**Clinical AI** from prior auth to appeals

Cohere Unify is the intelligent foundation that powers all our authorization solutions. Rather than a standalone product, it's the highly-composable underlying platform that provides clinical AI capabilities, interoperability, and workflow intelligence across our entire solution portfolio. This platform approach means you integrate once and can add capabilities without disruption as your needs evolve.

A platform approach solves your most urgent challenges while building a foundation for future growth. Unlike point solutions that create new silos, every capability built on Cohere Unify shares the same clinical intelligence, connects through the same integration points, and delivers consistent experiences for you and your providers.

Unlike traditional authorization tools that focus primarily on digitizing manual processes, Cohere Unify was built from the ground up as a clinical precision AI platform that embeds responsible intelligence directly into clinical workflows.

No. Cohere Unify is designed to complement and enhance your existing systems. We can start with specific high-impact areas (like specialty-specific authorizations) while maintaining your current processes elsewhere, allowing for gradual transformation rather than disruptive replacement.

Cohere's clinical AI functions as an intelligent copilot throughout the authorization process and additional clinical decision workflows. For providers, it offers guidance within their clinical workflows, suggests appropriate missing documentation before the authorization is submitted, and with 85% real-time approvals for routine requests based on evidence-based guidelines. For health plans, increased auto-approvals achieved with clinical AI reduce the volume of manual reviews and peer-to-peers to drive administrative savings. When manual reviews are still necessary, clinical AI is used to identify unstructured data within clinical documentation, which is mapped to medical policy indications, streamlining the work for reviewers to drive additional savings and improved clinical accuracy. Clinical AI can also be leveraged to identify more appropriate care settings based on the member records, supporting clinical quality and medical expense savings for customers in delegated specialty management arrangements.

Our clinical AI is built on a foundation of evidence-based clinical guidelines and trained on millions of real authorization decisions.  >350 Clinician-trained, fine-tuned models consistently outperform state-of-the-art LLMs. Our precision AI offers the ability to assist clinical reviewers with AI/ML to enhance review quality for complex cases. Unlike general-purpose AI, our highly trained LLMs pull unstructured data from clinical attachments using a minimum necessary approach to optimize responsible AI. The result is decision support that both providers and health plans can trust.

The Cohere Unify platform leverages CRD, DTR, and PAS APIs that fully align with HL7® Da Vinci™ Project implementation guides. The platform also supports “single front door” integrations whereby the provider can submit authorizations through Cohere APIs regardless of which entity performs the clinical review. In addition, Cohere’s approach to medical policy digitization supports greater provider burden reduction in the DTR workflow by eliminating the need to surface clinical assessment questions to the reviewer, instead pulling unstructured indication data directly from clinical documentation. This full support for CMS-0057-F is also available to customers via Cohere Connect™, a standalone solution powered by the Unify platform.

Yes, Cohere adheres to regulations under both the Health Insurance Portability and Accountability Act (HIPAA) and HiTECH. All Protected Health Information (PHI) received by Cohere Health is protected by administrative, physical, and technical safeguards. All sensitive information we collect is protected by encryption software, both in transit and at rest via AES-256 bit keys and TLS 1.2+, respectively.

‍

Yes, Cohere is certified by HITRUST, NCQA, and URAC. Cohere has a Compliance Program based on the OIG Seven Elements of Compliance. This plan has been reviewed and approved by both NCQA and URAC.

‍

Much like in UM, Cohere Validate and Cohere Complete for PI leverage precision AI, specifically trained on clinical data and reimbursement methodologies, to ensure the highest accuracy in coding and clinical validation.

The Unify platform uses AWS and many of its core services, including the latest cloud and database technology. The portal is available through TLS 1.2+ Cloudfront content distribution and includes a Web Application Firewall (WAF) attached to analyze and monitor all incoming traffic. Multiple AWS VPCs are leveraged to ensure the isolation of environments and overall security. Elastic Load Balancers then direct traffic onward. Fargate and ECS are all used to facilitate the development process in a secure and repeatable manner.