healthcare AI platforms The reference deployment
is in production.
Genzeon Platforms is one of six commercially available PA platforms processing Medicare FFS prior authorizations under the CMS WISeR Model — and the only one consumable as a full platform or as individual agents, deployable across every shape (sovereign, government cloud, commercial cloud, on-prem). Operating in production with Novitas Solutions in the New Jersey market since January 1, 2026.
Prior authorizations processed since go-live
3-day TAT compliance — the federal benchmark
Auto-denials. Every non-affirmation routes to a human reviewer.
A six-year CMS innovation model.
The Wasteful and Inappropriate Service Reduction Model (WISeR) runs 2026–2031 and brings AI-assisted prior authorization to Medicare Fee-for-Service for the first time. CMS selected six commercially available PA platforms to process Medicare FFS prior auths in partnership with Medicare Administrative Contractors. Genzeon Platforms is one of the six. Our jurisdiction is MAC JL. Our operator partner is Novitas Solutions. Our market is New Jersey. Our first production day was January 1, 2026.
CMS WISeR
2026–2031 · Medicare Fee-for-Service prior authorization · AI-assisted, human-decided. CMS →
Sovereign
Full agent stack runs inside CMS-aligned infrastructure · no PHI exits the perimeter.
The numbers, unredacted.
A reference deployment operating at federal SLA standards across throughput, turnaround, document processing, and clinical-review staffing — the production envelope a CMS-grade platform is expected to hold.
Prior authorizations processed since the January 1 go-live. End-to-end — provider intake through clinical decision through letter delivery.
Full compliance with the federal SLA standard — sustained throughout the quarter, not a one-week peak.
Document processing throughput at full hardware utilization — the OCR / extraction / classification pipeline at production load.
17 active reviewers · 8 nurses · 9 MDs · standardized procedures supporting ongoing recruitment and growth.
From account generation to first clinical case review. Training materials streamlined to support continuous capacity expansion.
Dashboards, reporting, and exec status running on automated pipelines across the four production streams.
One platform. Four surfaces. End-to-end.
A WISeR submission flows through four discrete streams — each instrumented, each with its own SLA, all coordinated by a single integration layer. The streams are not point tools stitched together. They run on the same Aether One™ agent substrate.
Submission & status
Provider-facing portal for PA request submission, ADR management, peer-to-peer scheduling, status tracking, and facility administration.
Intake & routing
Real-time intake, validation, dismissal screening (AI agent), and routing to the correct clinical queue at production volume.
Medical review
Nurse intake → non-affirm screening → MD specialty routing → decision → finalization. DSS checklist live for every WISeR service area.
The clinical operations envelope, end to end.
Nine production capabilities anchoring the WISeR clinical workflow — from intake routing through MD decision through audit-grade traceability. Each is in live use under federal SLA standards.
End-to-End MD Review Workflow
Full Nurse → Non-Affirm → MD specialty routing → MD decision → Nurse finalization → Service Ops submission pipeline.
MD Specialty Group Infrastructure
Admin dashboard for creating specialty groups, associating/deassociating MDs, and routing non-affirm cases without engineering involvement.
MD Workflow for P2P
Provider-to-clinical-reviewer peer-to-peer connections with structured note exchange on specific patient cases.
SLA Tracking Platform-Wide
Due dates, SLA status (Overdue / Due Today / On Track), and filters across case cards, Review List, and Unassigned Queue.
Clinical Analytics Dashboards
Production analytics across two modules — Unassigned Queues (depth and SLA by specialty) and Case Tracker & SLA (lifecycle, compliance, XLSX export).
Unassigned Queue + Self-Assignment
Role-aware queue for nurses and MDs with race-condition handling. Assignment shifts from manager-driven to self-service.
Letter Generation
Production letter generation pipeline. Auto-triggered on decision events — provider and beneficiary.
Review List & Filters
Active Filters Bar, SLA status filters, Pending-only filter, role-based default views — tuned for high-volume daily use.
Compliance & Audit
Append-only notes on completed cases with audit logging, full audit trail, and Affirm/Non-Affirm auto-save for traceability.
Three commitments most platforms can't make.
CMS-grade deployment isn't about feature parity. It's about the constraints you've designed into your architecture — and that an auditor doesn't have to take on faith.
Architectural, not policy
Every clinical non-affirmation routes through Agent 871 to a mandatory human reviewer. The constraint lives in the agent graph, not in a written policy. An auditor can verify it from the code path itself.
Audit response is a build artifact
Aether SDLC produces the audit packet as part of every release. Rule-pack hash, evidence chain, agent reasoning, human-review record — reconstructable from on-premise logs alone. Read the methodology →
New service category in a markdown file
Adding a new WISeR service category — or a new MAC jurisdiction — requires only a rule-pack markdown file and a mapping-table row. Not a new service. Not a new build. Not a new deploy.
Auto Approval Agent. Near real-time PA.
The next capability landing on the WISeR platform is the Auto Approval Agent — bringing eligible prior authorizations to a determination in near real time, while every non-affirmation continues to route through mandatory human review.
Near real-time auto approvals
For PA requests where the clinical evidence cleanly meets criteria, the Auto Approval Agent issues a determination in seconds — not days. Providers and beneficiaries get an answer at the speed of submission.
Auto-deny remains prohibited
The Auto Approval Agent only approves. Every non-affirmation still routes through Agent 871 to a mandatory human reviewer. The architectural commitment doesn't change — the speed of the affirmative path does.
Faster care for eligible patients
Eligible patients receive the equipment, procedure, or service authorization they need without waiting on a queue. Clinical reviewers focus their time on the cases that genuinely require clinical judgment.
Authoritative sources.
Direct links to the CMS, MAC, and federal-system pages that anchor the WISeR deployment. The same canonical sources our rule packs and operations cite.
CMS WISeR Model
Innovation Center program page. Model overview, participants, performance years 2026–2031, six-state geography. Open →
cms.govWISeR FAQ
Frequently asked questions on the model — coverage, participation, prior authorization workflow, and beneficiary impact. Open →
cms.govMAC JL overview
CMS page for A/B MAC Jurisdiction L — Novitas Solutions awardee, contract details, beneficiary and provider counts. Open →
novitas-solutions.comNovitas Solutions · JL
Operator partner portal. Provider-facing resources for MAC JL services across DE, DC, MD, NJ, PA. Open →
cms.govHETS
HIPAA Eligibility Transaction System — CMS's real-time 270/271 eligibility verification API for Medicare beneficiaries. Open →
pecos.cms.hhs.govPECOS
Provider Enrollment, Chain & Ownership System — CMS system of record for all Medicare provider and supplier enrollment data. Open →
cms.govesMD
Electronic Submission of Medical Documentation — CMS's gateway for transmitting medical records in support of claims and appeals. Open →
cms.govLCD L33906 · ESI
Local Coverage Determination for Epidural Steroid Injections for Pain Management — the coverage policy our ESI rule pack is anchored to. Open →
cms.govWISeR launch announcement
The June 2025 CMS press release announcing the WISeR Model — full program rationale and stakeholder context. Open →
Key team members.
The team accountable for the live CMS Medicare FFS prior authorization deployment in New Jersey — architecture, program management, operations, and platform infrastructure.
Production Medicare. Production proof.
If you're a payer, provider, or government program evaluating healthcare AI, the WISeR deployment is what production looks like. Let's talk about what that means for yours.