Cohere Health™ AHIP and BCBSA Readiness Program

Get a data-driven blueprint to meet Association expectations for medical policy digitization (February 2026), scope reduction targets, and 80% real-time prior authorization by 2027—while navigating the unique complexities of the Blue structure

Schedule Your Consultation
Schedule Your Consultation
Schedule your consult

Don’t wait until 2026 to put your AHIP and BCBSA strategy into action

Blues plans that begin planning now will have time to implement defensible, data-driven strategies that position them as leaders in prior auth reform while meeting Association commitments.

Schedule a consultation to learn how Cohere Health BCBSA Readiness Program can help you:

  • Benchmark your PAL against 100+ health plans to identify scope reduction opportunities
  • Digitize medical policies into machine-readable formats by February 2026 deadline
  • Develop strategic roadmap for policy management and transparency requirements
  • Plan for BlueCard complexities in real-time authorization workflows
Schedule your consult

Limited consultation slots available for 2025/early 2026 planning initiatives.

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Exclusive findings

Key prior authorization benchmarks: How does your plan stack up?

This report analyzes prior authorization trends across 100+ health plans to help optimize PA strategies by identifying where PA delivers the greatest medical cost savings relative to provider burden.

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What you will get from this consultation

Personalized PAL benchmark showing how your prior authorization list compares to 100+ health plans

Risk assessment identifying which automation approaches could inadvertently increase utilization

Strategic roadmap with phased implementation priorities based on your actual approval patterns and denial trends

Expert guidance on navigating the unique Blue structure, including cross-plan reciprocity and network complexities in your automation roadmap

The clock is ticking, and the challenges are complex.

Here are some risks we can help you prepare for:

Hourglass

Meeting aggressive timelines

Medical policy digitization (Feb 2026), demonstrated scope reduction (Jan 2026), and 80% real-time authorization (2027).

Policy management complexity

Digitizing medical policies, making criteria publicly available, and maintaining transparency standards while meeting Association expectations.

Puzzle

Creating a strategy, not chaos

Simply removing codes without a comprehensive strategy could inadvertently increase utilization and compromise visibility.

Balance

Balancing automation and scope reduction with medical necessity

Automatically approving authorizations to hit an 80% target risks false approvals, inconsistent provider experiences, and medical expense impact.

How Cohere's AHIP Readiness Program will help you

A clipboard with a magnifying glass next to it.

Policy and Prior Auth List (PAL) analysis

Evidence-based reduction using your actual clinical data—examining approval rates, clinical variation patterns, and provider performance. Compare your PAL against Cohere's research analyzing over 100 health plans.

Phased automation roadmap

We help you develop a data-driven strategy that sequences automation based on risk, volume, and impact. You'll know exactly which auth categories to tackle first, and which should remain in traditional review.

Policy management & digitization strategy

Meet the February 2026 deadline by codifying policies into machine-readable formats and creating public-facing transparency tools for members and providers. Compare your policies against 100+ health plans to identify scope reduction opportunities aligned with Association expectations.

BCBSA commitment navigation

Our team helps you understand the interplay between Association expectations, CMS mandates, and state-specific requirements. We guide you through Local Operations and National Programs Scorecard alignment, enhanced transparency requirements, and provider communication standards.

Proven automation success at scale

  • 85

    %

    of prior authorization approvals in real time

  • 93

    %

    provider satisfaction rating

  • 4000

    +

    digital policies supported

  • 15

    M+

    authorizations leveraging APIs

Get your AHIP readiness assessment