AI-powered sepsis auditing that adapts to your policies

Cohere Validate’s Sepsis Audit Agent configures to your unique sepsis criteria with AI-powered automation to deliver superior accuracy, faster decisions, and optimized savings you can trust for your payment integrity operations.

Experience Sepsis Audit Agent

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Delegate Services in a Heartbeat

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AI-powered sepsis audits, 24/7

Powered by AI, the Sepsis Audit Agent is a fully agentic payment integrity experience. The agent works autonomously scanning hundreds of pages of medical records, surfacing only claims with findings, adapting to your sepsis criteria and empowering validated decisioning - helping your team focus where human judgment matters most.

24/7 AI-powered sepsis audits: Continuous, autonomous claim reviews, even while your team is offline

Policy flexibility: Configurable to various sepsis frameworks, from Sepsis-3 to provider-friendly SIRS criteria and hybrid models

Significant time savings: Automated review reduces hundreds of pages and hours of work to just minutes per case

Integrated workflow efficiency: Grouper and pricer integration enables real-time coding updates and instant DRG regrouping

On-demand clinical auditors: Effortlessly scale with Cohere’s expert clinical auditors for hybrid or overflow support

Superior transparency: Automated SOFA/qSOFA/SIRS scoring with complete documentation and detailed calculations eliminates inconsistency and provides defensible audit trails.

Real results from DRG clinical validation audits

$4k-5k
Average savings per claim
58-83%
Improvement in hit rate
200%+
Lift in auditor efficiency

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White paper

Defining sepsis together

Sepsis costs hospitals over $52 billion annually due to fragmented management. Learn how a shared definition and tech-driven collaboration reduce disputes, improve financial predictability, and strengthen partnerships.

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Overview

Why sepsis audit agent?

Because not all sepsis cases - or health plan policies - are created equal.

Cohere Validate's Sepsis Audit Agent is the only solution that configures to your specific sepsis criteria, ensuring your audits align with your unique policies while maintaining clinical accuracy.

Policy framework customization

Seamlessly adapt to diverse clinical guidelines with five distinct sepsis frameworks. Our configurable policy options ensure precision and alignment with your specific criteria.

Sepsis-3: Employs a conservative standard for life-threatening organ dysfunction.
Sepsis-3 (exclude pre-existing): Includes life-threatening organ dysfunction, but omits pre-existing conditions from the SOFA score.
Sepsis-2: Utilizes SIRS criteria alongside evidence of organ dysfunction.
qSOFA: A rapid screening tool with customizable physician-led thresholds.
Hybrid: Integrates multiple scoring models for flexible policy alignment.

Intelligent sepsis audit agent

Empower auditors to concentrate on complex cases, as our automated intelligence handles initial review and validation. The system efficiently scans medical records and pre-calculates clinical scores.

Scans medical records, validates diagnoses, and calculates clinical scores before auditors begin.
Auto-closes non-findings, directing auditor focus to high-priority cases.
Reviews hundreds of pages of medical records automatically.
Calculates SOFA/qSOFA/SIRS scores with clinical precision, providing full calculations and links to supporting documentation.
Identifies valid diagnoses and flags questionable sepsis claims.
Provides direct link access to all supporting documentation.

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Streamlined workflow integration

Consolidate all essential auditing tools and information into one centralized location. This integration ensures a smooth, efficient process from documentation to payment calculation.

Automates documentation with direct links to all relevant records.
Provides a comprehensive claim view, including current DRG, weight, and clinical documentation.
Offers automated coding updates, eliminating the need for manual edits.
Integrates grouper and pricer to automatically update DRG codes, weights, and payments in real-time.
Instantly calculates payment and savings, leaving only review and confirmation.

Benefits

4 ways the sepsis audit agent takes your audit operations to the next level

Unmatched efficiency

Sepsis Audit Agent reduces hours of work to minutes by working before auditors even begin their day—automatically reviewing hundreds of pages of medical records and calculating clinical scores, with savings often exceeding $5,000 per case.

Superior clinical accuracy

With configurable policy frameworks and automated SOFA/qSOFA/SIRS scoring, we eliminate inconsistency and human error. Every audit follows your specific criteria with complete documentation, detailed calculations, and full audit trails that give your auditors clinical confidence.

Instant financial impact

No more system hopping or manual calculations. See the implications of every audit decision in real-time with integrated grouper and pricer functionality. Track savings case by case, auditor by auditor.

Stronger provider collaboration

Faster turnaround times, clinically defensible findings, and complete documentation and complete audit trails mean fewer disputes and better provider relationships. When providers trust your audits, everyone wins

Clinical Leadership

Physician-led expertise driving quality care

Cohere Health's board-certified physicians bring unmatched clinical leadership, guiding evidence-based decisions and elevating care standards across our solutions.

Brian Covino, M.D., FAAOS

Chief Medical Officer

With over 25 years of orthopedic surgery experience, Dr. Covino joined Cohere in 2020 after serving as a consultant since 2018. As a former partner at Knoxville Orthopaedic Clinic/OrthoTennessee, specializing in joint replacement surgery, he brings invaluable clinical expertise to our leadership team. Dr. Covino holds a bachelor's degree from Harvard University and an M.D. from Georgetown University School of Medicine, with surgical training from the University of Virginia and a fellowship at The Cleveland Clinic Foundation.

Traci Granston, M.D.

Senior Vice President of Clinical Strategy

For more than twenty years, Dr. Granston has been an orthopedic surgeon specializing in hand surgery. She received her undergraduate degree in science and master’s of business administration from the University of Washington, attended medical school at Vanderbilt University School of Medicine, and completed her orthopedic surgery training at the University Hospitals of Washington, Cleveland, and Case Western Reserve. Dr. Granston is active in the Vanderbilt University’s School of Medicine Campaign Cabinet, the American Academy of Orthopedic Surgeons, and the American Society of Surgery of the Hand.

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Your solution to keep pace with evolving sepsis criteria

Greater accuracy. Faster decisions. Optimized savings you can trust.

Request a Sepsis Audit Agent Demo

Sepsis audit agent FAQs

Explore answers to common questions about the Sepsis Audit Agent and transforming your payment integrity workflow.

How does the Sepsis Audit Agent handle different sepsis criteria?

Our Sepsis Audit Agent is configurable to 5 different policy frameworks—from conservative Sepsis-3 (2016) standards to provider-friendly SIRS-based models and hybrid approaches. You control which criteria align with your payer policies.

How much time does the Sepsis Audit Agent save per audit?

Auditors report saving hours per case by automating the review of hundreds of pages of medical records and SOFA score calculations. The Agent works before auditors even begin their day, so a typical audit that might take 2-3 hours can be completed in minutes, with some cases showing $5,000+ in savings.

Does this replace our audit team?

No - the Sepsis Audit Agent augments your team's expertise. The AI agent auto-closes all the no finding audits so that your team can focus on the audits with findings (aka savings opportunities). It also handles time-consuming data review and calculations, while your auditors apply clinical judgment and make final decisions. We also offer hybrid services where Cohere auditors can support your team for overflow support.

How does the integrated workflow actually work?

Everything happens in one platform: the Agent pre-reviews medical records and validates diagnoses before auditors open the case, auditors can drill into SOFA calculations with supporting documentation, promote valid diagnoses with one click (coding updates apply instantly), DRGs regroup automatically, and the integrated pricer calculates new payment amounts in real-time. No toggling between systems.

What makes Cohere Health different from other vendors?

Cohere Validate is the first AI-native payment integrity solution featuring an agentic AI designed specifically for sepsis audits. We also integrate UM and PI data to catch issues before payment (not months later), offer end-to-end automation with human oversight, and provide the industry's first configurable sepsis policy framework.

How quickly can we implement the Sepsis Audit Agent?

Implementation timelines vary between 8 -16 weeks based on your configuration needs and integration requirements. Contact us for a personalized demo where we can discuss your specific situation and timeline.

Can the Sepsis Audit Agent integrate with our existing systems?

Yes, Cohere Validate is designed to integrate with your existing workflow systems. We'll work with your team to ensure seamless data flow and workflow integration.

AI-powered sepsis auditing that **adapts to your policies**

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