Cohere PaaS™ Intelligent Prior Authorization
Replace prior auth complexity with intelligence
Cohere helps health plans digitize the process and apply clinical intelligence to enable in-house, end-to-end automation of prior authorization. Health plans can directly license Cohere’s PaaS intelligent prior authorization for use by the plan’s internal utilization management staff.
As a result, our client health plans achieve both significant administrative efficiencies and faster, better patient outcomes.
As a result, our client health plans achieve both significant administrative efficiencies and faster, better patient outcomes.
Our solutions
Cohere delivers a tailored, modular, and configurable solution suite for health plans.
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.
How Cohere PaaS™ works
Our intelligent digital technology reinvents the end-to-end prior authorization process
By bringing together responsible AI/machine learning and real-time analytics with deep, evidence-based clinical intelligence, Cohere enables the digital transformation of UM processes, driving greater operational efficiency, and most importantly, faster and better patient outcomes.
Cohere's solutions enable an end-to-end digitized prior authorization workflow
Automation Solutions
Intake
Decisioning
Review
Clinical Innovation Solutions
Optimization
Transformation
Unify Intake + Unify Decisioning enable an end-to-end digitized prior authorization workflow.
Unify Transformation adds data analytics, clinical choice influence and care path/episodic models to evolve from a transaction focus to a care journey focus.
Unify Intake + Unify Decisioning enable an end-to-end digitized prior authorization workflow
Unify Transformation adds data analytics, clinical choice influence and care path/episodic models to evolve from a transaction focus to a care journey focus.
All supported by the Cohere Unify™ Platform
The Cohere Unify Platform supports Cohere PaaS and Cohere Complete solutions with touchless and predictive technologies, evidence-based clinical content, and other advanced technical specifications.
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.
Results
Smart technology enables better results and experiences for your health plan and stakeholders
Health plan
25-40%
Reduction
in administrative costs
Provider
92%
Satisfaction rate
+ NPS score of 65
63%
Lower denial rate
without raising medical costs
Patients
70%
Faster
access to patient care
