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 below to the procedure you want to request and download the Part II Fax Form, 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 forms, with all supporting clinical documentation, by fax to Cohere Health.
Cohere Health Fax Number: 857-557-6787
For additional fax numbers by Health Plan, click here.
Part II Authorization Request Fax Forms by Specialty and Service:
Please note: these authorization request forms will be updated intermittently, please download the applicable form each time you submit a fax request to ensure you are using the most current version.
Diagnostic Imaging | |
Cardiovascular | |
Musculoskeletal |