CMS Prior Authorization and AI: How Three Federal Rules Are Reshaping Utilization Management
A structured policy analysis of how CMS-4201-F, CMS-0057-F, and the WISeR Model together constitute a deliberate federal strategy to introduce AI and electronic automation into prior authorization — examining each instrument's regulatory theory, compliance obligations, and the unresolved tensions around AI transparency, financial incentives, and health equity that will define the debate through 2026 and beyond. Written for health policy professionals, payer compliance officers, hospital administrators, and clinicians engaged in utilization management policy.