Meet the 6 vendors participating in the CMS WISeR Model
The vendors selected to lead a new CMS model will apply their technologies leveraging AI to streamline the Medicare prior authorization process in six states.
CMS has announced the six vendors it selected to participate in an upcoming prior authorization model that will leverage artificial intelligence to streamline this notoriously burdensome process in healthcare.
Cohere Health, Inc., Genzeon Corporation, Humata Health, Inc., Innovaccer Inc., Virtix Health LLC and Zyter Inc. are the vendors that will participate in the Wasteful and Inappropriate Service Reduction (WISeR) Model starting on January 1. The vendors will utilize technology to conduct Medicare prior authorizations in six states: Texas, New Jersey, Oklahoma, Ohio, Washington and Arizona.
These vendors will apply their technology for medical necessity reviews for specific items and services in an assigned state. The CMS Innovation Center will oversee the model, with the goal of expediting the prior authorization process and alleviating providers' administrative burden while reducing Medicare spending.
CMS said the vendors have expertise in medical necessity of coverage recommendations for payers using enhanced technology, like AI. The vendors must also have clinicians with expertise to conduct medical reviews to validate determinations.
However, the WISeR Model has stirred controversy, with some lawmakers even seeking to cancel the pilot before it begins. Critics argue that the modeel is an inappropriate use of AI in healthcare and will limit access to care for Medicare beneficiaries.
Additionally, the vendors will be paid based on how much they save Medicare, with the total sum adjusted for performance on measures, such as provider experience.
CMS is forging ahead, though, with these six vendors preparing to apply AI and machine learning at scale in an effort to improve prior authorizations.
Cohere Health Inc. -- Texas
Headquartered in Boston, Cohere Health is a "clinical intelligence" technology company that leverages AI-powered solutions to streamline access to care through a utilization management platform.
The company works with over 660,000 providers across the U.S., handling over 12 million prior authorization requests annually. Leading payers use its technology to improve their utilization management processes, including Humana, Geisinger and Medical Mutual in Ohio. Its main product, the Cohere Unify™ platform, claims to automate up to 90% of prior authorization requests using AI designed specifically for healthcare.
Cohere explains that its blueprint for prior authorizations is to optimize the process through "real-time, AI-powered nudges" for providers. These include administrative nudges that alert providers to potential issues, such as missing information, to increase the likelihood of auto-approvals. AI also delivers clinical nudges to recommend evidence-based care alternatives, such as shifting a procedure from an inpatient to an outpatient setting.
As part of the WISeR Model, Cohere will operate in Texas.
Genzeon Corporation -- New Jersey
Genzeon is a healthcare AI and automation company out of Pennsylvania. The company provides technology solutions and services to payers, providers and healthcare technology companies. Its HIP One platform uses advanced AI and generative AI for prior authorizations.
Genzeon's approach to AI-driven prior authorizations is to balance automation, agentic AI and human review through a platform method. This layered model, the company states, leverages robotic process automation bots for deterministic, rules-based tasks like intake and system updates and agentic AI for decision support, including summarizing clinical records, comparing against clinical guidelines and triaging complexity. Additionally, there is human-in-the-loop oversight to ensure accuracy and compliance while preventing inappropriate request denials.
The company also touts its "hyperautomation" approach, which involves a strategy to combine AI, machine learning, natural language processing and RPA to automate complex, end-to-end processes in healthcare.
Genzeon will work with Medicare medical necessity reviews in New Jersey.
Humata Health, Inc. -- Oklahoma
Humata Health is a physician-led healthcare technology company that specializes in "touchless" prior authorizations using AI capabilities. The company was founded by Jeremy Friese, M.D., a former radiologist at Mayo Clinic, and is backed by investors, including Blue Venture Fund, LRVHealth, 406 Ventures and Highmark Ventures.
The company focuses solely on solving the challenges of prior authorizations to ensure timely care for patients. Its AI can connect to a provider's EHR system and use machine learning to select, index and classify relevant clinical information for prior authorization requests. It then uses AI to bundle the information into a clinical package to submit to health plans and monitor its decision status.
Humata states that its AI-powered prior authorization technology is also "built for yes," meaning it can deliver fast, automated approvals for requests that meet the criteria. The company aims to leverage this approach for 90% of touchless requests, with a human-in-the-loop strategy for complex cases.
For the WISeR Model, Humata seeks to reduce Medicare prior authorization timelines in its assigned state, Oklahoma, from weeks to days using AI. The company reassured in a press release that its technology never automatically denies prior authorization cases, only approving those that meet the criteria immediately.
Innovaccer Inc. -- Ohio
A leading name in health IT, Innovaccer is a healthcare data technology company that specializes in connecting and eliciting insights from the data generated by healthcare stakeholders. The company does this through its flagship product, the Healthcare Intelligence Cloud.
Innovaccer announced in August a new AI-powered prior authorization solution called Flow Auth, which is part of the company's revenue cycle performance platform, Flow by Innovaccer. Flow Auth aims to automate the entire prior authorization process through an end-to-end automation framework powered by an integrated ecosystem of AI agents. Key features, according to Innovaccer, include proactive prior authorization detection, payer rule integration, payer-ready packet creation, full-spectrum submission, real-time tracking, and automated appeals drafting.
The philosophy behind Innovaccer's prior authorization technology is to streamline the administrative process, removing it from the path of patients and clinical care, and creating a process that is invisible to patients and effortless for providers.
Major healthcare organizations, including CommonSpirit Health and Banner Health, already utilize technology from Innovaccer. The company also collaborates with California's PopHealth Learning Center to provide a statewide population health analytics solution, supporting the state's Medicaid program.
Innovaccer will participate in the WISeR Model in Ohio.
Virtix Health LLC -- Washington
Virtix Health is a Phoenix, Arizona-based healthcare technology company that specializes in clinical data acquisition, quality reporting and risk adjustment coding for payers and providers. The company focuses on enhancing efficiency and accuracy in managing clinical information, offering solutions such as medical record retrieval and clinical coding validation.
The company boasts digital and credentialed access to over 80,000 site locations, which powers its medical record retrieval and clinical data connectivity. However, detailed public information on its proprietary prior authorization technology is limited.
Gleaned from its website, though, Virtix's philosophy is human-powered, technology-enabled solutions. The company also dives deep into risk adjustment data validation and quality reporting for Healthcare Effectiveness Data and Information Set, or HEDIS. Its main product is the LINX Platform that seeks to provide the infrastructure payers and providers need to make informed decisions at scale, including in operations.
CMS has assigned Virtix to Washington for the WISeR Model.
Zyter Inc. -- Arizona
Zyter is a privately held company headquartered in Rockville, Maryland that also does business as Zyter|TruCare, which symbolizes the unification of best-in-class healthcare technology platforms Casenet TruCare and Zyter Health. The company specializes in population health management technology and services for health plans and managed care organizations. Currently, its products serve 45 health plans and over 44 million covered lives.
Zyter|TruCare delivers prior authorization technology through its TruCare Population Health Platform, TruCare 25.1. In June, the company also announced that it has integrated AI directly into the prior authorization intake process, combining optical character recognition and automated routing to minimize manual steps and triage workflows.
The company has also stayed abreast of upcoming CMS requirements for digitizing prior authorizations through the CMS-0057 rule, which specifically mandates the use of application programming interfaces that use Fast Healthcare Interoperability Resources, or FHIR, standards.
AI implementation is a top priority for Zyter|TruCare. The company appointed a new CEO, Sundar Subramanian, in July 2025 to drive AI transformation, particularly through agentic AI, for population health management.
Zyter|TruCare will apply its technology in Arizona for the WISeR Model.
Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.
