Primary source: Humata Health via Business Wire, November 10, 2026, 9:00 a.m. · opened through the Hastings Tribune wire reprint. Business Wire returned 403 on a direct fetch.
On November 10, 2026, Humata Health said it is issuing provisional affirmations for Oklahoma providers in CMS’s WISeR model. When its system confirms a request meets Medicare medical-necessity criteria, the practice hears it within three minutes, instead of waiting on CMS, which the company says can take up to 24 hours. In the last 30 days it provisionally affirmed over 65% of eligible WISeR requests across more than 2,980 cases. The same day, Humana, Evolent, and American Oncology Network said qualifying AON clinics no longer submit traditional prior authorization for most anticancer drugs. Prior auth is splitting into two faster paths: a yes you can schedule on, and a case you no longer have to ask about.
Share of eligible Oklahoma WISeR requests Humata says it provisionally affirmed in the last 30 days, across more than 2,980 cases. The company says the rest may have needed more documentation or failed NCD or LCD criteria. That remainder is not published as a denial rate.
The wire is datelined Winter Park, Fla., November 10, 2026, and the Hastings Tribune reprint marks it published at 9:00 a.m. Humata says it is Oklahoma’s technology partner for CMS’s WISeR model, Wasteful and Inappropriate Service Reduction. The release says Humata was recently acquired by R1. The About section dates that acquisition to September 2026. RevCycleAI covered the agreement when it was announced, in August. Today’s operating numbers are not results from that earlier article, and they are not Ascension’s.
The new product is a timing change, not a new authority. Humata says its system has been able to make affirmative clinical determinations since WISeR began, but until now it told the provider only after CMS had processed the request. Providers can now get the provisional yes within three minutes, “often well ahead of when CMS finishes its own processing.” CMS still processes each request and still issues a unique tracking number on its own timeline. The company is explicit that a provisional affirmation covers clinical criteria only. Coding rules and payment rules still apply before a claim is paid.
The system’s limit is the part your denial team should underline. Humata says its AI “can only say ‘yes’ to a case and cannot issue a denial.” Anything it cannot clear routes to a licensed clinician. When the system cannot affirm in minutes, the release says human review is running at an average provisional turnaround of 2 hours and 15 minutes. That clock is the company’s, for the cases the model did not clear in minutes. It is not a CMS decision time, and it is not a claim-payment time.
| Figure | What the November 10 wire says it is |
|---|---|
| Within 3 minutes | How fast a provider can learn of a provisional affirmation, versus waiting up to 24 hours for CMS’s own processing. |
| Over 65% of more than 2,980 | Eligible WISeR requests provisionally affirmed in the last 30 days. The denominator is eligible requests, not all Medicare services in Oklahoma. |
| 2 hours, 15 minutes | Average provisional turnaround when the system cannot affirm in minutes and a person reviews. |
| 29 providers | Oklahoma providers qualified for Humata’s gold-carding program as of October 1. The company expects the count to grow. That is an expectation, not a result. |
“When a physician seeks prior authorization before moving forward with a scan or procedure, every extra hour that request sits in review means a longer wait for the patient,” said Jeremy Friese, MD, founder and CEO of Humata Health. “We spent months making sure we understood exactly how CMS applies its rules on the back end before implementing provisional affirmation. Our goal is to ensure Oklahoma providers experience the fastest, smoothest and most reliable prior authorization process possible.”
Gold-carding is the other door. Humata says the program exempts high-performing providers from prior authorization requirements. Twenty-nine Oklahoma providers qualified as of October 1. The release does not define the qualification rule, the services covered, or what happens if a gold-carded provider’s later requests miss the criteria.
Humata’s own newsroom, checked the same day, lists older items, including the R1 agreement and a November 2025 note that Humata was picked as a WISeR technology partner in Oklahoma. It does not yet list this provisional-affirmation release. The text used here is the Business Wire copy as reprinted by the Hastings Tribune, which points back to the Business Wire URL above. The company’s About boilerplate calls the platform “the only truly end-to-end prior authorization solution” and cites “the industry’s largest ecosystem of integrations.” Those are company lines. They are not a measured share.
This is the scheduling problem. A provisional affirmation is permission, from Humata’s read of Medicare medical necessity, to start the scan or the procedure without waiting on CMS’s tracking number. Your front desk can move a patient onto the schedule. Your billing office cannot treat that ping as a clean claim.
The release says the quiet part in one sentence: a provisional affirmation covers clinical criteria only, so other payment and coding rules still apply before a claim is processed for payment. Clinical approval is not payment. An NCD or LCD miss, a missing modifier, a unit count, a place of service, or a diagnosis that does not support the code will still edit or deny the claim after the patient has been treated. If your workqueue is set up to drop a WISeR case out of review the moment the provisional yes arrives, you have moved the denial from the auth desk to the claim editor. That is a location change, not a save.
The 65% needs the same treatment. It is a share of eligible WISeR requests, company-reported, over a 30-day window the release does not date beyond “the last 30 days,” across more than 2,980 cases. The parenthetical is the company’s, and it is doing real work: the rest “are not necessarily cases where the SI was unable to make an accurate determination.” They may have needed more documentation, or they may have failed the applicable Medicare NCD or LCD and gone to a person. You cannot read the complement as a 35% denial rate. You also cannot read 65% as the share of Oklahoma traditional-Medicare services that no longer need auth. Eligible WISeR requests are a slice. It is also not Humata’s earlier figure. On June 23, 2026, KFF Health News reported that Friese said there is an “immediate yes” in 88% of cases for which clinical data supports an approval. That denominator is cases the data already supports. Today’s 65% is a share of eligible requests, with a case count. They are not the same rate. RevCycleAI’s earlier JAMA coverage is about what happened to utilization in the six WISeR states. It is not this 65%. The House panel vote is a separate political track. Neither number in those pieces is Humata’s 30-day count.
Store three statuses, not one. Provisional clinical yes. CMS tracking number, which still arrives on CMS’s clock. Claim edit, which the release says is still in force. A scheduler who treats the first as the third will book the case. A biller who treats the first as the third will send a claim the payer can still reject.
Humana’s newsroom carries a second November 10 release, datelined Louisville, Ky. Humana Inc., Evolent Health, and American Oncology Network announced a cancer-care model “designed to improve the quality, timeliness and affordability of cancer care while reducing reliance on traditional prior authorization.” The model “has initially been rolled out across eight states to clinics within AON.” The release does not name the eight states. This article does not name them either.
The operating rule is narrower than “no prior auth in oncology.” Participating AON providers get a streamlined process for managing most anticancer drug therapies. Practices that demonstrate adherence to established quality and evidence-based treatment standards no longer submit traditional prior authorization for those therapies. “Most anticancer drug therapies” is the release’s scope. It does not say imaging, radiation, or every test is out of auth. A November 6, 2025 Evolent and AON announcement, a different document, talked about gold-carding most tests and treatments. That is not this Humana model, and its extra pieces are not imported here.
What the clinics do get, in this release: quality-improvement work, with periodic testing of patients on immunotherapy given as the example; automated reminders in the AON EHR; provider education; performance scorecards; Evolent oncology clinical pathways; and a data platform powered by Meaningful Insights Biotech Analytics, MiBA, developed with AON, using real-time EHR data. Evolent’s support line is pathways, quality programs, and provider performance reporting. No savings figure, no auth-volume baseline, and no count of exempted drugs is in the release.
“We are committed to easing access to quality oncology care for our members and helping to reduce the administrative burden for providers,” said Dr. Traci Granston, Humana vice president of clinical innovation. “A cancer diagnosis is difficult news to hear. By making access to affordable, quality care even easier to navigate and enabling more efficient use of high-cost therapies, we are working to ease the burden of cancer treatment. When members can accelerate the start of cancer treatment, the probability of better health outcomes increases.”
“We are excited to support Humana members living with cancer through this model,” said Dr. Stephen “Fred” Divers, AON chief medical officer. “Community oncology centers are the lifeblood of the cancer treatment landscape. Through this partnership, we’re bringing them the latest evidence and proven quality interventions to support their treatment decisions, while avoiding the typical friction around approvals that frustrates patients and providers.”
“Clinical innovation is not simply about introducing new technology. It is about creating systems and partnerships that make it easier for our care teams to do what is right for patients,” said Susan Sabo-Wagner, AON vice president of clinical innovation. “This collaboration represents an opportunity to shift from retrospective approvals toward proactive clinical quality improvement, where physicians and health plans work from trusted clinical information to support timely, appropriate care.”
“We’re honored by the trust that Humana has placed in us over the years to support its members in some of their most pivotal health moments,” said Dr. Von Nguyen, Evolent chief medical officer. “This new oncology model is emblematic of a partnership that is energized by the opportunity to rethink healthcare and innovate. Together with AON, we’re building a model that reduces reliance on prior authorization by aligning payers and providers around quality and affordability.”
The agreement, Humana says, builds on more than 20 years with Evolent, including Evolent’s New Century Health business. The About section says AON was founded in 2018 and represents more than 350 providers practicing across 21 states. That 21-state figure is the network. It is not the eight-state rollout, and the release does not say the model covers every AON clinic. RevCycleAI’s October note on Cencora’s announced agreement to acquire AON is a different transaction. Today’s release does not mention Cencora, and it does not say that agreement has closed.
Granston’s name will look familiar. She is the same Humana executive in the November 3 athenahealth FHIR expansion, which is about the electronic path for authorizations that remain. Humana’s earlier Medicare Advantage cuts are in the June coverage. Today’s oncology model is a third move: not a faster portal, and not a published code-list reduction, but an exemption for practices that stay on the pathway. Humata and Evolent are different companies on different books of business. Do not file a Humana anticancer-drug exemption as a WISeR gold card.
This is RevCycleAI’s read. Both announcements move prior auth off the case-by-case pile and onto a status you have to store. Humata’s status is a provisional clinical yes, a pending CMS tracking number, or a clinician review with a 2-hour-15-minute company average. Humana’s status is whether that AON practice is inside the exemption for that anticancer drug. Gold-carding, in Humata’s Oklahoma program, is a third status: 29 named-but-not-listed providers who no longer submit the auth at all, under rules the release does not print.
RCM teams that treat “no auth task in the workqueue” as “nothing to document” will lose the next audit. The exemption is the documentation. Eligibility of the practice, the drug, the pathway, and the payer-specific rule are the new fields. A Humana member at an AON clinic in one of eight unnamed states is not an Oklahoma traditional-Medicare WISeR patient, and a WISeR provisional yes is not a Humana drug exemption. Your editors still have to know which rule file applied on the date of service.
Humata’s release puts a 30-day count on a yes-only WISeR rate: over 65% of more than 2,980 eligible Oklahoma requests, back to the provider in three minutes. That yes is clinical. Coding and payment rules still apply. The June “88% of cases the data supports” is a different denominator. On the same day, Humana’s oncology move is the other version of “faster”: most anticancer drugs, at qualifying AON clinics, no longer go through traditional prior auth at all.
Schedule on the provisional yes if your medical director will own it, and still hold the claim to the coding rules the release refused to waive. The 65% is a real company operating statistic, with the company’s own caveat attached, and it is the first time this release has tied the yes to a 30-day count of eligible requests. It is not the 88% Friese gave KFF in June, it is not a denial rate, and it is not proof the model cut waste. CMS’s tracking number still arrives later. A later claim edit can still disagree with a three-minute clinical yes.
For the Humana model, the field to add is exemption status, not another portal login. Eight states, unnamed. Most anticancer drugs, not every oncology service. Pathway adherence is the condition, and the release does not publish the score that keeps a practice inside it. Until that score and those states are public, the announcement is a design, not a book-of-business forecast.
What the payer actually waived, what the AI is allowed to say, and what still has to be on the claim.
Sources: Humata Health via Business Wire, “Humata Health Launches Provisional Affirmations, Which Can Reduce the Prior Authorization Process to Within 3 Minutes,” November 10, 2026, 9:00 a.m., Winter Park, Fla. A direct Business Wire fetch returned 403. The body was opened on the Hastings Tribune reprint, which attributes the copy to Business Wire and links the same URL. Humata’s newsroom index did not list this release when checked. Humana newsroom, “New oncology model from Humana, Evolent and American Oncology Network eliminates prior authorization burden,” November 10, 2026, Louisville, Ky. (page opened). The matching Business Wire URL is the wire Humana’s page cites; a direct fetch of that URL timed out, and the Humana newsroom text is the copy used. Jeremy Friese’s quotation is verbatim from the Humata wire. Quotations from Traci Granston, Stephen “Fred” Divers, Susan Sabo-Wagner, and Von Nguyen are verbatim from the Humana newsroom text. The 65%, 2,980, three minutes, 24 hours, 2 hours 15 minutes, 29 providers, and October 1 date are Humata’s November 10 wire. The 88% is Jeremy Friese’s statement to KFF Health News, Darius Tahir, June 23, 2026, for cases in which clinical data supports an approval, and it is not the same denominator. The eight states are unnamed. AON’s more-than-350 providers and 21 states are the About section’s description of the network, not the model footprint. No savings figure was disclosed, and none is estimated.