Guide to Meeting AHIP Prior Authorization Commitments

Prior authorization is evolving. As health plans navigate new AHIP commitments and prepare for 2026 federal mandates, the need for a clear, strategic approach has never been greater. These industry-wide initiatives to streamline prior authorization represent a significant opportunity for health plans to enhance operational efficiency, improve system integration, and strengthen provider collaboration.

This guide provides the expert insights and considerations needed to turn these commitments into strategic advantages for your organization.

Download the guide to learn how to:

• Standardize electronic prior authorization: Meet the technical requirements for the CMS Final Rule and FHIR® APIs, while supporting provider partners who may lack the resources for complex integrations.
• Reduce the scope of your prior authorization list: Learn how to strategically pare down your PAL without increasing utilization risks or losing valuable data for care management and payment integrity teams.
• Expand real-time approvals to meet the 80% target: Balance the need for medical necessity evaluation with the goal of real-time approvals. See how Cohere Health is already achieving 85% of PA approvals in real time.
• Enhance communication and transparency: Move beyond the "black box" of prior authorization by providing clear, understandable explanations for determinations and real-time status updates for providers.

The healthcare industry is moving toward a more efficient and transparent future. Learn how Cohere Health can help you lead the way, ensuring compliance while improving outcomes for your members and providers.