Features
Break free from legacy vendors and outdated solutions
Discover healthcare operations powered by clinical intelligence and flexibility. Our innovative approach combines the best of insourcing with precision AI + a modular approach.
End-to-end prior authorization automation you control
Empower your in-house team with a modern clinical intelligence platform.
You don’t have to settle for the status quo
In-house hodgepodge of legacy solutions
- Administrative costs/complexity
- Broad expertise needed
- Outdated provider portals with low adoption rates
Delegated legacy vendors
- Largely denial-based approach
- Lack of transparency
- Negative provider and member experience
Powerfully scalable
Build an integrated technology stack with products that scale with you.
Smarter approvals & faster access
Reduce care delays by 70% through policy transparency and streamlined approvals.
Trusted by providers
Achieve 93% provider satisfaction with guidance.
Benefits
Key advantages of Cohere Health
Cohere streamlines the prior authorization process, making it efficient and effective. With our platform, health plans can leverage automation to enhance clinical decision-making.
Support until you’re ready
Cohere has a clear pathway to full insourcing at your pace. If you're poised for change, we're here to help you achieve it.
Clinician-trained precision AI
Leverage AI to automate authorizations and extract insights from unstructured data in attachments, expanding your team’s capabilities and confidence.
Dynamic prior authorization
Experience the power of a fully digitized, AI-enhanced prior authorization solution that puts efficiency and member care first.
Impactful results
Cohere in action
90%
Auto-approval rate
35%
Reduction in portal input time
5
days faster to appropriate care
93%
provider satisfaction
Platform overview
Free your team from the status quo and achieve remarkable results
A comprehensive, intelligent platform solution and composable products to meet you and your providers where you are for scalable, long-term success.
Lower administrative costs
47% reduction in administrative cost powered by responsible, clinically-derived AI and approval automation.
Automate approvals
Your policies, rules, and UM population strategy are automated through Cohere's clinical intelligence platform.
Support compliance needs
CMS-0057-F compliant and proven. More than six million authorizations have already run through Cohere’s APIs.
Intake
Digitizes all prior authorization requests into a single automated workflow.
- Omni-channel intake: fax, phone, app, EHR
- Automated prior auth requirement checks
- Intelligent missing info nudges in the provider submission workflow
Decision
Automates prior authorization decisions using health plan-preferred policies and accelerates manual review.
- Automated approvals for up to 90% of submissions
- Medical policy codification and management (NCDs, LCDs, custom policies, etc.)
- Advanced rule design & configuration for automation workflows
Review
Helps clinical reviewers adjudicate complex requests with clinician-trained AI/ML and automation capabilities.
- Available as a platform product or lightweight add-on to your existing utilization management solution
- Leverages clinician-trained AI to source indications from unstructured attachments
- Supports a longitudinal view of member health with authorization & claims history
Explore Cohere Align
Create a tailored provider experience aligned to performance or to replace gold carding and out-of-date exemption programs, allowing you to:
- Identify and dynamically manage provider cohorts-rewarding stars, addressing outliers
- Engage cohorts with provider-friendly communication tactics
- Continuously monitor to ensure sustained improvements and reduce risk of overutilization
Why choose our end-to-end solution?
Our clinical intelligence platform powers an end-to-end solution that doesn't lean on denials to drive savings.
Operational efficiency
Reduce administrative overhead and streamline prior authorization processes.
AI-powered insights
Leverage advanced clinical intelligence for smarter decision-making.
Real-time optimization
Continuously improve workflows with intelligent tracking and analytics.
Seamless integration
Proven interoperability with existing healthcare systems and workflows.
Ready to modernize your approach to prior authorization?
Contact Cohere today to:
- Discuss your specific utilization management challenges
- Learn how health plans have successfully transitioned from legacy solutions
- Understand what it takes to bring a solution in-house
Smarter UM starts with the right questions
Explore common questions about how Cohere helps health plans modernize utilization management with automation, flexibility, and clinical intelligence.
Why should we consider insourcing utilization management (UM) when our current delegated model works?
Insourcing UM gives your health plan greater control, transparency, and long-term cost efficiency. It eliminates dependency on third-party vendors that may not be aligned with your regulatory, operational, or clinical goals, especially as CMS and other regulators increase scrutiny. With the right partner and platform, insourcing enables faster decisions, better provider satisfaction, and more intelligent automation.
What makes Cohere different from other automation vendors?
We offer more than software. Our platform is built with clinical depth, designed to scale with your in-house team, and backed by real-world outcomes like 90% auto-approval rates and 96% provider adoption. Plus, our configurable approach means we adapt to your policies, not the other way around.
How do we build an in-house UM program if we don’t have existing clinical or operational teams?
You don’t need to go from zero to full capacity overnight. A phased approach allows you to gradually build your clinical team specialty-by-specialty, while leaning on a technology partner for support. The right platform will help you scale intelligently, with workflows, automation, and staffing strategies that grow with your organization.
Can we insource some parts of UM while keeping others delegated?
Absolutely. Cohere’s modular platform and flexible operating model let you insource at your own pace. Keep delegated support for clinical areas you're not ready to manage internally, while building internal capabilities step by step.
How do you help ensure compliance with regulations like CMS-0057-F?
Cohere helps you build compliant processes from day one, including configuration tools to codify policies and audit-ready tracking for transparency. Our team stays current on evolving regulatory requirements so your workflows don’t fall behind.
How does Cohere handle unstructured data like clinical attachments?
Our platform uses clinician-trained, precision AI to extract insights from unstructured data, such as notes in faxes or uploaded documentation. This enables faster, more accurate decisions without manual digging or delays.
What kind of support will our team receive during the transition?
We don’t believe in “plug-and-play.” Cohere provides white-glove implementation support, clinician-informed best practices, and ongoing guidance to help your team adopt new workflows, build internal confidence, and drive provider engagement.