Humata Health, a physician-led health technology company specializing in AI-driven prior authorization, has been selected by the Centers for Medicare & Medicaid Services (CMS) as a key partner in the WISeR model, a new initiative aimed at making clinical approvals faster, fairer, and more efficient. The program, set to launch in January 2026 across six states—Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington—focuses on 17 high-risk medical services with a history of fraud, waste, abuse, and potential patient harm. Humata will serve as Oklahoma’s primary technology partner, processing all WISeR prior authorization requests for providers in the state. The company’s AI-powered platform will automatically review clinical documentation against existing Medicare coverage criteria, delivering rapid “yes” decisions in days instead of weeks for the majority of appropriate care. While the system can approve requests instantly, it will never deny one on its own. Any case that doesn’t qualify for an immediate approval will be routed to a human clinician for further review, ensuring safety and accuracy. The goal is to reduce unnecessary care, improve patient safety, and protect Medicare funds. According to a 2024 report by The Lown Institute, up to 40% of Medicare beneficiaries receive low-value care each year—services that offer little or no benefit, may cause harm, and are excessively costly. This includes over 200,000 unnecessary back surgeries on Medicare patients in a three-year period, or one every eight minutes, costing an estimated $2 billion. The WISeR model targets specific high-risk services, such as knee arthroscopy for patients over 65—shown in a 2018 Johns Hopkins study to provide minimal benefit in this age group—and skin substitutes, which saw Medicare spending surge to $10 billion in 2024, a 640% increase from two years prior, despite limited clinical evidence and documented cases of fraud and patient harm. Humata’s technology has already demonstrated strong results in pilot programs. The platform reduces authorization cycle times by over 50%, cuts preventable denials by up to 40%, and lowers administrative burden by reducing manual touches by 45%. These improvements are driven by AI that intelligently extracts and interprets clinical data to align with payer policies. Jeremy Friese, MD, Founder and CEO of Humata Health, said the partnership represents a pivotal moment in healthcare transformation. “Our mission is to ensure every patient gets the right care, as quickly as possible. This is a defining opportunity to bring physicians and payers together through technology—proving that speed, transparency, and safety can coexist.” Humata Health, founded in 2023, is backed by a group of strategic healthcare investors including Blue Venture Fund, LRVHealth, 406 Ventures, and Highmark Ventures. The company’s platform is now used by hundreds of hospitals nationwide and is the only end-to-end prior authorization solution that supports all services and procedures with a focus on “Built for Yes” principles—making the process seamless for providers, payers, and patients alike.