Intelligent prior authorization enables faster access to care and higher quality outcomes for members while enhancing provider experience and improving operational efficiencies
BOSTON, CLEVELAND, and COLUMBUS (June 4, 2024) – Cohere Health®, a recognized leader in clinical intelligence and prior authorization automation, Medical Mutual®, the oldest and one of the largest health insurance companies based in Ohio, and Rhyme®, the leading EHR-integrated prior authorization automation company, announced a strategic partnership that completely automates the end-to-end prior authorization process, when clinically appropriate.
Cohere’s intelligent prior authorization platform streamlines Medical Mutual’s process by digitizing and automating all authorization requests regardless of source. The solution digitizes portal requests and seamlessly integrates with EMR systems via Rhyme to provide a touchless authorization experience. This allows for real-time automatic approval when clinically appropriate. As a result, Medical Mutual will surpass turnaround time and other federal requirements outlined in CMS’s Interoperability and Prior Authorization final rule well before the 2026 and 2027 deadlines.
“Working with Cohere Health and Rhyme is a major step toward executing our strategy to streamline the prior authorization process,” said Christian Corzine, Vice President, Clinical Population Health, Medical Mutual. “This partnership enables faster, improved clinical outcomes for our members while reducing administrative burdens for our providers through enhanced workflows and automation.”
Currently, several major Ohio health systems are utilizing Cohere’s intelligent prior authorization platform and Rhyme’s EHR-integrated network for a touchless provider experience, including the Cleveland Clinic, The Ohio State University Wexner Medical Center, and OhioHealth.
“We’re thrilled to partner with Medical Mutual to provide a best-in-class experience for their providers and members,” said Krishna Kottapalli, Chief Growth Officer, Cohere Health. “Through deep clinical expertise, analytics, and advanced AI technology, we are providing a differentiated approach that fully automates their prior authorization process, facilitates faster member access to care, and lays the foundation for an enhanced holistic approach to managing the patient care journey.”
“Our partnership with Medical Mutual and Cohere enables an industry-leading, end-to-end, touchless prior authorization process, which eliminates provider burden, returns decisions in real-time, and allows providers to see results almost immediately,” said Joe Anstine, CEO, Rhyme.
Cohere’s intelligent prior authorization platform uses a unique blend of AI and deep clinical intelligence to help providers and members get to an appropriate “yes” more quickly, which in turn drives better, faster clinical outcomes, and saves unnecessary expense vs. traditional utilization management programs. It also transforms prior authorizations into a springboard for providing patients with services that support them from the start to the end of their treatment.
Cohere processes over 5.6 million intelligent prior authorization requests annually, positively impacting more than 15 million health plan members and 457,000 healthcare providers nationwide.
###
About Cohere
Cohere Health is a clinical intelligence company that provides intelligent prior authorization as a springboard to better quality outcomes by aligning physicians and health plans on evidence-based care paths for the patient’s entire care journey. Cohere’s intelligent prior authorization solutions reduce administrative expenses while improving patient outcomes. The company is a Top 5 LinkedIn™ Startup, winner of the TripleTree iAward, consecutive KLAS Research’s Points of Light recipient, and has been named to Fierce Healthcare’s Fierce 15 and CB Insights’ Digital Health 150 lists. Cohere’s investors include Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.
About Medical Mutual of Ohio
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million Ohioans through our high-quality health, life, disability, dental, vision, and accident and critical illness plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and Individual and Family plans. Medical Mutual’s status as a mutual company means we are owned by our members, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that help people live healthier through all stages of life.
About Rhyme
Rhyme is an EHR-integrated prior authorization service that enables automated touchless processing of prior authorizations for providers and payers, eliminating burden and making results observable in real-time. Rhyme currently partners with over 300 health plans and 50 of the largest health systems in the country processing over 4 million authorization cases per year. Rhyme was the KLAS Points of Light overall award winner in 2023 and 2024 in recognition for collaboration between providers, payers and partners in healthcare.
Share:
About the Author: Cohere Health
