In cases where you can’t use the Cohere portal to submit your authorizations, please follow these steps to submit a request by fax:
Download the Part I Fax Form, fill in all available details.
If applicable, navigate to the article of the procedure you want to request and download the Part II Fax Form (Computerized Tomography Angiography (CTA), which contains the clinical assessment questions that relate to that procedure, and answer all questions.
Answers to these questions can typically be found in the patient's chart, but we recommend you reach out to the requesting provider if more details are needed.
Send all completed documentation, with all supporting clinical documentation, by fax to Cohere Health.
Cohere Health Fax Number: 857-557-6787
As these forms will be updated intermittently, please re-download them each time you fill out a fax form.