Cite as: Real Problem AI problem “How do I get prior authorization approved under Medicare's new WISeR AI program?”. Opportunity score 7.9 out of 10 (severity 9, AI feasibility 7, market signal 8, competition gap 7). Category HealthTech. Trend Agents. Source signal: r/medicine post "Trump admin using AI to deny medical care for seniors in disastrous experiment", 26 September 2026, 52 comments.. Canonical URL: https://www.realproblem.ai/idea/how-do-i-get-prior-authorization-approved-under-medicares-new-wiser-ai-program.
How do I get prior authorization approved under Medicare's new WISeR AI program?
Traditional Medicare never needed prior authorization, but in six WISeR states AI vendors now review requests for spine injections, nerve stimulators and skin substitutes, and they are paid a share of the care they deny.
Who has it: Pain, spine, wound care and urology practices in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington, and their traditional Medicare patients.
- Severity9/10
- Feasible today7/10
- Market signal8/10
- Competition gap7/10
Heard in public
“for every denied request, CMS will determine what the regional benchmark cost for that care would have been and then pay the company 25 percent.”
Quoted word for word from the public post linked below. Nobody submitted it to Real Problem AI.
r/medicine post "Trump admin using AI to deny medical care for seniors in disastrous experiment", 26 September 2026, 52 comments.What nothing does yet
A WISeR specific prior auth assistant that knows each vendor's documentation checklist per service, assembles the chart evidence before submission, tracks decisions and deadlines, and builds the appeal when an AI reviewer denies.
Tools that solve this
4 named so far, and where each one stops.
- WISeR vendor portals
Each vendor runs its own submission flow and checklist, with no shared view across them.
- Prior auth automation (Cohere Health, Availity)
Built for Medicare Advantage and commercial payers, uneven support for WISeR vendors.
- Practice billing staff
Assemble records by hand under tight timelines.
- Gold carding
Exempts trusted providers in some programs, not offered in WISeR.