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Medicare will pilot AI-driven prior authorization in 2026 across six states, targeting high-risk services while clinicians make final decisions.

AI-Powered Prior Authorization Comes to Traditional Medicare

Traditional Medicare will pilot AI-assisted prior authorization in 2026 across six states, focusing on high-risk outpatient services. Clinicians retain final say, but incentives and access concerns loom as CMS tests fraud reduction and “gold card” exemptions. Here’s what providers and patients should know.

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