Cohere Advises Government on Prior Authorization Standards

Cohere Health Advises Federal Government on the Development of Electronic Prior Authorization Standards

Utilization management collaboration company supports FHIR data standards and implementation specifications, offers additional interoperability recommendations

BOSTON (March 29, 2022) – Cohere Health, a recognized leader in collaborative utilization management technology, announced that it has submitted recommendations to the Office of the National Coordinator for Health Information Technology (ONC) on the development of electronic prior authorization standards. Cohere urged ONC to help reduce the burden of adoption on providers by requiring electronic medical record (EMR) vendors to adopt ONC standards to drive a fully interoperable healthcare system.

Cohere’s intelligent authorization platform uses machine learning, interoperability, and advanced analytics to streamline the prior authorization process and accelerate patient access to high-value care. The platform aligns physicians and health plans on evidence-based treatment plans for the patient’s entire episode of care, driving improved care quality and reduced cost.

In January 2022, ONC issued a request for public input regarding electronic prior authorization standards, implementation specifications, and certification criteria that could be adopted within the ONC Health IT Certification Program, a voluntary health information technology certification program that uses requirements established by the Secretary at the Department of Health and Human Services.

In its response to ONC’s request for information, Cohere commented on the ability of the ONC Health IT Certification Program to successfully facilitate electronic prior authorization, noting the need for payers to be able to interrogate provider attachments for sufficient evidence to determine medical necessity. Cohere also expressed support for the adoption of Fast Healthcare Interoperability Resources (FHIR) standard to simplify the administrative workflow in prior authorization. As a modern data standard, FHIR allows for more flexibility than the X12 standard to convey critical clinical information regarding the patient’s condition and history.

“Transforming the prior authorization paradigm is a critical element of shifting our nation’s healthcare system toward value-based care,” said Siva Namasivayam, CEO of Cohere Health. “We will continue to engage with the ONC and other federal agencies to help inform the development of electronic prior authorization standards that facilitate the seamless sharing of information across providers, and between providers and payers, to support the delivery of high quality, evidence-based care.”