hifi-health-news: medicare uses ai for prior authorization concerns

A Medicare pilot program that requires patients to get prior authorization for healthcare in six states is raising concern among enrollees. Prior authorization, which is when an insurer will agree to pay for a service only after it reviews a particular case to determine if the specific service is necessary, is not currently needed for traditional Medicare members. But the new program, dubbed WISer (Wasteful and Inappropriate Service Reduction) will use AI to identify when prior authorization is necessary. A human will make the final determination. #ai #healthcareai #healthcare #medicare