Review Assist instantly surfaces actionable insights from lengthy, complex clinical documentation, improving nurse efficiency and accuracy
Cohere Health, the leader in clinical intelligence solutions for health plans and risk-bearing providers, announced the launch of Review Assist, a breakthrough agentic AI solution that improves medical necessity review efficiency by up to 50% with over 99% precision. Designed to work seamlessly with health plans’ existing utilization management (UM) workflows and technology stacks, Review Assist reduces review time, eases administrative burden, and improves decision accuracy by helping nurses quickly identify the most relevant clinical information.
Today, prior authorization reviews remain highly manual, requiring reviewers to sift through hundreds of pages of clinical records to identify the data for evaluating medical necessity according to clinical guideline criteria. As an evolution of its proven Review solution, Review Assist extends the focus to improve clinical productivity and nurse reviewer experience. In addition, the technology can be deployed for any use case related to review of complex medical records.
“While existing automation tools attempt to assist reviewers, they are often limited in their ability to identify, surface, and cite data from unstructured clinical documentation, particularly in high-volume, high-cost, and complex areas,” said Matt Parker, chief product officer at Cohere Health. “The Review Assist copilot experience is a significant advancement in how health plans can address challenges in getting patients to care. This intelligent assistant enables faster, clinically sound decisions without disrupting existing workflows, and demonstrates the foundation for how we’ll apply this agentic technology to challenge the status quo.”
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Review Assist leverages Cohere’s clinically trained AI and fine-tuned large language models (LLMs) to analyze unstructured and structured clinical data in real time, surface relevant evidence, and present clear, actionable insights for reviewers. By providing this added layer of clinical intelligence, Review Assist enhances review accuracy and consistency, and improves nurse productivity and experience.
With an intuitive, lightweight design that works on top of a health plan’s technology, Review Assist is quick to implement and easy to adopt, ultimately helping health plans drive operational efficiencies and faster access to appropriate member care–without adding complexity to or changing nurses’ workflows. This agentic AI technology can enable other health plan clinical intelligence workflows downstream from prior authorization approvals.
Key capabilities and benefits of Review Assist include:
- Operates directly within existing UM workflows or can be integrated into any client case system
- Real-time extraction and citation of indication data and source evidence via clinically trained AI
- Reduced review time, error rates, and administrative burden for nursing staff
- Faster access to medically necessary care for members
Source: PRNewswire
