it affirmed during that period. Cohen described these rates as "alarmingly high," noting providers have reported patients being harmed by widespread authorization delays.

Real-World Impact on Patient Care and Medical Practices

The technical failures have translated into tangible patient suffering. One provider wrote in feedback: "I have had to watch three patients cry at bedside for not hearing back on their prior auth for kyphoplasty...These patients are in deep pain." Arizona interventional pain specialist Matthew Crooks called the system "unsustainable" after waiting months for payment on epidural steroid injections performed under the program, even those with valid authorization numbers. Michael Ryan, finance expert and founder of MichaelRyanMoney.com, told 2

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: "When a request that is supposed to take 72 hours can sit unanswered for weeks, that is no longer administrative efficiency. For the beneficiary, it is delayed treatment."

Questions About AI Deployment in Healthcare Oversight

The WISeR pilot program contracts with multiple technology vendors to review prior authorization requests using "enhanced technology," including AI, to assess whether requests meet Medicare coverage requirements. Each participating state has one assigned contractor, which must also have clinicians with expertise to conduct medical reviews validating determinations. However, the Electronic Frontier Foundation raised concerns about testing for accuracy, bias and hallucinations, as well as audits and monitoring of participating vendors. Kevin Thompson, CEO of 9i Capital Group, noted: "The systems were not thoroughly tested prior to launch, which is now causing lengthy delays beyond the 72-hour prior authorization turnaround." CMS stated it is "firmly committed to ensuring timeliness, accuracy, and transparency" under the WISeR pilot program and will take corrective actions as appropriate, though the agency did not respond to specific questions about the documented problems.