Submitting Therapy Requests

Humana has made Cohere Health the delegated preauthorization vendor for outpatient physical therapy effective January 1, 2022, in all 50 states and Washington, DC for most commercial and Medicare plans. This means practices will no longer use the Optum/OrthoNet system for new authorization requests for dates of service on or after January 1, 2022.

  • The patient is the center of all we do – Our programs are patient-centric and focus on rapid access to care, services, and treatment that promote the best patient experience and best patient outcomes.
  • We endorse transparency – We provide access to practice guidelines, policies, performance scorecards, and benchmarking at provider and peer-group level to strengthen engagement and trust in our provider relationships.
  • Simplicity and clarity achieve optimal results – Through concise, grounded, ongoing user-focused education, training, and bi-directional communication, partnerships are enhanced with our providers.

Key Features of Therapy at Cohere

Auto-Approval (when medical necessity criteria are met)

  • PT providers will receive immediate auto-approval of predetermined PT units based on diagnosis when medical necessity criteria are met.
  • Auto approval thresholds are differentiated by initial and subsequent authorization requests. The table linked here reflects the number of physical therapy sessions that will automatically approve by body site.
  • Please note that this content is subject to change without notice.

Patient-Reported Outcome Measures (PROM) Toolkit 

  • Cohere has developed a comprehensive PROM toolkit designed to assist PT providers in easy navigation of PROM tools per applicable body site. The PROM toolkit utilizes standardized, evidence-based tools endorsed by the American Academy of Orthopaedic Surgeons for assessment of the patient’s functional disability. 
  • These are not required, so if your organization utilizes a different scoring system, please utilize that. Additionally, if you do not have this information, please enter "0" or skip the question.

The table below indicates which document should be completed by the patient for the specific body site and condition. To download and view the questionnaire, click the link within the table. If you are interested in the comprehensive toolkit, please click here.

Patient's related issue Questionnaire to use
Spine - lower back Oswestry low back pain disability 
Spine - neck NDI (Neck Disability Index) Vernon and Mior Cervical Spine
Knee KOOS (Knee Injury & Osteoarthritis Outcome) Jr.
Hip HOOS (Hip Disability & Osteoarthritis Outcome) Jr.
Shoulder ASES Shoulder Score
Foot FADI (The Foot & Ankle Disability Index)

 

How to submit occupational and speech therapy requests

    1. Enter your diagnosis and procedure code(s)
    2. Press 'Check requirements' and once the authorization check is complete, continue by selecting 'Continue with procedure codes'. 
    3. In the pop-up, enter the diagnosis and stage of care as appropriate.
    4. When prompted to answer "What best describes the procedure?", select 'None of these'.

       

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    5. If there are no additional procedures, press 'continue with procedure' at the bottom right of your screen.
    6. Lastly, fill in the details of your request, by first entering the service category at the top. In the case of OT or ST. Here you can select Speech Therapy or Occupational Therapy and continue with the remaining details. After this step, the submission process is the same.

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