Cohere Health’s Scope of Management:
Inpatient Admission for Geisinger Health Plan
Overview
Cohere Health, a patient journey optimization company, has been asked to deploy its Digital Prior Authorization solution to allow users to submit a variety of services directly through Cohere’s platform. Beginning April 29, 2024, Cohere will manage Geisinger Health Plan submission for most inpatient prior authorizations for any of the categories listed in the table below. This change excludes authorizations for radiology, cardiology, musculoskeletal, and pain intervention.
For more information, please visit Geisinger's provider website. If you decide to fax a request for the categories listed below, please send them directly to Geisinger.
All practices are encouraged to submit preauthorization requests electronically by registering* for a Cohere account. Only Cohere users can benefit from instant authorization decisions, if eligible.
- New users: register for an account: www.coherehealth.com/provider/register
- Existing users: log in to Cohere: www.next.coherehealth.com
* If your practice already has access to Cohere, please ask any existing Cohere administrative user(s) at your practice to create an account for you.
Inpatient Admission Categories |
|
| Category | Description |
| Hospice |
An integrated set of services and supplies to provide palliative and supportive care to terminally ill patients. |
| Long Term Acute care |
Treatment of patients with serious medical conditions that require care on an ongoing basis but no longer require intensive care or extensive diagnostic procedures. |
| Medical Care |
Medical services to diagnose and/or treat a medical condition, illness, or injury. |
| Mental Health |
Mental Health services provided by a physician or other healthcare providers who are trained and educated to perform services related to mental health and may be licensed or practice within the scope or licensure or training. |
| Rehabilitation |
Services related to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible. |
| Residential Psychiatric Treatment |
Psychiatry services provided at a live-in facility to a person with emotional disorders who requires continuous medication and/or supervision or relief from environmental stresses. |
| Skilled Nursing Care |
Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services. |
| Substance Use Disorder |
Services provided at a hospital, office or other covered facility as they are related to the diagnosis and treatment of Substance Abuse. |
| Surgical |
Surgical services provided by a healthcare provider. |
| Transplants |
Services related to the transfer of living organs or tissue from one body to another. |
Please note that issuance of an approval decision for any preauthorization request does not represent a guarantee of payment. Always refer to Geisinger’s Clinical Guidelines and additional resources at www.geisinger.org/health-plan for the most up to date prior authorization requirements, coverage policies, and related plan policies.