Q&A: Cohere Health’s Matt Parker on Meeting CMS Prior Authorization API Requirements
Published:
January 14, 2026
Insights from Healthcare Innovation’s Q&A with Matt Parker
Health plans are under growing pressure to modernize prior authorization workflows as CMS interoperability requirements move closer to enforcement. In a recent interview with Healthcare Innovation, Cohere Health Chief Product Officer Matt Parker discussed the challenges payers face in digitizing medical policies, the role of AI in accelerating approvals, and how Cohere Policy Studio™ is helping organizations meet the new API mandates. His perspective highlights why structured, machine‑readable policies are becoming essential for real‑time decisioning and a more seamless provider experience.
Excerpt from the Interview
Health plans are starting to realize that without digitized, structured policies, they cannot effectively automate authorization workflows and can’t meet CMS interoperability requirements or fulfill the goals outlined in AHIP’s 2025 pledge to standardize electronic prior authorization, enhance transparency, and expand real-time response capabilities.
Matt Parker is chief product officer at Cohere Health, a company that works with more than 660,000 providers and handles over 12 million prior authorization requests annually. Its AI approves in real time up to 90% of requests for millions of health plan members. He recently sat down with Healthcare Innovation to talk about which aspects of the upcoming CMS requirements health plans are finding the most challenging, as well as how his company developed a solution to help eliminate the technical complexity and manual burden of policy digitization.
Parker explains how Cohere Health’s clinical intelligence layer is designed to reduce friction between payers and providers by surfacing the right clinical information at the right time. He emphasized that many delays stem from missing or incomplete documentation, and that real‑time guidance during submission can prevent unnecessary denials and appeals.
He notes that interoperability standards such as FHIR are reshaping expectations for transparency. Health plans, he said, are increasingly focused on how to translate complex medical policies—often stored as static PDFs—into structured, machine‑readable formats that can power automated decisioning and meet CMS’s API requirements.
Written by
Matt
Parker
Matt has more than 20 years of experience designing, developing and launching healthcare-related technology solutions. Prior to joining Cohere, he was SVP of Product Development at Kyruus Health, a healthcare technology company that provides health systems with search and scheduling solutions . Previously, Matt led Product at HealthSparq, where he developed industry-leading products for health plans to help their members take more control of their healthcare. He has held senior positions at DestinationRx and DrugCompare where he led the product development teams. Matt received his B.A. in Psychology from The Catholic University of America and his J.D. from Loyola University Chicago School of Law.
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