Medicare WISeR Gold-Card Exemption Program Launches July 6; Providers Face 90% Prior Authorization Threshold

Short summary

CMS launches gold-card exemptions for WISeR (Medicare's AI prior-authorization system) on July 6, exempting high-performing providers from review requirements. Providers must achieve 90% affirmation on prior-auth requests, but Texas data shows the AI model only affirms 62% versus 92% under traditional Medicare. Multiple legal and regulatory challenges loom, but WISeR continues expanding with new AI audit programs like AERO.

• •Gold-card exemption program launches July 6 in Washington state with quarterly rollouts
• •Providers need 90% affirmation rate on minimum 10 prior auth requests to qualify
• •AI model approval rate (62% in Texas) significantly lower than traditional Medicare (92%), making threshold difficult to reach

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