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Medicare Embraces AI for Prior Authorization: A 2026 Pilot

Medicare Embraces AI for Prior Authorization: A 2026 Pilot

Medicare, the nation's largest public health program, is set to embark on a significant transformation, integrating artificial intelligence (AI) into its prior authorization process. Beginning in 2026, a federal pilot program will test whether advanced algorithms can efficiently determine which medical treatments and procedures receive coverage. This initiative marks a pivotal moment, potentially reshaping how millions of Americans access crucial healthcare services. The Dawn of AI in Medicare: A 2026 Pilot Program The new program, officially known as the Wasteful and Inappropriate Service Reduction model, is slated to launch in six key states: Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington. It will initially focus on 17 specific outpatient procedures, allowing for a controlled examination of AI's effectiveness. The primary objective, as outlined by the Centers for Medicare and Medicaid Services (CMS), is to streamline the prior authorization process, reduce unnecess…

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