Medicare Releases Regulatory Notice About Original Medicare Prior Authorization Process Revisions

CMS released a regulatory notice that will revise prior authorization requirements for original Medicare beneficiaries in certain selected states. The Wasteful and Inappropriate Service Reduction Model is a six-year demonstration model that will use enhanced technologies like artificial intelligence and machine learning to “streamline the review process for certain items and services that are vulnerable to fraud, waste and abuse.” 

Participants in the WISeR model will be companies with expertise in managing prior authorization process for other payers. The participants will apply their technology in predefined states, which include New Jersey (JL), Ohio (J15), Oklahoma and Texas (JH), and Arizona and Washington (JF).