Overview

Notifications are a key part of the authorization process, and one of the five main means of notification are letters (i.e., mailing a physical letter). While Cohere utilizes other types of notifications, such as portal notifications, phone calls, email notifications, and fax notifications, we want to offer some clarification regarding letter notifications by client and line of business. Additionally, a letter is only generated in certain circumstances.

Please see the section for specific clients below for information on when Cohere generates a letter.

Humana

Recipient	Authorization Decision	Phone notification successful	Is the submitter opted in to electronic letters?	Line of Business (LOB)	Does Cohere generate a letter?
Requesting or Ordering provider	Approved	N/A	Yes¹	All	No --------- Yes
Requesting or Ordering provider	Denied or partially approved	N/A	N/A	All	Yes
Performing provider	All	N/A	All	All	No
Primary care physician (PCP)	All	N/A	All	All	No

¹State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:

The requestor’s provider organization has opted into electronic notification
The member’s LOB, coverage state of issue, and auth decision allow electronic notifications.
In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases, we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification.

Geisinger Health Plan

Recipient	Authorization Decision	Is the submitter opted in to electronic letters?	Line of Business (LOB)	Does Cohere generate a letter?
Requesting or Ordering Provider	Approved	Yes²	Any	No
Requesting or Ordering Provider	Approved	No	Any	Yes
Requesting or Ordering Provider	Denied or partially approved	Any	Any	Yes
Requesting or Ordering Provider	Denied or partially approved	Any	Any	Yes
Performing Provider	Any	Any	Any	No
Primary Care Physician (PCP)	Approved	Any	Medicare/ Commercial	No
Primary Care Physician (PCP)	Approved	Any	Medicaid/ CHIP	Yes
Primary Care Physician (PCP)	Denied or partially approved	Any	Medicare/ Commercial	No
Primary Care Physician (PCP)	Denied or partially approved	Any	Medicaid/ CHIP	Yes

²State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:

The requestor’s provider organization has opted into electronic notification
The member’s LOB, coverage state of issue, and auth decision allow electronic notifications.
In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification

Medical Mutual (MMO)

For Therapy, Chiropractic, Radiology, Cardiology, Sleep and Gastrointestinal Requests:

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¹State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:
- The requestor's provider organization has opted in to electronic notifications
- The member's LOB, coverage state of issue, and authorization decision allow electronic notifications.
- In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases, we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification.
²VAT is attempted only if all of the following are true:
- At least 2 days before TAT
- Coverage is Medicare
- Authorization decision is approval
- The preferred language is not Mandarin
- The coverage state of issue is not New York

For all other Medical Mutual services Cohere does not generate letter notifications.

Avera

Recipient	Authorization Decision	Phone notification successful	Is the submitter opted in to electronic letters?	Line of Business (LOB)	Does Cohere generate a letter?
Requesting or Ordering provider	Approved	N/A	Yes¹	All	No
Requesting or Ordering provider	Approved	N/A	No	All	Yes
Requesting or Ordering provider	Denied or partially approved	N/A	N/A	All	Yes
Requesting or Ordering provider	Denied or partially approved	N/A	N/A	All	Yes
Performing provider	All	N/A	All	All	No
Primary care physician (PCP)	All	N/A	All	All	No

¹State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:

The requestor’s provider organization has opted into electronic notification
The member’s LOB, coverage state of issue, and auth decision allow electronic notifications.
In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases, we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification.

Oak Street Health

Recipient	Authorization Decision	Phone notification successful	Is the submitter opted in to electronic letters?	Line of Business (LOB)	Does Cohere generate a letter?
Member	Approved	Yes¹	N/A	Medicare	No
Member	Approved	No	N/A	Medicare	Yes
Member	Denied or partially approved	N/A	N/A	Medicare	Yes
Member	Denied or partially approved	N/A	N/A	All	Yes
Requesting or Ordering provider	Approved	N/A	Yes2	All	No
Requesting or Ordering provider	Approved	N/A	No	All	Yes
Requesting or Ordering provider	Denied or partially approved	N/A	Yes2	All	No
Requesting or Ordering provider	Denied or partially approved	N/A	No	All	Yes

¹VAT is attempted only if all of the following are true:

At least 2 days before TAT
Coverage is Medicare
Authorization decision is approval
The preferred language is not Mandarin
The coverage state of issue is not New York

2State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:

The requestor's provider organization has opted in to electronic notifications
The member's LOB, coverage state of issue, and authorization decision allow electronic notifications.
In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases, we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification.

BlueCross BlueShield of Tennessee

Recipient	Authorization Decision	Is the submitter opted in to electronic letters?	Line of Business (LOB)	Does Cohere generate a letter?
Ordering Provider	Approved	Yes	Commercial	No
Ordering Provider	Approved	Yes	Medicaid	No
Ordering Provider	Approved	No	Commercial	Yes
Ordering Provider	Approved	No	Medicaid	No
Ordering Provider	Partially approved	Yes	Commercial	No
Ordering Provider	Partially approved	Yes	Medicaid	N/A
Ordering Provider	Partially approved	No	Commercial	Yes
Ordering Provider	Partially approved	No	Medicaid	N/A
Ordering Provider	Denied	Yes	Commercial	No
Ordering Provider	Denied	No	Commercial	Yes
Ordering Provider	Denied	N/A	Medicaid	Yes
Performing Provider and Facility	Any	N/A	Commercial	Yes
Performing Provider and Facility	Approved	Yes	Medicaid	No
Performing Provider and Facility	Partially Approved	Yes	Medicaid	N/A
Performing Provider and Facility	Denied	Yes	Medicaid	Yes
Member	Approved	Any	Any	Yes
Member	Partially approved	Any	Commercial	Yes
Member	Partially approved	Any	Medicaid	N/A
Member	Denied	Any	Any	Yes

State by state regulations may override provider e-notifications and a letter will be generated. A provider is only eligible for an electronic notification if:

The requestor's provider organization has opted in to electronic notifications
The member's LOB, coverage state of issue, and authorization decision allow electronic notifications.
In some phone or fax email auths, either the requestor does not have an account in our system or we aren’t able to map them to an account. In these cases, we don’t know the requestor’s provider organization, and the authorization is considered ineligible for electronic notification.

BlueCross BlueShield of South Carolina

Authorization decision notification letters for BlueCross BlueShield of South Carolina are managed by the Health Plan. For further details or assistance, please reach out to the health plan by referring to the prior auth phone number on the back of the member’s ID card.

Oak Street Health Aetna

Final determination letters will be faxed to the ordering provider for Oak Street Health Aetna. When submitting an authorization request, please ensure the fax field is completed with the most appropriate fax number to facilitate these notifications. If no fax number is provided, Cohere will mail the determination letter.

Frequently Asked Questions

When do letters appear in the portal?

Letters will only appear in the portal if they are generated by Cohere. There are situations where the provider opts for electronic letters – which means that they can see the details for their authorization in the portal. You can use the charts above to see when you should expect to see a letter in the portal.

Differences Among Payers: Edits, Continuations, Duplications, and Voids

How to View and Print Final Determination Letters in the Portal

How to Check the Status of an Authorization

Humana Frequently Asked Questions (FAQs)

Medicare - Novitas: Frequently Asked Questions (FAQs)