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LEVERAGE AI TO TRANSFORM
PRIOR AUTHORIZATION


FROM TRANSACTION


TO CARE JOURNEY


MANAGEMENT


THE PROBLEM


THE PRIOR AUTH MAZE CAN SLOW CARE ACCESS AND HINDER QUALITY OUTCOMES.


THE ANSWER


COHERE UNIFY™ PLATFORM

Our solutions


OUR AI THOUGHT LEADERSHIP ARTICLES


AI IS ALREADY TRANSFORMING PRIOR AUTHORIZATION

SEPTEMBER 29, 2023


FORECASTING HEALTHIER TOMORROWS: THE PREDICTIVE POWER OF AI AND PATIENT DATA

SEPTEMBER 21, 2023


AI GUARDRAILS THAT CAN ELIMINATE PA DENIAL NIGHTMARES

AUGUST 3, 2023


HEALTH CARE’S QUEST FOR RESPONSIBLE INNOVATION

AUGUST 23, 2023


FUTURE PROOFING HEALTHCARE AUTOMATION: CONSTRUCTING A RESPONSIBLE AI FRAMEWORK
FOR PRIOR AUTHORIZATION

SEPTEMBER 28, 2023


5 WAYS TO DRIVE INTELLIGENCE INTO THE PRIOR AUTHORIZATION PROCESS

AUGUST 3, 2023





Discover Our AI-Powered Outcomes


DIGITIZE THE ENTIRE PRIOR AUTHORIZATION PROCESS AND DRIVE BETTER OUTCOMES WITH
THE COHERE UNIFY™ PLATFORM

Automation Solutions
Clinical Innovation Solutions


INTAKE


DIGITIZES ALL PRIOR AUTHORIZATION REQUESTS INTO A SINGLE AUTOMATED WORKFLOW.

Submits through a single sign-on portal
Integrates with electronic medical records (EMR)
Digitizes fax submissions via optical character recognition (OCR) 


DECISIONING


AUTOMATES PRIOR AUTHORIZATION DECISIONS USING HEALTH PLAN-PREFERRED POLICIES AND
ACCELERATES MANUAL REVIEW. 

Scans with prior authorization check
Checks for missing info with a completeness scan 
Guides automated clinical review 
Prepares pended review pre-processing documentation for clinical review 


REVIEW


ASSISTS CLINICAL REVIEWERS, USING RESPONSIBLE AI/ML AND AUTOMATED CAPABILITIES.

Prioritizes 100% of cases with automated queue management
Completes AI-assisted manual review 
Develops letter generation



OPTIMIZATION


LEVERAGES CLINICAL INTELLIGENCE TO IMPROVE UTILIZATION MANAGEMENT PERFORMANCE.


Performs trend monitoring and management
Provides prior authorization list (PAL) recommendations.
Deploys care choice guidance 
Identifies clinical policy optimization

Enables provider green lighting

Alerts on abuse detection

Reports early trend signals



TRANSFORMATION


IMPROVES PATIENT AND POPULATION OUTCOMES WITH INNOVATIVE, SPECIALTY-SPECIFIC
PROGRAMS.  

Generates personalized care path authorizations
Bundles requests into episodic authorizations
Identifies care program links 
Provides network intelligence and provider improvement
Delivers outcomes measurement reports

Cohere Unify™ Platform
Cohere PaaS™
Cohere Complete™
Cohere
PaaS™
Cohere
Complete™
Cohere
Unify™ Platform


COHERE UNIFY™ PLATFORM


DRIVES COHERE'S ADVANCED CAPABILITIES WITH INNOVATIVE TECHNOLOGY AND DESIGN

The Cohere Unify Platform incorporates artificial intelligence/machine learning,
rules, and advanced analytics engines, plus current integration/interoperability
capabilities (including FHIR), to drive Cohere’s innovative, end-to-end
capabilities.

Cohere Unify™ Platform


THERE ARE TWO DELIVERY OPTIONS FOR THE COHERE UNIFY PLATFORM.


COHERE PAAS™


ENABLES HEALTH PLANS TO LICENSE ANY OF COHERE'S PLATFORM AS A SERVICE (PAAS) FOR
USE BY THE PLAN'S INTERNAL UM STAFF.


Cohere PaaS™


COHERE COMPLETE™


INCLUDES ALL OF OUR SOLUTIONS, PLUS INTAKE AND CLINICAL STAFF, TO PROVIDE FULLY
OUTSOURCED AND DELEGATED SPECIALTY UM SERVICES.

For select medical specialties, Cohere Complete provides a fully outsourced,
delegated service to manage a health plan’s entire UM operations.
Cohere Complete


OUR CAPABILITIES HAVE DRIVEN THESE UNIQUE, ACTUAL 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


GET STARTED WITH COHERE




ACCREDITATIONS


AWARDS





SEE A REAL STORY OF HOW OUR APPROACH TO PRIOR AUTHORIZATION IMPROVES PATIENT
OUTCOMES WHILE ALSO SAVING TIME AND COST.




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