The Center for Medicare and Medicaid Innovation (CMMI) launched the Wasteful and Inappropriate Service Reduction (WISeR) Model, a six-year voluntary initiative (2026-2031) in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
Unlike previous models, WISeR partners are technology companies instead of providers. These companies will deploy AI and machine learning tools combined with clinician review to manage prior authorization and pre-payment reviews for select Medicare services. Participants will earn shared savings by reducing unnecessary care and meeting performance targets.
Participant Name |
MAC Jurisdiction |
State |
| Cohere Health, Inc. | JH Novitas | Texas |
| Genzeon Corporation | JH Novitas |
New Jersey |
| Humata Health, Inc. | JH Novitas | Oklahoma |
| Innovaccer Inc. | J15 CGS | Ohio |
| Virtix Health LLC | JF Noridian | Washington |
| Zyter Inc. | JF Noridian | Arizona |
Providers and suppliers who do not submit prior authorization requests for included services claims will automatically be subject to medical review to confirm compliance with Medicare coverage, coding and payment criteria before payment.
For more information, contact Alicia Blakey, ACR Principal Economic Policy Analyst.
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