Pain Management Auto-Approval Building Blocks

At Cohere, our goal is to make it easy to get approvals for clinically appropriate care. In response to your questions, Cohere has put together some quick tips to help you get more automatic approvals for your pain management requests.

The information below may be used as a guide for submitting pain management authorizations that will be eligible for auto-approval. The four categories below must all be included with your request. Click here to print this information.

 

1.  Document Conservative Care

Has conservative care been attempted? Conservative management is an approach to treating a variety of conditions utilizing non-surgical treatment options, such as physical therapy and medication.

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Any type of conservative care has been attempted All 5 types of care have been attempted for more than 12 weeks (except ESI; > 6 weeks)

 

2.  Demonstrate Improvement for Subsequent Injections

Is this request for a subsequent injection? The guidelines and requirements for requesting subsequent injections vary based on the procedure being requested.

3.  Attach Advanced Imaging

Was advanced imaging performed? Some procedures require that advanced imaging be performed. Please add the imaging documentation as an attachment prior to answering clinical questions.

4.  Document Patient Symptoms

A crucial piece to the auto-approval process is indicating all of the patient’s symptoms from the most recent finding. Please ensure all symptoms are thoroughly documented within the clinical assessment questions.

 

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