AI-Powered prior authorization automation

Evolve from transactions into seamless provider collaboration and patient care optimization.

The challenge

Prior authorization processes are costing your organization millions while frustrating providers and delaying patient care.

Our solution

Cohere's AI-driven platform automates up to 90% of prior authorizations while ensuring compliance with business rules and enhancing clinical quality.

Features

Achieve better care and measurable results with less friction

You need a clinical intelligence platform that fosters collaboration, not abrasion. Cohere combines responsible AI, deep, evidence-based clinical expertise, and real-time analytics to digitize the prior authorization process and support CMS-0057-F compliance needs.

Lower administrative costs
Achieve 47% reduction in administrative costs 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.

Benefits

Why health plans (of all sizes) choose Cohere

Finding an effective solution involves more than just technology. Based on proven results and successful implementations, we help you scale your utilization management transformation, ensuring it meets your current and future needs.

Integrate smarter workflows without starting from scratch

Embed Cohere into your existing systems to drive immediate improvements in provider experience, turnaround time, and operational efficiency—without requiring a full tech overhaul.

Refocus clinical effort on care, not paperwork

Free up clinicians for high-impact work by removing redundant documentation steps and automating policy management. The result? A 15% drop in avoidable hospitalizations and faster care access for members.

Build a compliant AI strategy backed by clinical rigor

Digitize policies—including NCDs, LCDs, third-party, and custom guidelines—with support from clinician-developed models and national associations like AAOS. Our AI platform supports responsible automation, not black-box denials.

How it works

We offer a flexible approach to transitioning to a clinical intelligence platform with critical principles we stand behind:

Responsible clinical AI - Evidence-based intelligence for consistent, appropriate decisions
Seamless integration - Works with your existing systems and EHRs with unmatched connectivity
Flexible deployment - Choose the in-house, delegated, or hybrid approach that fits your organization's needs

Cohere utilization management

Flexible paths to prior authorization excellence

Streamline operations, reduce costs, and improve patient outcomes with Cohere's flexible UM solutions

In-House utilization

Empower your internal UM team

Leverage a proven blueprint for your prior auth evolution
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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. Our platform delivers:

Nearly half the administrative costs of traditional systems
Provider documentation time reduced from hours to minutes
Clinical review efficiency increased by over one-third

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Delegated utilization

Level-up your UM operations with full-service expertise.

Experience comprehensive (and proven) utilization management operations across various specialties

We combine our clinical intelligence platform with an experienced operational and clinical staff to provide health plans with complete, end-to-end, and fully delegated utilization management operations for select specialties. Unlike other vendors, at Cohere, same-specialty physicians handle peer-to-peer reviews.

Patients accessing care in days rather than weeks
Provider satisfaction rates that exceed industry benchmarks
Immediate authorization decisions for the vast majority of cases

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APIs utilization

Cross CMS compliance off your list

Exceed standards with a truly interoperable solution

Drive interoperability across your prior authorization workflows and reduce provider burden while complying with the Centers for Medicare & Medicaid Services' (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F).

Millions of authorizations successfully processed through our mature API infrastructure
Seamless integration with existing healthcare IT systems
Full compliance with the latest CMS regulations

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Impactful results

Cohere in action

73%
Faster access to patient care
Driven by real-time clinical intelligence at the point of diagnosis.
63%
Decrease in denial rates
Driven by evidence-based intelligence that guides clinically appropriate requests before submission.
18-43%
Decrease in adverse outcomes
Driven by AI/ML-based clinical suggestions (“nudges”) and analytic features in the prior authorization workflow.

Ready to take the next step in modernizing your approach to utilization management?

See how Cohere works with your specific use cases.

Schedule a Consultation

Want to learn more about our solutions?

Browse the most common questions we are asked to help you make the most of your decision to modernize your UM operations…and beyond!

What makes Cohere different from other prior authorization solutions?

Unlike traditional prior auth solutions, Cohere combines technological and clinical expertise to pioneer innovative and responsible AI-powered workflows. Informed by real-time analytics and a team with decades of real-life clinical experience, our approach streamlines UM processes while improving care access and provider relationships.

How long does implementation typically take?

A full implementation is typically completed within 6 months. Implementation timelines can be shortened depending on the complexity of your solution and the availability and readiness of internal resources.

How does Cohere ensure compliance with changing regulations?

Our dedicated compliance team continuously monitors regulatory changes and updates our platform accordingly. Our solution is fully compliant with CMS-0057-F, and the Cohere team is actively involved with the Da Vinci Project to ensure alignment with evolving implementation guides and industry standards.

Can my health plan start working with Cohere in one clinical specialty area and expand later?

Absolutely! Many clients begin with high-volume specialties like cardiology or orthopedics before expanding. We can also blend in-house and delegated offerings to help health plans on the path to insourcing specialty management. Our modular approach meets plans where they are and supports them in achieving their long-term goals.

How do you maintain clinical quality while automating decisions?

Our clinical intelligence is built on evidence-based guidelines developed by practicing clinicians, who also ensure our AI models reflect best clinical practice. Our technological and clinical expert teams work hand-in-hand to drive continued innovation while supporting responsible AI practices and clinical accuracy.