You can use Cohere Unify to automate prior authorizations, review medical necessity, and manage claims for health plans. The system evaluates clinical requests against established medical guidelines to approve requests in real time or prepare records for clinician review. It checks claims data to prevent overpayments before approval, tracks care gaps against quality measures like HEDIS, and surfaces clinical evidence to process patient appeals faster. Care managers can also identify rising-risk members and coordinate care plans directly within their existing operational systems.
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