Some Medicare beneficiaries in Ohio waited months for care under CMS’ Wasteful and Inappropriate Services Reduction model, an AI-driven prior authorization pilot, the Columbus Dispatch reported Oct. 22. The publication cited records the Electronic Frontier Foundation obtained through a Freedom of Information Act lawsuit.
CMS launched WISeR in January in Ohio, New Jersey, Arizona, Washington, Oklahoma and Texas, six months after announcing it. The model requires prior authorization for 13 services that previously needed none, including certain nerve stimulators, skin substitutes for chronic wounds and orthopedic pain-related services.
Innovaccer, Ohio’s WISeR vendor, warned CMS on Dec. 12, 2025, that its model would not be fully operational at launch. The program went live anyway, and Innovaccer auto-approved all requests to prevent a backlog. Some Ohio providers still waited more than a month for approvals and could not reach the company.
The records run to more than 1,000 pages. They also show that two vendors denied nearly 6,000 claims in the first three months. Washington’s vendor was put on a corrective action plan after missing the three-day approval window.
Eugene Chio, MD, an ear, nose and throat physician in central Ohio, said his office spent months learning the submission process and often could not access the promised online portal. Dr. Chio said working with Innovaccer has gotten easier in recent months.
“Our goal is to help patients, physicians, and clinicians quickly receive answers on prior authorizations because delayed authorizations mean delayed treatments,” Innovaccer said in a statement. The company added that the Ohio program is now “fully live.” CMS said the issues have been resolved and that the records reflect only the pilot’s earliest months.
WISeR runs through Dec. 31, 2031. CMS is weighing whether to add cardiac catheterization, pacemakers, MRIs and specialized cancer care to the model.
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