Overview
This article houses some of our most frequently asked questions and their answers for Medical Mutual (MMO) specifically.
What do I need to include when submitting a request for therapy visits?
When submitting an initial request for therapy visits, please include the initial evaluation documentation.
If you are requesting additional therapy visits, please include a Progress Note, or Re-Evaluation Note that aligns with the requested date of service range. This should include tolerance to therapy, progress toward goals, and an objective comparison of current function to baseline.
Please Note: Daily Treatment Notes do not qualify as appropriate clinical documentation for therapy requests.
Who do I contact if I have questions about my authorization or technical issues?
Please visit our "How can I contact Cohere" article to view specific details about how to contact Medical Mutual or Cohere for various requests.
When submitting Outpatient Therapy and Chiropractic authorizations, what is the “performing facility or agency” field in the Cohere portal?
Outpatient Therapy and Chiropractic providers submitting authorizations via Cohere must complete the “performing facility or agency” field in the Cohere portal, as this is now a required field. Providers may also use the performing group information to complete this field.
Where do I find the Cohere guidelines used to decision authorizations?
Cohere Guidelines are created from an adaptation of peer-reviewed clinical research, medical society guidelines, and coordinated peer reviews. Medical Necessity Criteria and Site of Service Criteria are derived from this knowledge base within the guidelines and serve as a decision support tool to help approve prior authorizations for the most appropriate treatment, setting, and help assure consistency of care for each individual.
Click here to view Cohere's guidelines
What do I need to know about Cohere and Rhyme?
To learn more about the codes that can be submitted for Medical Mutual (MMO) patients, please see this article.
Medical Mutual is working with Cohere Health and the Rhyme LiveAuth™ network to streamline the prior authorization process, enable faster, better clinical outcomes and decrease provider administrative burden via enhanced workflows and automation.
Beginning March 25, 2024, Medical Mutual contracted providers must submit prior authorization requests for outpatient and investigational/experimental services and procedures through Cohere Health’s web-based portal or through the Rhyme application. In addition, prior authorization requests for outpatient diagnostic radiology/imaging can be submitted through Rhyme’s EMR application.
The benefits to you include:
Real-time prior authorization requirement for determinations, resulting in elimination of unnecessary prior authorization requests. (Cohere Health)
Transparency requirement for prior authorization policy documentation, resulting in less back-and-forth between health plan and provider. (Cohere Health)
Opportunities for prior authorization real-time auto-approval (in some cases), resulting in faster turnaround times for determinations. (Cohere Health & Rhyme)
Automatic extraction and population of key data to build the prior authorization request, resulting in less redundant data entry. (Rhyme)
Existing Rhyme clients will have access to Medical Mutual’s expanded modalities beginning on December 13, 2024. Please work with your Client Success Manager at Rhyme to coordinate these additions. New providers interested in EHR integrated prior authorizations should contact Rhyme at https://www.getrhyme.com/get-in-touch.
Please note that there is no change to the inpatient prior authorization submission process at this time. Please continue to submit requests for inpatient admission through MedCommunity.
If you have any questions, please contact your Medical Mutual Provider Contracting Manager at 1-800-625-2583.
What is the performing facility or agency field in the Cohere portal?
Outpatient Therapy and Chiropractic providers submitting authorizations via Cohere must complete the “performing facility or agency” field in the Cohere portal, as this is now a required field. Providers may also use the performing group information to complete this field.