Cohere Health AHIP Readiness Program

Get a data-driven blueprint to achieve 80% real-time prior authorization automation without increasing medical expense or creating provider chaos

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Exclusive findings

The hidden cost of prior authorization

Our new white paper, based on a national survey of 200 providers, reveals how prior authorization delays impact care.

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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 hidden complexities of AHIP commitments and CMS 0057F compliance

The clock is ticking, and the challenges are complex.

Here are some risks we can help you prepare for:

Meeting aggressive timelines

It’s two years to the 2027 deadline, health plans can't afford to delay PAL optimization and automation planning.

Creating a strategy, not chaos

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

Balancing automation with medical necessity

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

Lack of benchmarking data

Most health plans lack visibility into how their PAL compares to peers or which automation strategies will yield the best results.

How Cohere's AHIP Readiness Program will help you

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.

Medical expense protection strategies

We identify the specific utilization tripwires in your data—patterns that signal where automation could inadvertently increase costs—and build safeguards into your roadmap.

Regulatory navigation

Our team helps you understand the interplay between AHIP commitments, CMS mandates, and state-specific requirements so you can build a compliance strategy that works across your markets.

Proven automation success at scale

  • 85

    %

    of prior authorization approvals in real time

  • 93

    %

    provider satisfaction rating

  • 4000

    +

    digital policies supported

  • 9

    M+

    authorizations leveraging APIs

Illustration of two arrows circling a heart with labels for specialists, workflows, and non-denial approach
Schedule your consult

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

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

Schedule a consultation to learn how Cohere's AHIP Readiness Program can help you:

  • Benchmark your PAL against 100+ health plans
  • Identify automation opportunities
  • Develop a strategic roadmap for 2027
  • Navigate CMS compliance requirements
Illustration of two arrows circling a heart with labels for specialists, workflows, and non-denial approach
Schedule your consult

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

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Cohere Unify Platform

Need additional support to achieve CMS 0057F compliance and your commitments to AHIP?

Policy platform digitization

Codify policies into machine-readable formats for CMS 0057F compliance, enabling baseline automation and public-facing lookup tools. Learn About Cohere Health Connect

Prior Auth Automation with AI

Our ML and AI models extract medical necessity criteria from unstructured data like encounter summaries to help you reach your 80% commitment. Explore Cohere’s In-House Solutions

6 core components of Cohere Complete