Clinically trained AI to streamline **payer and provider** collaboration

Scalable solutions for utilization management and beyond that meet you and your providers where you are, driving efficiency on patient care decisions while giving you control.

Explore UM Transformation
Clinically trained AI platform streamlining payer and provider collaboration for improved utilization management and patient care efficiency
Explore UM Transformation

Built for plans. Trusted by clinicians.

Cohere in action.

  • 90%

    automated prior authorizations

  • 47%

    admin-cost savings

  • 70%

    faster care access

  • 30%

    more accurate clinical decisions

  • 93%

    provider satisfaction

Why Cohere Health®?

Choose a clinical intelligence platform, not a utilization management platform

Cohere's clinical intelligence platform equips health plans with AI-driven actionable insights that go far beyond traditional utilization management systems and legacy portals, powering decisions on care quality and utilization.

Status quo

Our solution

Traditional prior authorization platforms and portals simply process approval requests or deny authorizations to meet quotas, delaying care and creating downstream impact that builds administrative friction.

Cohere leverages responsible AI for data collection and interpretation, enabling real-time, clinically oriented care decisions that enhance efficiency, quality, and patient outcomes.

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.

Automate prior authorization

Digitize care requests in a single workflow, including building detailed patient profiles, to automate decisioning for up to 90% of care needs.

Improve care decision accuracy

Reduce burden with intelligent insights and guidance for 50% faster inpatient and outpatient reviews, and 30% more accurate decisions.

Manage medex risk

Guide providers to patient and cost-optimized decisions, such as site-of-service changes, for 15% incremental medex savings.

Cohere Unify platform interface illustrating responsible AI in clinical decision-making, prior authorization evaluation, and collaborative healthcare workflows
Cohere Unify platform interface illustrating responsible AI in clinical decision-making, prior authorization evaluation, and collaborative healthcare workflowsCohere Unify platform interface illustrating responsible AI in clinical decision-making, prior authorization evaluation, and collaborative healthcare workflows

Cohere Unify™ platform

Responsible AI for clinical decisions and collaborative workflows

Cohere Unify gathers and deciphers patient clinical data, evaluates prior authorization submissions against policy, and generates decisions or recommendations to keep clinicians practicing at the top of their license.

Learn More
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Cohere utilization management

Scalable, AI-powered utilization management and clinical intelligence built for all health plans

AI-powered intelligence dramatically reduces administrative burden while improving accuracy–delivered as a platform, as a service, or through our 0057-compliant APIs (or somewhere in between).

Illustration of in-house utilization management team using clinical intelligence platform to reduce administrative burden and improve provider efficiency

In-house utilization

Cohere’s modern clinical intelligence platform empowers your in-house utilization management team to achieve administrative efficiencies, improve provider satisfaction, streamline care access, and improve patient outcomes, including:

  • 47% reduction in administrative costs
  • 61% reduction in provider input time
  • 35-40% reduction in clinical review time
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Delegated utilization

We combine our clinical intelligence platform with an experienced operational staff (peer-to-peer and medical necessity determinations made by same-specialty physicians) to provide health plans with complete, end-to-end and fully delegated utilization management operations for select specialties.

  • 70% faster access to patient care
  • 93% satisfaction among providers
  • 96% of total auths approved within seconds
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Illustration of collaborative agreement symbolizing delegated utilization management with clinical intelligence and peer-to-peer physician support
Illustration of API-based interoperability for prior authorization showing puzzle integration on laptop screen, representing healthcare data connectivity

API-Based

Drive true interoperability across your prior authorization workflow and reduce provider burden while complying with the Centers for Medicare & Medicaid Services’ (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). Cohere offers a proven, scalable solution for your compliance needs.

  • CRD, DTR, PAS APIs included
  • APIs leveraged for over 9 million authorizations
  • 4,000+ policies supported
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Testimonials

Clinical intelligence magic happens here

Real results from payers and providers.

Exceeded expectations

The results of Cohere’s digital authorization platform have exceeded our expectations.

William Shrank

MD, MSHS, Chief Medical Officer at Humana

Proactive care suggestions

Working with Cohere Health is transformational in Geisinger’s long history of clinical innovation…our network providers can take advantage of the platform’s evidence-based, proactive care suggestions to make better health easier for our patients to ensure they receive optimal care specific to their medical history and condition.

John Bulger

MD, CMO for Geisinger Health Plan

Improved clinical outcomes

This partnership enables faster, improved clinical outcomes for our members while reducing administrative burdens for our providers through enhanced workflows and automation.

Vice President of Clinical Population Health at a Regional Health Insurance Plan

Great partner

Cohere has been a great partner in helping us gain better and earlier insight into the care our members are receiving while continuing to decrease administrative burden for our providers.

VP at Regional Health Plan

Visual comparison of traditional authorization management versus leveraging clinically trained AI for improved flexibility, provider experience, and clinical outcomes
Visual comparison of traditional authorization management versus leveraging clinically trained AI for improved flexibility, provider experience, and clinical outcomes

Experience the difference between managing authorizations and **leveraging clinical** intelligence.

Connect with our team to explore your clinical intelligence needs.

Schedule a Personalized Demo
Schedule a Personalized Demo