Overview
In this article you will learn best practices and understand why including clinical documentation is so important when submitting an authorization.
Why is including documentation in your authorization so important?
Cohere encourages users to submit clinical documentation with all requests. Submitting clinical documentation showcases medical necessity, which helps our clinicians better assess patient needs, streamline documentation for holistic patient care, and reduce waste.
You may obtain faster approval when your request:
Meets specific policy requirements and
Includes clear, supporting clinical documentation required by policy
Failure to meet these requirements may result in delays, peer-to-peer consults, and denial.
Click here to download a PDF version of the details below.
Documentation Best Practices
You MUST include two patient identifiers. This can be included either on all pages of the document or also on the first page of the document with other pages in continuation of the first (e.g., 1/10, 2/10, 3/10, etc.)
Full name and date of birth are recommended.
Medical record number cannot be used as an identifier when using the Cohere portal.
Document specific % of improvement
Demonstrate a consecutive timeline - the specific date range that the treatment(s) were completed.
Indicate the time between treatment - if a policy requires a specific number of weeks or months between the initial and subsequent procedure, include all dates and BE SPECIFIC.
Include all details about medications - this means indicating the medication name, dosage, and duration.
Note all attempts and contraindications - even if the treatment was unsuccessful it must be documented.
Answering clinical assessment questions
The clinical assessment questions in the Cohere portal play a pivotal role in our ability to approve your request. We listed out the top 3 keys to success when you get to this point in the submission process.
All of your answers to these questions must be supported by information in the patient’s medical records.
If you come across a question that is not supported by documentation, check the box that denotes this question is not applicable.
It’s always better to be sure about the answer to a question, so if needed, you can save the request as a draft and come back when you have the response.