Leverage AI to transform
prior authorization
from transaction
to care journey
management
The problem
The prior auth maze can delay care access and hinder quality outcomes
Our AI thought leadership articles
Automation Solutions
Compliance Solutions
Clinical Innovation Solutions
Intake
digitizes all prior authorization requests into a single automated workflow
Submits through a single sign-on portal
Integrates with electronic medical records (EMR)
Digitizes fax submissions via optical character recognition (OCR)
Decisioning
automates prior authorization decisions using health plan-preferred policies and accelerates manual review
Scans with prior authorization check
Checks for missing info with a completeness scan
Guides automated clinical review
Prepares pended review pre-processing documentation for clinical review
Review
assists clinical reviewers, using responsible AI/ML and automated capabilities
Prioritizes 100% of cases with automated queue management
Completes AI-assisted manual review
Develops letter generation
Compliance
helps plans looking to meet and exceed CMS-0057-F requirements
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Provides prior authorization FHIR®-standards-based APIs
Digitizes medical policies and manages updates
Offers SMART® on FHIR® app to streamline provider documentation submission
Optimization
leverages clinical intelligence to improve utilization management performance
Performs trend monitoring and management
Provides prior authorization list (PAL) recommendations.
Deploys care choice guidance
Identifies clinical policy optimization
Enables provider green lighting
Alerts on abuse detection
Reports early trend signals
Transformation
improves patient and population outcomes with innovative, specialty-specific programs
Generates personalized care path authorizations
Bundles requests into episodic authorizations
Identifies care program links
Provides network intelligence and provider improvement
Delivers outcomes measurement reports
Cohere Unify™ Platform
Cohere PaaS™
Cohere Connect™
Cohere Complete™
Our capabilities have driven these unique, actual results
Our capabilities have driven these unique, actual results
70%
Faster
access to patient care
Driven by real-time clinical intelligence at the point of diagnosis
63%
Decrease
in denial rates
Driven by evidence-based intelligence that guides clinically appropriate requests before submission
18-43%
Decrease
in adverse outcomes
Driven by AI/ML-based clinical suggestions (“nudges”) and analytic features in the prior authorization workflow
Get started with Cohere
Accreditations
Awards
See a real story of how our approach to prior authorization improves patient outcomes while also saving time and cost.
