Do you submit authorizations for Instil? Use the information below to help guide you when submitting authorizations through Cohere.

Instil for general support
Phone Number: (888)-801-9617

Cohere Technical Support
Please use the contact details below for technical support only, (available 8am-5pm ET Monday-Friday):
Phone Number: (888) 787-0309
Email: bcbs-sc.support@coherehealth.com
Fax number: 803-870-6200.

Missing Information Peer-to-Peer Consults Denials & Appeals

There are two primary reasons you may receive outreach regarding missing information:
The request was submitted without the required clinical documentation attached.
The submitted attachments are incomplete and do not include all the necessary information for review.

Please note that the missing information outreach process is managed and conducted by Instil. If you need to provide updated clinical documentation to support your pending prior authorization review, you can upload the missing information directly to the original authorization request through the Cohere portal.

All Peer-To-Peer (P2P) requests are conducted by Instil. Please refer to the denial letter for instructions on how to request a P2P with Instil or visit Peer To Peer Request | Medical Forms Resource Center.

For more information on denial, appeal rights, or filing an appeal, please refer to the information provided in the denial letter.

Once a prior authorization has been submitted in the Cohere portal, no edits are allowed, except for uploading additional clinical attachments. If any aspect of the original request needs to be modified (e.g., changing a provider, adjusting the start date, etc.), please submit the necessary changes directly to instil via fax to 803-870-6200..

Through our collaboration, Instil and Cohere, aim to automatically approve as many cases as possible. However, if a submission does not meet the criteria for automatic approval, Instil completes the review and assumes full responsibility for ensuring compliance with all state and federal timeliness standards, as well as, for some products additional accreditation requirements established by quality organizations. Instil is committed to not only meeting these standards but also exceeding them to deliver the highest level of service and care.

Out-of-network (OON) exceptions:

Network checks are automatically conducted for every request regarding the performing provider, provider group, and facility fields. If any of the providers you have selected are out-of-network (OON), no further action is required to submit your authorization request through Cohere. You may proceed with submission regardless of the OON status.

However, if you wish to request an out-of-network exception, please contact Instil directly at 888-801-9617 to initiate the exception request process.

When submitting a prior authorization request through the Cohere portal, you are now required to input specific procedure codes for review and decision-making. This ensures greater accuracy and faster processing of your request, as the codes provide detailed information necessary for a thorough review.

Even though the patient has not yet been admitted, the request must be reviewed for the medical necessity of both the procedure and the anticipated duration of the patient’s stay. The requested length of stay (LOS) should reflect the number of days the provider expects the patient to remain admitted for services related to the procedure.

If you’re unsure of the required LOS for the procedure, you can initially request one day. Once the patient has been admitted, if additional days are needed, you can submit a Continued Stay Review (CSR) to request approval for an extended stay.