Cohere Health Unveils Cohere Connect™ to Address Prior Authorization Compliance Gaps for Health Plans

Cohere delivers proven APIs to support CMS-0057-F interoperability compliance and end-to-end submission process support–from digitization and integration, through submission and response

BOSTON, Jan. 29, 2025 /PRNewswire/ -- Cohere Health^®, a recognized leader in clinical intelligence, announces Cohere Connect^™, offering health plans the tools and support to meet and exceed the prior authorization (PA) compliance mandates outlined in the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). With Cohere Connect, providers can initiate the prior authorization process right from the provider EMR–reducing the provider burden and accelerating access to care for patients. Cohere Connect offers scalable APIs built to HL7^® FHIR^® standards, along with end-to-end process and integration support, addressing CMS requirements and their gaps.

Benefitting from Cohere's deep clinical and PA technology expertise, Cohere Connect goes beyond mandate specifications to address the unique complexities of prior authorization. With this offering, Cohere digitizes complex medical policies to address specialty and procedure-specific clinical guidelines, supporting an end-to-end prior authorization workflow. The APIs have supported six million submissions and offer providers intelligent guidance with workflow-based prompts and in-network checks to streamline processes. Cohere Connect also configures and connects to the required clinical and claims data needs based on line of business, procedure, diagnosis, place of service, and provider type to accelerate time to approval.

"Automated and expedited prior authorization is often more complex than it may appear," notes Cohere Chief Product Officer, Matt Parker. "Health plans need more than standards-based APIs to streamline processes and achieve faster decisions on care. Plans need to address system integration and policy digitization that go beyond the traditional API call and response. Using our years of experience in UM and PA automation–and our involvement in the Da Vinci Steering Committee–our solution addresses medical policies, as well as EMR, UM, claims, and other system integrations, to deliver a more complete solution."

Cohere Connect helps health plans with the critical capabilities for their CMS-0057-F compliance needs including:

• HL7 FHIR standards-based APIs supporting Da Vinci implementation guides, including:
  • Coverage Requirements Discovery (CRD) API, both highly configurable and scalable
  • Documentation Templates and Rules (DTR) API with support for thousands of policies
  • Prior Authorization Support (PAS) API, delivering smooth submission and response submissions
• SMART^® on FHIR app launched from the provider EMR to streamline documentation submission
• Policy digitization, mapping, and management services
• Developer documentation to support streamlined implementation

Cohere is unique in its comprehensive solutions for health plan prior authorization workflows beyond Cohere Connect. The company has achieved 96% digital platform adoption, and a provider NPS score of 64, through its AI-powered intelligent prior authorization platform and comprehensive clinical services. Cohere's portfolio delivers proven administrative efficiency, clinical quality, and medical expense savings.

To see a demo of Cohere Connect or Cohere's other capabilities, please contact us at https://coherehealth.com/connect/.

About Cohere Health, Inc.
Cohere Health is a clinical intelligence company delivering AI-powered intelligent prior authorization solutions, which streamlines patients' access to quality care by aligning their physicians and health plans for improved collaboration, transparency, and care coordination. Cohere works with nearly 600,000 providers and processes more than 12 million prior authorization requests annually, using AI to auto-approve up to 90% of requests for millions of health plan members around the country. The company was recognized twice in the Gartner^™ Hype Cycle^™ for U.S. Healthcare Payers, is a Top 5 LinkedIn^™ Startup for 2023 & 2024, and is a three-time KLAS Points of Light award recipient. Its investors include Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.

Contact:
Kat Long
anthonyBarnum Public Relations
[email protected]

Rachel Spiro
Cohere Health
[email protected]

SOURCE Cohere Health