“Another company built a system that allowed clinical reviewers to reject claims without opening patient files; clinical reviewers using this system spent an average of just 1.2 seconds on each case.”
CMS sells a human in the loop as the safeguard against AI denials. A reviewer who spends 1.2 seconds per claim is not reviewing anything. CMS launched WISeR six months after announcing it and was chasing four of its six vendors within three months. Seniors pay for the rush in delayed and denied care.