What questions are you asked over and over? Here’s mine: when I tell health plan leaders that we have achieved a 92% provider satisfaction rating, they always ask how we do it. I’ll let you in on the secret.

In a sentence: By designing innovations that help health plans better collaborate with physician partners.

One of the most innovative ways we facilitate collaboration is with physician green lighting. By using AI to leverage prior authorization (PA) data, green lighting is a gold carding alternative that eases providers’ prior authorization burden without sacrificing control over utilization.

Here’s how it works:

🖥️ AI analyzes provider PA data to identify outlier providers and provider groups
✅ PAs from high-value providers are expedited but don’t shut down PAs entirely
📊 Provider scorecards can be used to address gaps in documentation or clinical education
⏱️ Routine PAs are likely to be automatically decisioned, improving timely access to care

Prior authorization is often a point of friction between physicians and health plans. But it doesn’t have to be. Learn the secret to reducing physician burden in prior authorization.

Featured Content

Regulatory 360 Series: Six questions to guide a discussion inclusive of the provisions in CMS’s interoperability & PA rule.

News You Can Use

💳 Gold carding has mixed effects on streamlining prior authorization processes (HealthPayerIntelligence)
An AHIP survey of commercial health plans found that gold carding policies may not consistently deliver, citing decreased quality and administratively difficult implementations.

🩺 Facing care denial, oncologist sees 4-week wait for P2P consult (AMA)
Texas physicians hoped gold carding law would “help lessen the maddening care impact of prior authorization,” but implementation has proved problematic.

❌ Insurers end gold card programs for these 3 reasons (Becker’s)
Commercial plans discontinue gold card programs for three main reasons: administratively difficult to implement; decreased quality/patient safety; higher costs without improved quality.

Regulatory Roundup

🗓️ Now is the time to develop your CMS Prior Authorization Rule compliance plan
Curious to see how our solutions stack up against the six compliance questions above?

4️⃣ Four things you need to know about the CMS Medicare Advantage Rule
What does CMS’s Medicare Advantage and Part D Final Rule mean for utilization management?

Cohere Minute

🎙️ Improving patient care access through enhanced prior authorization
We talk with Urban Health Today about CMS’s proposed rule on advancing interoperability and improving the PA process.

🤝 KLAS recognizes health plan & provider collaboration
Our partnership to streamline the cardiovascular prior authorization process and incorporate suggested care plans received national recognition.