Humana to expand partnership enabling digital prior authorizations in 95% of orthopedic cases

Carly Behm -   Print  |
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Humana and Boston-based Cohere Health are expanding their partnership enabling a digitized prior authorization process nationwide, according to an Oct. 13 news release.

The upcoming expansion will extend Cohere's platform to all Humana Medicare Advantage and Commercial members nationally and to more than 65,000 individual practitioners.

Humana and Cohere Health partnered in January, and digital prior authorizations with the platform were implemented in 12 states. The platform uses artificial intelligence and machine learning to automate both provider and payer steps.

Ninety-five percent of authorization requests for musculoskeletal services go through the platform, which drives a median approval time of zero minutes. This allows Humana providers to schedule patients immediately in 89 percent of cases, according to the release.

For orthopedic cases, Cohere's clinical criteria are informed by the American Academy of Orthopaedic Surgeons' policies.

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