Intelligent Prior Authorization
Digitize prior authorization and improve care quality
Solutions that foster
collaboration, not abrasion
Cohere combines responsible AI and machine learning (ML), deep, evidence-based clinical expertise and real-time analytics to digitize the process, support CMS-0057-F compliance needs, and guide the best and fastest care across the entire patient journey.
Lower administrative costs and support compliance needs for your health plan
Less abrasion and faster turnaround for your providers
Faster and better outcomes for your members
Our solutions
Cohere’s Automation Solutions digitize and streamline manual prior authorization processes, enabling Clinical Innovation Solutions to apply AI/ML to data and influence the end-to-end patient journey. Cohere’s Compliance Solutions support API-based prior authorization mandates.
Automation Solutions
Intake
Digitizes all prior authorization requests into a single automated workflow.
Decisioning
Automates prior authorization decisions using health plan-preferred policies and accelerates manual review.
Review
Helps clinical reviewers adjudicate complex requests, using responsible AI/ML and automated capabilities.
CMS 0057-F Compliance
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.
All supported by the Cohere Unify™ Platform
The Cohere Unify Platform delivers touchless and predictive technologies, evidence-based clinical content, and other advanced technical specifications to power Cohere PaaS, Cohere Complete, and Cohere Connect.
Touchless technologies
Reduces or eliminates manual steps toward creating an end-to-end fully automated prior authorization process.
Predictive technologies
Predicts the “next likely step” or “next best action” to virtually eliminate prior authorization workflow steps and automatically craft specific evidence-based patient care plans that are clinically appropriate.
Advanced technical specifications
Enables interoperability with all related provider and payer IT systems, including EHRs and UM systems, via FHIR, 278, SSO, and other widely-accepted standards, as well as proven compliance support for CMS-0057-F.
The ROI of a better approach - actuarially verified 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
