Optimizing Neurology Prior Authorization with Cohere Health

The Intersection of Neurology and Cohere Health Workflows

Neurology prior authorizations are characterized by high-cost specialty drugs, advanced imaging, and complex diagnostic criteria. Cohere Health, as a payer-side AI platform, aims to streamline these processes. Klivira acts as the provider's automation engine, ensuring that the extensive clinical documentation required for neurology PAs—such as for MS DMTs, CGRP migraine biologics, and Alzheimer's therapeutics—is accurately prepared and submitted to meet Cohere Health's specific intake requirements, reducing manual effort and potential denials.

Key Neurology PA Categories Impacted by Klivira + Cohere Health

• **MS Disease-Modifying Therapies (DMTs)**: Automating the submission of McDonald criteria, EDSS scores, relapse history, and prior DMT trials for agents like ocrelizumab or natalizumab.
• **CGRP Migraine Prevention Biologics** : Streamlining documentation for migraine days, headache diaries, and prior preventive trial failures for drugs such as erenumab or fremanezumab.
• **Alzheimer's Disease Therapeutics** : Ensuring complete submission of amyloid confirmation (PET/CSF), MRI for ARIA screening, and ApoE genotype for anti-amyloid antibodies like lecanemab.
• **Advanced Imaging** : Expediting prior authorization for brain MRI, MR angiography, and amyloid PET scans, which are crucial for diagnosis and monitoring across various neurological conditions.
• **Botox for Chronic Migraine** : Facilitating the documentation of specific indications and prior therapy trials to meet payer criteria for onabotulinumtoxinA.

Streamlining Documentation and Adherence to AAN Guidelines

Klivira's platform is designed with an understanding of critical clinical guidelines, including those from the American Academy of Neurology (AAN). For neurology cases processed through Cohere Health, Klivira automates the extraction and organization of necessary data from EMRs. This includes detailed patient histories, diagnostic test results, and treatment plans, ensuring that all required documentation—like amyloid biomarker confirmation for Alzheimer's drugs or step therapy compliance for MS DMTs—is complete and aligns with payer-specific policies and clinical evidence frameworks.

Addressing Common Neurology PA Challenges with Klivira

• **Step Therapy Requirements**: Klivira applies AAN-guideline-aware logic to track and document prior treatment failures for MS DMTs and CGRP migraine prevention, minimizing denials.
• **Complex Documentation for Specialty Drugs**: Automated data capture ensures all required elements for high-cost treatments, like specific biomarker confirmations for Alzheimer's therapeutics, are present.
• **Periodic Re-authorization Workflows**: Manages and proactively initiates re-authorization processes for chronic neurology treatments, reducing lapses in care.
• **MRI Monitoring Protocols**: Integrates ongoing MRI monitoring requirements into the PA workflow for drugs like MS DMTs and Alzheimer's anti-amyloid antibodies, ensuring timely approvals for follow-up imaging.

Klivira's EMR Integration and Payer Connectivity for Cohere Health

Klivira integrates seamlessly with leading EMR systems, leveraging standards like SMART on FHIR to extract clinical data efficiently. This data is then intelligently structured and formatted for submission to payer platforms, including Cohere Health, often via X12 278 or direct portal integration. By automating data flow and reducing manual data entry, Klivira minimizes administrative burden for prior authorization coordinators, allowing them to focus on patient care rather than paperwork, even with the complexities of neurology PA.