Transformative solutions digitize prior authorization and add clinical intelligence to reduce administrative burden while drive faster, better care
Cohere Health, a recognized leader in transformative prior authorization (PA) technology, today introduced Cohere Unify™, a health plan software-as-a-service solution suite that automates prior authorization intake and decisioning using advanced analytics and AI/ML algorithms, to drive administrative efficiency while adding transformative capabilities to speed and improve patient outcomes. The offering includes solutions proven in Commercial, Medicare and Medicaid lines across national, Blue Cross Blue Shield, and provider-sponsored health plans representing over 15 million lives.
Prior authorization remains a massive administrative burden for health plans and their provider partners, and can delay patient care. As a result, new state and CMS regulations will require plans to automate and speed up PA. For forward-thinking plans, investing in compliance also presents an opportunity to improve patient care journeys, and to enable more successful value-based care arrangements. Cohere Unify offers intelligent prior authorization solutions that enable regulatory compliance, while improving patient experience and outcomes across the entire care journey.
“For too long, prior authorization has relied on manual, disconnected processes that ultimately delay patients’ access to care,” said Siva Namasivayam, CEO of Cohere Health. “Cohere Unify applies advanced technology to remove the administrative and technical roadblocks that hinder seamless authorization. Beyond improving PA, Cohere Unify adds clinical intelligence and advanced analytics to enable truly collaborative, optimal care journeys, leading to better patient experience and outcomes. Over 4.5 million PA requests transactions are processed today on Cohere Unify, proving its scalability and successful implementations. Our solutions can be deployed immediately.”
Cohere Unify can be licensed by health plans, health providers taking risk, and other organizations with UM operations, utilizing a software-as-a-solution approach. The suite supports all medical service types, and is comprised of three distinct solutions that can be deployed together or standalone:
- Cohere Unify Intake digitizes and consolidates prior authorization requests across all sources to decrease health plan and provider administrative burden. The solution converts fax requests to an electronic format, integrates with provider EHRs, and integrates with health plan authorization portals, enabling automated request input and clinical review.
- Cohere Unify Decisioning ensures clean authorization requests and drives automatic, real-time PA decisions based on a health plan’s preferred clinical policies, while accelerating manual clinical review when necessary. Together, these capabilities have been proven to drive a high rate of immediate approvals, reducing turnaround times by 70% and administrative costs by 30-40%.
- Cohere Unify Transformation goes beyond traditional transaction-based PA by leveraging deep, evidence-based intelligence, AI and machine learning technology to improve care quality while reducing denials – without raising costs. The solution also provides advanced clinical guidance to providers at the point of authorization, suggesting optimal care choices based on patient cohort-specific data. Cohere Unify Transformation’s use of care paths and episodic authorizations enables stronger collaboration between health plans and providers by supporting the entire patient care journey, which enables more successful value-based care arrangements and better overall patient outcomes.
Cohere Unify is available immediately. Learn more about the suite’s components, features, and options on the dedicated Cohere Unify hub.
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