General-purpose AI tools can summarize text, but clinical appeals require much more than summarization. Appeals reviewers need policy-aware reasoning, traceable evidence evaluation, new evidence summarization, audit-ready outputs, and workflows aligned to health plan operations, documentation standards, and turnaround-time requirements. Cohere appeals agents are built specifically for that environment and trained on real health plan decisions, benchmarked against clinical reviewers, and governed through evaluation-driven development before deployment. Additionally, Cohere runs analytics on the outcomes of appeals, supercharging value across our connected solutions such as utilization management.

Cohere appeals management is built for clinical appeals–cases where medical necessity, level of care, or clinical documentation is at the center of the determination (e.g. Procedure Medical Necessity, Level of Care and LOS Medical Necessity, Dx Clinical Validation, etc.) It is not designed for purely administrative appeals. If you're not sure whether your appeal mix is a fit, we'll tell you directly in a discovery conversation.

No, and that's by design, not limitation. Cohere appeals agents prepare, summarize, evaluate, and draft as outlined above. The clinical determination always belongs to your reviewer. As quality benchmarks are met and confidence grows, the platform is built to take on more, but complex clinical decisions will always have a human in the loop.

This is where most AI solutions quietly fail and where Cohere has deep investments. Reading, reasoning over, and citing indication data buried in physician notes, discharge summaries, and operative reports requires models trained on real health plan decisions, not general clinical text. Ours are. The result is clinical evidence that surfaces accurately, cites completely, and holds up when it's challenged.

Every capability goes through our evaluation-driven development process, benchmarked against human reviewers before it ever reaches production. We target greater than 99% AI clinical accuracy and don't release what hasn't earned it. In production, every AI action is logged and traceable to its source, so your reviewers, auditors, and compliance teams can verify every step. Trust isn't a feature here. It's the foundation.

Cohere appeals agents draw from authorizations, claims, appeals records, clinical attachments, guidelines, and plan-specific work instructions. Data governance, HIPAA compliance, and PHI handling follow the same standards as Cohere's UM suite–HITRUST-certified, data never leaves your approved environment, and deployment is flexible based on your residency requirements.