This article provides an overview of all steps of submitting a prior authorization request in the Cohere portal for Medicare - Novitas only.
Step 1: Log in to the Cohere Portal
Using the platform will make you much more likely to receive an auto-approval than non-platform submission methods like fax of phone. Submitting requests online allows you to ensure you submit all of the necessary information required for approval.
To submit a request online, you will first need to log in by going to next.coherehealth.com and entering your email and password. If you are unsure if you have an account, please try signing in to the portal first, and then contact the applicable support team using the information in this article.
If you or others at your organization do not have an account, please select the "Register for an Account" option here: coherehealth.com/provider/resources.
Step 2: Navigate the Cohere Dashboard
After signing in, you will land on the Cohere dashboard, where you can see authorization requests and their statuses for the patients at your practice. You can filter the requests that are shown on the dashboard by several different criteria, including:
Authorization status
When filtering requests on the dashboard by status, you will see the options to filter by “approved” and “denied.” For your Medicare authorizations, the actual determination language will display as “affirmed” or “non-affirmed” on the authorization request itself.
The approved and denied labels are just used for filtering and searching to find the correct authorization within the dashboard.
The user that submitted the authorization
Use the search bar at the top of the page to search by patient name, member ID, tracking ID, or authorization ID.
If you submit authorizations for multiple payers, you will also be able to filter by payer.
You also have the option to sort the requests by either the most recently created or edited request or by the date of service.
Step 3: Start Auth Request
For your Medicare-Novitas requests, to determine medicare eligibility, here select the Medicare - Novitas under "health plan" to look up a member for that program.
Once the “Medicare - Novitas” health plan is selected, you will see a few additional fields that need to be completed in order to perform member lookup: patient first name, last name and ordering provider NPI. If you use Cohere to submit on behalf of other health payers, please note this particular step is only for Medicare - Novitas submissions.
Step 4: Tell us about your request
In this step, we will enter some basic information about the request.
First, indicate whether the request is going to be inpatient or outpatient.
If you're looking for more information on how to submit an inpatient request, click here.
Next, you will enter a start date, or the date the requested service will take place.
Next, enter in the primary diagnosis. You can search either by name or diagnosis code.
If you have any additional diagnoses, you can enter them in the optional secondary diagnosis field.
Lastly, you will enter in the procedure codes. Once again, this field is searchable by name or the CPT/HCPCS code.
Please note: Medicare - Novitas authorization requests are limited to no more than five (5) procedure codes per submission.
Once you are ready to move forward in the submission process, click "Continue."
At the very top of the page you’ll see a gray box with contact details. These details may be used to reach out for missing information or to notify you of request updates. You’ll want to make sure the contact details shown here are correct. If you’re not the appropriate contact, you can update the information directly here in this box.
Step 5: Enter Provider Details
For Medicare-Novitas submissions, the ordering and performing provider fields will always require a PTAN.
Whether a PTAN or CCN is required for the Provider Facility field will vary by place of service:
Please note: If you already submit requests through Cohere for other payers, here you’ll see that for your wiser medicare submissions, a TIN is not required here in the provider details section.
Step 6: Check authorization details
When we get to this page, we see a notice at the top, in green, that we have entered services that require authorization by Cohere. Complete the remainder of the details:
First, we'll be asked to confirm our start and end dates.
The start date will autofill based on what was initially entered when we started our request, but if you have more than one service date, you will need to indicate the end date, meaning that all visits or service dates will take place during this time frame.
The number of units or visits refers to how many times each service will take place.
The numbers that autofill here is generally what is deemed clinically appropriate.
These numbers can be changed, but that may cause your request to pend for medical necessity review.
All codes you entered will autofill into the appropriate procedure, but you do have the option to make changes to these fields in this step.
Toward the bottom of each request form, you will see the option to expedite the request.
You should only expedite the request if the "standard turnaround times could seriously jeopardize the life or health of the enrollee" or their "ability to regain maximum function." If either or both of these are determined to be the case, you can select the appropriate reason(s) to expedite the request.
Expediting a request when it does not meet the criteria will delay your request. Only select these options when appropriate.
Step 7: Upload Clinical Documentation.
Including clinical documentation in a Medicare - Novitas authorization is required.
Click “add files” to add clinical documentation to support the authorization.
If no supporting clinical information is attached, the request cannot be submitted. If you see the following message please upload the required files to proceed.
If all required documentation for your request is not included, you will see a message prompting you to consider including additional documentation. You can go back and add attachments or dismiss and continue your authorization.
Step 8: Review before submitting
This brings us to the final step of our authorization submission process, which is simply to review all the details of the request before submitting it.
If you notice anything here that needs to be changed, you can click any of the blue "Edit" buttons and make any needed changes.
Once you have confirmed that all of the details are correct, you can click "Submit."
Once you press submit, we immediately begin processing the request.
When possible, based on the information provided, we will issue an auto approval. In this case the authorization will display "affirmed".
Otherwise, an authorization status will appear indicating the current stage of review.
Step 9: Successfully Submitted, redirected to patient summary
After submitting, you will be redirected to the patient summary.
You can view the status of the request either here, or on the dashboard.
Here in the patient summary, we can see more details about this patient on the left side of the screen, as well a other requests submitted for this patient.
To navigate to the dashboard from the patient summary, click the "Cohere Health" icon at the top of the page.
