Physician-led company to use its AI-driven solution to bring speed, transparency and clinical expertise to reduce unnecessary care and increase patient safety
Humata Health, the leader in AI-powered prior authorization technology, has been selected by the Centers for Medicare & Medicaid (CMS) as a key partner for its WISeR model, an initiative focused on safeguarding patients and protecting Medicare funds. Humata will use its proprietary technology to help build a more modern, efficient and fair clinical approval process for CMS, the single largest payer for healthcare in the U.S.
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The WISeR model — which launches in January 2026 in six states: Arizona, Ohio, Oklahoma, New Jersey, Texas and Washington — targets a specific list of 17 items and services that have historically high rates of fraud, waste, abuse and potential for patient harm. Humata will serve as Oklahoma’s primary technology partner, processing all WISeR prior authorization requests for providers across the state. The company will intelligently apply existing Medicare coverage criteria to deliver rapid automated approvals wherever possible.
The primary function of Humata’s AI-powered technology in the WISeR model is to accelerate approvals. By matching clinical documentation to Medicare policy criteria, the technology helps providers get a rapid “yes” decision in days, not weeks — streamlining care for the vast majority of appropriate services. The technology approves requests immediately, but can never deny them; complex cases that are not an instant “yes” must go to a human clinician for review.
“Humata’s core mission is to ensure that every patient receives the right care as quickly as possible. We feel a profound responsibility to prove that this can be done the right way,” said Jeremy Friese, MD, Founder and CEO of Humata Health. “We look forward to partnering with CMS and medical providers across Oklahoma to leverage our technology to help ensure that every patient journey is one of transparency, speed and safety. This is a defining opportunity to set a new standard — one where technology finally brings physicians and payers together — for the good of the patient.”
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The high variability of care in the U.S., ranging from exceptional to inappropriate, is staggering. Each year up to 40% of Medicare beneficiaries receive a low-value service: care that the best available evidence suggests provides little-to-no benefit to patients, is likely to cause more harm than benefit, and is too expensive given its benefits. With 68 million beneficiaries in 2024, that’s approximately 27 million seniors annually receiving potentially harmful care they don’t need. Over one three-year period, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries — or one low-value back procedure every eight minutes — costing Medicare about $2 billion in total, according to a 2024 report by healthcare think tank The Lown Institute.
Examples of low-value services selected for the WISeR model include knee arthroscopy for seniors, which has been shown to yield little or no benefit to people over 65, according to a 2018 Johns Hopkins study. Another item on the list is skin substitutes, materials used for wound care when natural skin grafts aren’t available or suitable. Medicare spending on skin substitutes has skyrocketed — to $10 billion in 2024, a 640% increase from just two years earlier — despite limited clinical evidence and documented cases of fraud and patient harm, according to a September 2025 report by the U.S. Department of Health and Human Services.
Humata was selected as a technology partner for the WISeR model based on its proven ability to deliver fast, transparent and accurate decisions. The company, which was founded in 2023 and whose technology is now deployed at hundreds of hospitals nationwide, has quickly amassed an impressive track record with its provider partners: By intelligently matching clinical documentation to payer policy, Humata improves authorization cycle times by over 50% and reduces preventable denials by up to 40%. Clinical teams have seen their administrative burden lifted, with manual authorization touches reduced by 45%.
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Source- businesswire
