Cohere Connect™
Accelerate prior authorization compliance with proven APIs
Drive true interoperability across your prior authorization workflow and reduce provider burden. Give providers the ability to easily submit requests from their workflows–without calls or faxes. Cohere Connect enables health plans to comply with the Centers for Medicare & Medicaid Services’ (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). Six million authorizations have already run through Cohere’s APIs, giving you a proven, scalable solution for your compliance needs.
Automating prior authorization is more complex than it seems. Cohere also digitizes medical policy that is essential to automating workflows, helping health plans reduce resources spent to minimize the overall administrative burden for providers and your UM team.
Automating prior authorization is more complex than it seems. Cohere also digitizes medical policy that is essential to automating workflows, helping health plans reduce resources spent to minimize the overall administrative burden for providers and your UM team.
93%
provider satisfaction rating
94%
digital adoption rate for payers
6M
authorizations processed
Connect with providers to reduce administrative costs
Cohere’s APIs are in production today with health plans. They meet and exceed the HL7® Da Vinci Implementation Guide standards, along with SMART® on FHIR® app, and deliver additional capabilities essential to supporting efficient prior authorization workflows.
CMS-0057-F APIs
Coverage Requirements Discovery (CRD)
Check if prior authorization is required and confirm service is covered.
Documentation Templates and Rules (DTR)
Gather and submit required documentation for the request.
Prior Authorization Support (PAS)
Submit the authorization request and learn the outcome.
Address the hidden complexities of prior authorization with provider guidance, policy management, and data configuration
Automate provider guidance
Give providers support to deliver the right information up front and adhere to rules with Cohere’s API-based process prompts.
Digitize medical policies
Benefit from digitization and support to streamline provider workflows and plan operations.
Configure data connections
Configure clinical documentation requirements based on procedure, diagnosis, site of service, and more.
How Cohere Connect works
Partner with UM experts
Reduce the time and resources spent on prior authorization and avoid care delays with support for the end-to-end clinical workflow. Cohere Connect was developed by prior authorization experts to be configurable and support changing policies and frequently updated member requirements.
Deliver streamlined submissions. Give providers the exact documentation requirements, configurable by procedure, diagnosis, place of service, and provider type.
Save on administrative costs. Efficiently route requests when using multiple prior authorization vendors or teams.
Gain flexible policy support across lines of business. Cohere Connect works with a broad range of policies, including CMS, industry guidelines, and health plan custom policies.
Unify Intake + Unify Decisioning enable an end-to-end digitized prior authorization workflow
Unify Transformation adds data analytics, clinical choice influence and care path/episodic models to evolve from a transaction focus to a care journey focus.
Gain comprehensive support for UM
Transform your utilization management workflows with additional solutions supported by the award-winning Cohere Unify™ Platform, including automation and delegated services. Cohere provides the capability and the flexibility to streamline your UM operations as they are today, and help you get where you want to be tomorrow.
