AuthParency

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. Cohere delivers a tailored, modular, and configurable solution suite for health plans. Digitizes all prior authorization requests into a single automated workflow. Automates prior authorization decisions using health plan-preferred policies and accelerates manual review. Helps clinical reviewers adjudicate complex requests, using responsible AI/ML and automated capabilities. Leverages clinical intelligence with AI/ML and advanced analytics to improve utilization management performance. Improves patient and population outcomes with innovative, specialty-specific programs.

The Cohere Unify platform supports all of our intelligent prior authorization solutions with touchless and predictive technologies, evidence-based clinical content, and other advanced capabilities. Our technologies reduce or eliminate manual steps toward creating an end-to-end fully automated prior authorization process. This predictive capability enables health plans to virtually eliminate prior authorization workflow steps. Instead, the system can automatically craft specific care plans based on patient and population auth and claims data, including multiple services that can all be pre-approved upfront before they are even requested. Evidence-based clinical criteria for select specialties that inform our touchless and predictive technologies. Proven single sign-on capabilities with Availity, NaviNet, and other common portal technologies. Rules configuration and deployment proven to scale over multi-million+ transactions.