For benefits professionals, compliance is more than an obligation—it’s an opportunity to streamline care access, reduce frustrations, and enhance the overall employee benefits experience.


Prior authorization has long been a contentious process in health care. Providers often see it as a barrier to patient care, while health plans recognize the process as essential for cost control and care quality. As we head into 2025, however, regulatory shifts and technological advancements are transforming prior authorization into a tool that benefits professionals can leverage to improve employee health outcomes and satisfaction.

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)–of which some provisions are set to take effect by 2026–mandates faster decision-making, improved transparency, and better data sharing throughout the prior authorization process. Combined with state-level reforms, these changes will require both health plans and benefits administrators to innovate. For benefits professionals, compliance is more than an obligation—it’s an opportunity to streamline care access, reduce frustrations, and enhance the overall employee benefits experience.

Published On: December 12th, 2024Categories: News

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About the Author: Brian Covino, M.D., FAAOS

Dr. Brian Covino oversees more than 50 physicians as Cohere Health’s Chief Medical Officer. After practicing orthopedic surgery for more than 25 years, Dr. Covino joined Cohere in 2020 after having served as a consultant since 2018. During his years as a practicing surgeon, Dr. Covino was a partner at Knoxville Orthopaedic Clinic/OrthoTennessee specializing in joint replacement surgery. He holds a bachelor’s from Harvard University as well as an M.D. from Georgetown University School of Medicine. Dr. Covino received his surgical training at the University of Virginia Graduate School of Medical Education and completed a fellowship at The Cleveland Clinic Foundation.