Source: The National Law Review

The Centers for Medicare & Medicaid Services (CMS) in the US has introduced a new AI-powered prior authorization model, called WISER, for reviewing coverage requests involving electrical nerve stimulators used on the skin. The goal is to make the approval process more efficient, consistent, and evidence-based.

The system uses AI to assess medical necessity, analyze claims, and flag exceptions, potentially reducing delays and administrative burdens for patients and providers. The article notes that, while this innovation could improve patient access to important devices, it also raises questions about transparency, accuracy, and due process in automated decision-making.

Legal observers are monitoring how WISER complies with existing health, privacy, and administrative laws, and whether it sets new standards for using AI in government healthcare programs.