Evidence-based Suggestions

At Cohere, our goal is to streamline and simplify the authorization process to improve patient experience and make this process easier for you and your team.  Evidence-based suggestions are one feature in our software to help your organization provide high-quality care for your patients, ultimately leading to more auto-approvals

What is an evidence-based suggestion?

Evidence-based suggestions are simple messages that indicate how to align your request with Cohere’s clinical guidelines. You are not required to accept these suggestions.

What are the different types of evidence-based suggestions?

The table below provides a brief description of each type of suggestion when you could encounter these, and if there is an action required. Please see page 2 for screenshot examples.

The platform will also alert you if there are no evidence-based suggestions for the information you entered within the request.

Type Action When will you experience it? Description
Platform No action required Pre-submission within the Cohere platform When we suggest making changes to your authorization so your request can become eligible for auto-approval.
Action recommended Post-submission via fax

You will receive an automated fax after you submit your authorization request if there are no attachments included with your request.


At this stage, you are not blocked from moving forward, however, you will need to upload documentation for Cohere to review your request.

Operational Action recommended

Post-submission

A phone call or email (when possible) directly from our nurse reviewers when we suggest making changes to your authorization so your request can become eligible for auto-approval.
Redirect Action required: “Hard stop” Within the Cohere platform during submission

Based on guidelines, these messages will present when you need to make a change. Examples include: 

  • When a service or state is not delegated to Cohere 
  • When a procedure code is not affiliated with the service you are requesting

 

Examples

In platform pre-submission: NO ACTION REQUIRED

  • When you see a message like this, you are NOT required to take action.
  • In most cases, you will have the ability to accept these suggestions, or dismiss and continue with your submission.

Redirect message in the Cohere platform: ACTION REQUIRED

  • When you see a message like this, you will be required to take action. In this example, the procedure code entered is affiliated with a different service so you must either…
    • remove the code and continue with request OR;
    • cancel the service request

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Have more questions?
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