AI model for traditional Medicare prior authorizations coming to Oklahoma

Oklahoma is one of six states set to participate in a federal pilot program using AI for Medicare claims that’s already raising concerns about how automation will affect prior authorization decisions.

The program, which is set to begin in January 2026 and end on Dec. 31, 2031, is called the Wasteful and Inappropriate Service Reduction (WISer) Model. Created by the Center for Medicare & Medicaid Services, the model marks a change in the agency’s approach to prior authorization and prepayment reviews for Original Medicare, which includes Medicare Part A, hospital insurance, and Medicare part B, medical insurance.