🏥WISeR AI Medicare Pilot Denies More Than It Approves
AI Medicare pilot denies more requests than it approves
TL;DR
WISeR, an AI-driven Medicare pilot program, has been plagued by delays and errors, with one vendor denying more than half of requests. Providers face weeks of silence and patient distress.
WISeR, an AI-driven Medicare pilot program, has been plagued by delays and errors, with one vendor denying more than half of requests. Providers face weeks of silence and patient distress. Virtix, one of the contracted companies, reviewed 6,096 pre-authorization requests, approving 2,863 and denying 3,233 (53%). Decisions often took weeks, with some requests pending for 83 days. The program's rushed implementation left vendors struggling to meet the 72-hour window, leading to significant delays and patient suffering.
Key Points
WISeR, an AI-driven Medicare pilot, was rolled out in six states in January 2023.
One vendor, Virtix, reviewed 6,096 pre-authorization requests, approving 2,863 and denying 3,233 (53%).
Decisions often took weeks, with some requests pending for 83 days, far exceeding the 72-hour window.
Innovaccer set up its program to automatically approve all requests temporarily due to technology not being ready.
Zyter had data discrepancies for months due to misunderstanding the difference between Medicare Part A and Part B.
Why It Matters
If you're a healthcare provider dealing with Medicare prior authorization, the WISeR pilot program's issues mean delays and denials. Virtix's 53% denial rate and weeks-long processing times highlight the real-world impact on patient care. Providers are left with radio silence and frustrated patients.
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