Elevate **your plan's** performance through clinical excellence and precision AI
Experience unparalleled operational efficiency, strengthen provider relationships, and optimize care journeys with our enterprise platform designed for forward-thinking health plans.
Challenges
Solutions
Resource constraints across care continuum
Health plans face critical staffing shortages while managing increasingly complex authorization workflows AND payment integrity operations, often relying on expensive vendor stacks with limited transparency.
Cohere Health's clinical intelligence platform scales across both authorization and payment operations with flexible deployment (in-house, delegated, or hybrid) - leveraging the same AI models and clinical expertise to maximize efficiency from policy to payment.
Provider relationship strain
Traditional authorization processes create friction, and fragmented payment integrity operations compound the problem - providers face multiple record requests, retroactive denials, and a lack of transparency into audit decisions.
Cohere bridges UM and PI operations to deliver a unified provider experience. Our transparent, evidence-based approach reduces administrative burden in authorization (93% satisfaction rate) AND minimizes payment-related friction through proactive accuracy and consolidated medical record requests.
Vendor dependency and operational silos
Health plans struggle with expensive PI vendor stacks (30%+ contingency fees) that operate with opaque algorithms, while UM and PI teams work in silos, missing opportunities for integrated cost containment.
Cohere's unified platform eliminates legacy opaque service vendor dependency by connecting UM and PI data for superior case selection, transparent audit rationale, and the ability to leverage authorization insights for payment accuracy - reducing both operational costs and vendor fees.
Leveraging AI effectively across cost containment
Health plans want AI benefits but struggle with opaque algorithm concerns in both authorization decisions AND payment integrity audits, while managing costs, risk, and provider trust.
Cohere's platform delivers transparent AI across the entire cost containment spectrum - from automated routine authorizations to clinical coding validation - with full visibility into decision logic and human safeguards throughout.
Case study
Explore the Humana experience
Humana partnered with Cohere Health® to transform prior authorization and improve patient care.
*Key advantages of Cohere Health
Looking to automate manual, time-intenstive workflows without adding provider friction?
Cohere offers flexible deployment models and omnichannel intake, meeting you where you are to achieve admin savings.
Struggling with provider abrasion in a legacy delegated model?
Outsource utilization management for precision medex management and build tailored provider experiences.
Searching for a solution to address CMS-0057-F compliance?
Cohere offers full CMS compliance on a proven platform, which has processed millions of authorizations through our mature APIs.
Tired of legacy opaque PI vendors with 30%+ contingency fees?
Take control with transparent, AI-powered payment integrity that delivers superior results while building internal capabilities and reducing vendor dependency.
Struggling with post-pay recovery and provider abrasion?
Shift left with proactive payment accuracy by bridging UM and PI data to prevent overpayments before they happen, strengthening provider relationships.
Need modern PI services without the legacy vendor drawbacks?
Partner with an AI-native vendor that offers transparent audit findings, lower contingency fees, and actionable insights for upstream interventions.
Scalable solutions for health plan success
Resource-sensitive approach
From tech-empowered in-house operations to fully-delegated models to somewhere in between, with initial delegation options and a gradual transition to in-house operations as your team develops.
Enterprise performance-focused partnership
Our experience across health plans is broad and deep, and continues to grow with support from a dedicated client success team with health plan expertise, regular capability enhancements, and new modular product innovations that help our clients scale.
Performance analytics driving continuous optimization
AI-driven analytics for smarter decision-making and faster cycle times.
Complimentary Gartner® report
Key technologies shaping healthcare payers in 2025
The Gartner® Hype Cycle™ for U.S. Healthcare Payers, 2025 provides actionable strategies and expert insights into generative AI’s role in transforming operations, reducing costs, and enhancing member satisfaction. Empower strategic decisions with this essential resource for healthcare payer CIOs.
Clinical intelligence magic happens here
Scalable solution packages
