CMS flagged multiple contractors for early problems in Medicare WISeR prior-authorization pilot

Newly released federal records show the Centers for Medicare & Medicaid Services flagged multiple contractors in a Medicare prior-authorization pilot within its first three months, citing delayed decisions, questionable denials, customer-service problems and incomplete provider tools.

The documents, published Tuesday by the Electronic Frontier Foundation, add concrete detail to concerns about the early rollout of CMS’ WISeR model, a six-year pilot in Original Medicare. EFF said it obtained more than 800 pages of records through a Freedom of Information Act lawsuit it filed against CMS on March 25, 2026. The release includes requests for information and corrective action plan requests sent by CMS to at least four of the six WISeR vendors, along with vendor responses, applications from 66 companies and contracts tied to the program’s implementation and monitoring.

According to EFF’s summary of the records, the issues were not limited to a single company or state. CMS sent RFIs or corrective action requests to at least four vendors during the program’s first three months.

Among the clearest examples, CMS told Virtix in one RFI that it found “determination turnaround times that exceed established guidelines” and “denials that appear inaccurate or inconsistent with applicable criteria.” The same notice also cited inadequate customer service, according to EFF’s description of the records.

CMS raised similar concerns with Zyter. In an RFI published by EFF, the agency wrote that “Zyter is not issuing determination letters in a timely manner” and that the company “may lack adequate processes for responding to and escalating provider/supplier concerns.”

Innovaccer, another WISeR contractor, received two corrective action plan requests and a Performance Notice of Non-Compliance tied to its failure to implement a fully functional portal for providers and suppliers, according to EFF’s summary of the records.

WISeR, announced by the CMS Innovation Center on June 27, 2025, launched Jan. 1, 2026, and is scheduled to run through Dec. 31, 2031. The model applies prior authorization or pre-payment review to selected services in Original Medicare in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

That makes the newly disclosed records notable beyond ordinary contractor oversight. Prior authorization is relatively unusual in Original Medicare, and CMS has said WISeR uses enhanced technologies, including artificial intelligence and machine learning, alongside human clinical review to evaluate requests. In its published FAQ for the model, CMS says, “Non-affirmations will require the review of a human clinician and cannot be performed solely by technology.”

The records released Tuesday also include the vendors’ explanations for some of the early failures. According to EFF, vendor responses said the compressed implementation schedule contributed to the problems. Innovaccer told CMS it had warned months earlier that it might not be ready to provide full portal functionality by launch, EFF said. Another vendor said it ran into stabilization problems because of the short timeline. EFF also cited prior CMS records describing an “extremely condensed timeline” for the rollout.

The release offers one of the clearest documentary looks so far at how the model functioned at launch. Rather than showing isolated trouble with one contractor, the records indicate CMS identified operational problems across several participating companies soon after the program began.

The WISeR model had already drawn federal scrutiny before Tuesday’s document release. On May 12, 2026, the Government Accountability Office, a congressional watchdog, said the model notice qualified as a rule under the Congressional Review Act. A Senate effort to block it later failed.

The new records do not just show outside critics objecting to the model in principle. They show CMS itself documenting missed deadlines, disputed determinations, service failures and rollout gaps across multiple vendors early in a federal Medicare pilot that remains in effect.