End-to-end 
**payment integrity** services with AI-powered savings

Modern, transparent services powered by precision AI

Drive Payment Accuracy
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Drive Payment Accuracy

Cohere Health’s AI-powered service excellence

We prevent overpayments and uncover savings traditional vendors miss while enhancing provider relationships.

  • Accelerated and optimized coding and clinical validation

  • Complete services from superior, UM-informed selection to appeals

  • Configurable workflows with client-specific customization and transparent output

  • Transparent root cause analysis for upstream provider intervention

Keep control while reducing operational burden

Cohere Complete for PI offers meaningful transparent payment integrity services that help you achieve risk-free operations without losing program control

AI-powered financial performance and strategic insights

Discover savings traditional vendors miss with our precision AI across both pre-pay and post-pay processes. Beyond individual outcomes, gain actionable insights into root cause coding and clinical validation errors to prevent future overpayments and drive systematic improvements.

Transparency in an opaque market

Unlike Traditional opaque payment integrity vendors, we provide detailed prospective and retrospective review findings, complete with root cause analysis capabilities at the provider level. Our transparent approach enables upstream interventions and provider education that prevent future issues, while our consultative methodology builds trust through clear communication and faster resolution times.

Low-cost, high-quality structure and service methodology

Our AI-native operations combine clinical and coding staff with complex reimbursement expertise, resulting in higher-quality reviews and audits, and faster turnaround times.

  • 30%

    increase in auditor efficiency compared to traditional operations

  • 1 in 4

    no-finding audits converted to findings through second-pass AI review

Cohere Health integration network logos showcasing EHR and UM interoperability with partners like Epic, CMS, NaviNet, Rhyme, Availity, MCG, and others
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Integrations

Unified services and platform with Cohere UM

Leverage the power of integrated utilization management and payment integrity data for superior selection and outcomes. Our platform seamlessly connects with leading adjudication and claims systems to maximize data utilization.

Cohere Health integration network logos showcasing EHR and UM interoperability with partners like Epic, CMS, NaviNet, Rhyme, Availity, MCG, and others
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Explore Cohere Complete for PI

Modern, AI-powered **payment integrity services** to exceed your expectations

Outsource complex clinical and coding validation to a transparent, AI-native partner that leverages the same precision technology our health plans use in-house. Lower costs, higher-quality prospective and retrospective reviews, and stronger provider relationships without the legacy vendor baggage.

Illustration of two interlocking arrows in yellow and blue with a pink heart in the center, accompanied by callouts highlighting Native AI Solution, 0% Black Box, and End-to-End Services.
Explore Cohere Complete for PI

Frequently asked questions

Get answers to common questions about our AI-powered payment integrity services

How do your payment integrity operations and expertise improve quality and speed?

Our AI-native operations are supported by clinical and coding staff with deep reimbursement methodology expertise. This enables higher-quality complex clinical and coding validation with faster turnaround times through automated insights and streamlined workflows, while ensuring financial and procedural accuracy.

How comprehensive is your coverage?

Cohere specializes in complex clinical and coding validation across inpatient, outpatient, and professional settings. Cohere Health offers comprehensive support for high-value reviews and audits, including complex professional, inpatient DRG (Diagnosis Related Group), HBA (Hospital Bill Audit), IBR (Itemized Bill Review), ASC (Ambulatory Surgical Center), and APC (Ambulatory Payment Classification).

How do you ensure compliance for Medicaid and other sensitive programs?

We have US-based operations, which is crucial for Medicaid and compliance-sensitive plans. Our platform maintains strict security standards and regulatory compliance while providing transparency into our audit methodology and findings.

What makes your provider experience better?

We reduce provider abrasion through more accurate initial selections using unified UM and PI data. Our transparent audit rationale, communication, and consultative approach focus on provider education and relationship building, resulting in faster resolution times and health plan trust.