Can we submit prior authorizations by fax? Why should we use the Cohere portal?

• We strongly recommend that you use our portal to submit prior authorizations. This method of submission will result in much faster turnaround times, often even automatic approvals, and allows you to easily reference past authorizations. However, we can accept submissions by fax, phone, or email if the portal is not an option.

Why do you ask clinical assessment questions?

• Asking clinical assessment questions helps enable us to auto-approve your authorizations if they are clinically appropriate, giving you an authorization number in real-time and allowing you to avoid delays in care for your patients. 

How do I check on the status of an authorization?

• To check on the status of an authorization, please log into Cohere’s portal and search for the relevant authorization. If you submitted an authorization via fax, phone or email, you can also check the status of your authorization online without logging in.

What happens if a request pends for review? What is your clinical review process?

• When the Cohere portal cannot auto-approve your authorization, our clinical team of physicians and nurses will review your request against our guidelines. This team will get in touch with you with any questions.
• You can view pended authorizations for your practice by logging in to the portal and selecting the “pended” filter on the left side of the page. Each authorization will have a pend reason which explains why the authorization is pending and any actions you need to take to resolve the issue. In addition, a member of our team will reach out to share more about what information is needed.

What are your expected turnaround times for pended authorizations? 

• Required determination timelines are set by standards required by the State and Federal government for different types of requests (Standard or Expedited). Medicare Guidelines are set by the Center for Medicare and Medicaid Services (CMS). Cohere’s goal is to surpass these required guidelines with aggressive turnaround time goals that exceed the required standards.
• If you are interested in viewing specific timing, please use your Cohere username and password to sign in to the Learning Center.

My provider or facility is not appearing in Cohere’s portal or is incorrect. What should I do?

• Submit a support request and then follow the suggestions below (as applicable):
  • Missing/incorrect ordering provider: Please notify the payer to have the provider directory updated. 
  • Missing/incorrect performing provider:  Please notify the payer to have the provider directory updated. Performing provider is optional and can be left blank if needed. 
  • Missing/incorrect facility: Please notify the payer to have the facility directory updated. You can also manually enter the facility information for the request.