Answering frequently asked questions about the CMS final rule’s prior authorization provisions
Cohere Health Blog
by Mary Krebs, M.D., FAAFP
1w ago
The passage of CMS-0057-F includes key prior authorization provisions to improve interoperability, turnaround times, transparency, and accountability. Of the frequently asked questions about the final rule we’ve received, intelligent prior authorization rises to the surface as the strategic choice for health plans seeking to satisfy the requirements. Answering frequently asked questions about the changes coming to prior authorization How will implementing standard APIs help health plans make the transition to greater interoperability? The prior authorization process is fraught with delays an ..read more
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How episodic prior authorizations position health plans to transform MSK care management
Cohere Health Blog
by Cohere Health
1w ago
Episodic authorizations use a high-profile event to consolidate authorizations for multiple related services to lighten the associated administrative burden and length of a care episode. After a two-phase pilot of using episodic authorizations to improve care for patients receiving total knee arthroplasty (TKA), Cohere Health has seen: Reduced administrative burden: Providers were no longer required to submit a prior authorization request for physical therapy (PT), saving 13 mins per patient. Improved Utilization: Average physical therapy utilization was reduced by six units per patient, li ..read more
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The Regulatory Issue: How CMS changes will drive better patient outcomes ?️
Cohere Health Blog
by Alina Czekai
1w ago
On January 17, 2024, The Centers for Medicare & Medicaid Services (CMS) finalized a rule to advance interoperability and improve prior authorization. Subscribe The final rule largely resembles its proposed form with some key additions, as follows: The implementation deadline for FHIR-based APIs is now January 2027 Enforcement of HIPAA X12 278 standard for interoperability APIs A publishing deadline for the first prior authorization metrics Additional components of patient access, provider, and payer-to-payer APIs An exception to turnaround time requirements (TAT) Having served as s ..read more
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Green lighting solutions to address barriers in health care prior authorizations
Cohere Health Blog
by Brian Covino, M.D., FAAOS
3w ago
Our Chief Medical Officer, Dr. Brian Covino, discusses how green lighting is a path forward to automating prior authorization workflows, reducing red tape, and complying with regulatory changes.  Please introduce yourself by stating your name, title, organization, and professional experience.  I am Dr. Brian Covino, Chief Medical Officer at Cohere Health, where I oversee more than 50 physicians. My team of doctors ensures the company’s intelligent prior authorization platform is grounded in evidence-based clinical knowledge and expertise. Before joining Cohere as one of the first e ..read more
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Five trends to watch: AI-powered prior authorization
Cohere Health Blog
by Brian Covino, M.D., FAAOS
1M ago
Increasing the use of advanced technology applications in the prior authorization process helps health plans reduce physician burden and improve quality of patient care. As health plans and other stakeholders get more comfortable with AI, it can drive true transformation in utilization management, as the five trends below demonstrate. 1. Vintage can still be modern Utilization management and prior authorization specifically, is facing much criticism for its time-consuming and inefficient processes that create an undue burden for providers and can delay care for patients. Recent regulations ..read more
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The AI Technology Issue: How AI is shaping healthcare in 2024
Cohere Health Blog
by Brian Covino, M.D., FAAOS
1M ago
2024 ushers in a new era of patient-centric care by overhauling outdated prior authorization (PA) processes. Subscribe Watch this 55-second video to see how health plans are using AI to fix PA problems. I’m excited about how AI makes it possible to process and analyze extensive data at an unprecedented scale and speed. When used responsibly, AI can help physicians anticipate potential health issues and proactively intervene to drive better patient outcomes. However, predictive modeling still requires the human touch of a clinician to determine the best course of action for ..read more
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Transform your utilization management with the increased use of advanced AI technology
Cohere Health Blog
by Cohere Health
1M ago
Based on five trends of how healthcare plans are using AI-powered prior authorization, here are some actions health plans can take: Meet providers where they are while satisfying regulatory requirements and laying the foundation for more advanced AI-driven capabilities Use AI to not only accelerate authorization approvals but to increase approval rates Leverage clinical notes and claims data to engage with physicians, reduce medical expense, and improve care quality Satisfy compliance concerns while improving collaboration with provider-specific and patient-specific analytics Tailor treat ..read more
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How keeping up with CMS regulatory changes will drive better patient outcomes, care collaboration, and interoperability
Cohere Health Blog
by Cohere Health
1M ago
The final rule (CMS-0057-F) represents a critical step toward alleviating the significant challenges long-faced by those navigating the traditional prior authorization process. Here are some key takeaways: Medicare and Medicaid plans should strategize and implement changes for the final CMS rule, which has an implementation deadline of January 1, 2027 (and January 1, 2026 for certain operational provisions). Digitizing prior authorization will solve many of the current issues facing health plans, patients, and providers because it will improve data exchange and collection and speed up the a ..read more
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Cohere Health Raises $50 Million in Equity to Meet Increased Demand for AI-Driven Transformation of Prior Authorization Process
Cohere Health Blog
by Cohere Health
1M ago
New funding propels Cohere’s expansion of intelligent prior authorization platform to drive better payer-provider collaboration, following CMS Interoperability and Prior Authorization Final Rule Boston, MA (February 1, 2024) – Cohere Health, a recognized leader in clinical intelligence and prior authorization automation, announced it has closed $50 million in additional equity funding. The funding was led by Deerfield Management, with participation from Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, and brings the total raised by Cohere to $106 million. The ..read more
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Four things you need to know about the final CMS prior authorization rule
Cohere Health Blog
by Alina Czekai
2M ago
How health plans can prepare On January 17, 2024, The Centers for Medicare & Medicaid Services (CMS) finalized a rule to advance interoperability and improve prior authorization for Medicare and Medicaid patients. At Cohere Health, we are especially encouraged by the stipulations for improving prior authorization included in the rule and see it as a step in the right direction. This initiative will improve transparency, reduce physician burden, and lead to faster patient access to care. Cohere sees the CMS final rule as an opportunity for plans to evolve from transaction-focused prior au ..read more
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