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Overview
Cohere Health simplifies healthcare by enabling patients, physicians, and health plans to collaborate on getting the right care, at the right time, at the right place, and at the right cost. Our focus is to enable an efficient and transparent patient journey where patient goals and achieving optimal clinical outcomes are central to decision making.
If you have questions about how to submit a referral request, you have come to the right page! Submitting a referral request is simple and easy, and can be done directly within the Cohere portal. This article contains all of the resources and answers to questions that you have about submitting referral requests with Cohere.
All details required for referral requests
Required details may vary depending on the payer, line of business, level of care, or other authorization details. For example, you may not see the TIN field. The following information is commonly required:
Health plan member ID
Member DOB
Start date of referral (the date where the patient will begin seeing the specialist for office visits. Also known as the date of service)
Diagnosis (name or code)
Referring provider details
Specialist practice details
Specialist provider details
Recorded demo video
Frequently Asked Questions
Can I submit referrals through Cohere?
Anyone who submits prior authorizations in the Cohere portal is also capable of submitting referral requests. However, referral requests can only be submitted for eligible patients. The platform will allow you to start a prior authorization or a referral request after searching for a patient, if they have compatible coverage:
You will also be able to start either a prior authorization request or a referral directly from an eligible patient's patient summary page.
The platform will only allow you to start a prior authorization if we cannot accept referrals based on their coverage.
What if I don't have the specialist provider or practice details?
The specialist provider details are optional, but you are required to include the speciality practice details. If you do not have this information, we recommend reaching out to the referring provider.
Am I able to see referrals submitted outside of my practice?
Once you have submitted a referral for a specific patient, you will have access to ALL historic referrals for that patient that were submitted through Cohere (even from other users outside of your organization or place of work). You can view ALL referral requests from the referrals patient summary page.
However, you will NOT be able to see referrals for this patient submitted from a platform outside of Cohere.
What happens if the specialist practice or provider I select are listed as out-of-network (OON)?
If the specialist practice or provider you select is OON, the portal will alert you.
You will be asked to answer attestations for both the practice and provider, when applicable. You will be asked to “attest that the provider is out of network with a valid exception reason” and then select an appropriate reason from the drop down menu.
These attestations are optional; they are designed to capture the results of evaluating an exception to inform the determination outcome.
Am I able to make edits to a referral request after it has been submitted?
No, you are not able to make any edits to referral requests once they have been submitted. If the patient needs to see a specialist for longer, please submit an additional referral request.
How long are referrals valid for?
Referral requests are valid for six (6) months from the start date entered when submitting the request. Referrals will be active throughout the indicated time frame, so any visits billed during this time will be covered. If you need to extend the referral window, please submit an additional referral request.
Why am I unable to enter procedure codes?
Referrals automatically include all standard office visit CPT codes. Since there is no way to know the duration or complexity of a billable event in the future, Cohere does not ask providers to “guess” which code(s) will be billed during the specialist office visit.
For CPT codes other than office visit codes, please submit a prior-authorization request instead.
Why am I unable to enter the number of visits?
All visits that are billed during the indicated time frame of the referral request will be covered. Referral requests are valid for six (6) months from the start date entered when submitting the request.
Since there is no way to know the duration or complexity of a billable event in the future, Cohere does not ask providers to “guess” how many visits will be billed by the specialist office.
What is the difference between prior-authorization and referral requests?
A referral request is submitted to request office visit CPT codes.
A prior-authorization request is submitted to request any other CPT codes.