What is Oak Street Health?
Founded in 2012, Oak Street Health is a network of value-based primary care centers for adults on Medicare. With a mission of rebuilding healthcare as it should be, the company operates an innovative healthcare model focused on quality of care over volume of services, and assumes the full financial risk of its patients. Oak Street Health currently operates more than 230 centers in over 25 states and is the only primary care provider to carry the AARP name. To learn more about Oak Street Health's proven approach to care, visit www.oakstreethealth.com.
Can I submit requests for concurrent reviews?
Concurrent requests for admission can be submitted at any time, and should be submitted as close to admission as possible. Cohere reviews, decisions, and sends notifications for the initial request within 3 days of submission.
Continued stay reviews are conducted by Cohere's clinical team every 7 days. Please upload additional clinical documentation prior to continued stay review to avoid any potential delays.
What specialities can I submit through Cohere Health?
Cohere is currently contracted with Oak Street Health’s (OSH) Humana delegated patients, and the clinical scope is select inpatient and outpatient services, as well as primary care physician referrals. You can find more details for what is in-scope with Cohere here. Additionally, if you enter codes in the portal, it will let you know whether or not the services you entered require authorization by Cohere.
Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Does Cohere generate letter notifications for Oak Street Health?
Yes! Please see this article for more details on which letter notifications are generated.
Can I make edits to a prior-authorization request after it has been submitted?
For information on which edits you are allowed to make in the Cohere portal, please reference this article. Please view the tab for the payer the patient is contracted with for the most accurate information.
Please note: NO edits can be made for referral requests after they have been submitted.
What is the difference between referral and prior-authorization requests?
A referral request is submitted to request office visit CPT codes.
A prior-authorization request is submitted to request any other CPT codes.
You can find more information about referral requests, including step-by-step instructions, a demo video, and referral-specific FAQs, here.
Do I have to go through Availity for any codes, or can all codes be submitted through Cohere?
You do not have to use Availity. If you go to Availity, you should see a message redirecting you to Cohere.
How long does it take to get an approval?
The time to approval will vary depending on the specific details of the request. Required determination timelines are set by standards required by the state and federal governments for different kinds of requests (standard or expedited). Cohere will always adhere to these requirements.
In some cases, you may be eligible for an automatic approval for your authorization. In other cases, your request may pend for either determination of medical necessity or due to missing information.The best way to reduce delays is to include all relevant clinical documentation within your request.
You can view more information about turnaround times in this article.
Where can I find information about peer-to-peer consultations?
You can find more information about peer-to-peer consultations in our learning center.
Here are the steps to schedule a peer-to-peer consultation:
Before issuing a denial, Cohere will reach out to the submitter to let them know to contact Cohere to schedule a P2P at (855) 473-3399.
You will be given a scheduling block (e.g., window between 8 am-12 pm) during which you will receive a call from an Oak Street Health MD to start the P2P.