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
Our solution
Resource constraints
Health plans face critical staffing shortages while managing increasingly complex authorization and clinical decision workflows.
A scalable clinical intelligence platform and flexible deployment methods (in-house and delegated) serve as your launch pad to transform your approach to authorization and clinical decision workflows.
Provider relationship strain
Traditional authorization processes create friction that damages network relationships and contributes to network leakage.
Cohere delivers a best-in-class provider experience (Cohere sees 93% satisfaction rate) by significantly reducing administrative burden through intelligent automation, enhancing provider satisfaction by meeting them where they are for submissions, and offering detailed transparency even for complex and peer-to-peer reviews.
Leveraging AI effectively
Health plans struggle to balance AI and clinical expertise, manage costs and risk, and maintain provider trust amid “black box” concerns.
Cohere’s Unify platform automates routine cases and frees up clinicians for high-impact cases. AI is tailored to your plan, policies, and rules–and never used to deny care.
Case study
Explore the Humana experience
Humana partnered with Cohere Health® to transform prior authorization and improve patient care.
*Cohere's flexible solutions
*Key advantages of Cohere Health®
Cohere Health streamlines the prior authorization process, making it efficient and effective. With our platform, health plans can leverage automation to enhance clinical decision-making.
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.
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.
Benefits
Scalable solutions for health plan success
From flexible implementation pathways and deep industry expertise to AI-powered analytics, Cohere offers comprehensive support that adapts to your needs and grows with your organization.
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.
Testimonials
Clinical intelligence magic happens here
Real results from payers and providers.
Why choose our end-to-end solution?
Scalable Solution Packages
Comprehensive healthcare technology and services that streamline operations, enhance clinical outcomes, and meet you and your providers where you are.
Connect with our team for a solution tailored to your plan's needs and goals.
See how forward-thinking plans get ahead.
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!
Do you offer an enterprise platform?
Yes. Cohere Unify is the intelligent platform that powers all our solutions. It’s not a standalone product—it’s the clinical AI and workflow foundation behind everything we do. With Unify, you integrate once and can flexibly deploy new capabilities across utilization management, clinical decision support, and prior authorization as your needs evolve, without disruption.
What’s the benefit of using a platform approach instead of a point solution?
Point solutions often create silos. Cohere Unify provides a unified foundation for transformation, enabling you to address immediate challenges, like automating routine authorizations or preparing for regulatory deadlines, while building toward a long-term strategy. Every component shares the same clinical intelligence, integration points, and experience layer for providers and reviewers.
Do we have to replace our current UM systems to use Cohere?
No. We designed Cohere to augment—not replace—your existing systems. Whether you're looking to delegate specific service lines or modernize in-house workflows, Cohere allows you to start with particular pain points and scale transformation at your own pace.
How does Cohere’s AI work in clinical workflows?
Our precision AI acts as a clinical copilot throughout the authorization process. It auto-approves up to 90% of routine cases based on medical policy, extracts relevant clinical data from documentation to assist reviewers, and suggests better care settings when appropriate. For health plans, this reduces manual workload, peer-to-peer reviews, and medical expenses, while improving consistency and quality.
What makes Cohere’s clinical AI trustworthy for providers and clinicians?
Cohere’s AI is purpose-built for clinical decisions, trained on millions of prior authorizations and grounded in evidence-based guidelines. With over 350 fine-tuned, clinician-developed models, our system ensures clinical accuracy using a minimum-necessary data approach. Everything is transparent, auditable, and aligned with the role of the human reviewer.
Can Cohere help us navigate CMS and state-level regulatory mandates?
Yes. Cohere fully supports the latest CMS-0057-F mandates with embedded CRD, DTR, and PAS APIs aligned with HL7® Da Vinci implementation guides. Through Cohere Connect, you get support for provider burden reduction and seamless regulatory compliance, including support for multi-entity “single front door” authorization submission models.
We’re facing provider friction—how does Cohere help?
Cohere dramatically simplifies the provider experience with streamlined digital intake processes, clinical documentation guidance, and faster turnaround times. These improvements translate to a 93% provider satisfaction rate, helping you build stronger network relationships.
We’re facing staffing shortages—can Cohere help us scale without hiring more staff?
Yes. Cohere offers a scalable, flexible deployment model that supports in-house and delegated workflows. Our AI-powered platform offloads routine decisions and empowers your existing team to focus on high-value, complex cases–extending your clinical capacity without increasing headcount.