Built for the teams managing utilization every day
Cohere Health supports the unique needs of health plans and risk-bearing providers.
AI-Powered prior authorization automation
Offerings:
Flexible models and meaningful insights to insource high-value audits
Offerings:
Ready to update your clinical and coding decision-making?
By Stakeholder
Empowering stakeholders with AI-driven solutions for prior authorization and payment integrity.
Offerings:
Flexible, specialty-specific solutions and actionable insights for high-value care management.
Ready to update your clinical and coding decision-making?
Utilization management suite
Drive high real-time approval rates, guide clinical reviewers, and improve the provider experience with a configurable, clinician-trained AI platform.




85%
real-time approvals
50%
faster clinician review time
70%
faster care access
94%
provider satisfaction
Cohere Health supports the unique needs of health plans and risk-bearing providers.



In-House Utilization

Delegated Utilization

APIs & Compliance

How it Works
Achieve 47% reduction in administrative costs powered by responsible, clinically-derived AI and approval automation.
Your policies, rules, and UM population strategy are automated through Cohere Health's clinical intelligence platform.
CMS-0057 compliant and proven. More than nine million authorizations have already run through Cohere’s APIs.
Impactful results
73%
Faster access to patient care
Driven by real-time clinical intelligence at the point of diagnosis.
63%
Decrease in denial rates
Driven by evidence-based intelligence that guides clinically appropriate requests before submission.
18-43%
Decrease in adverse outcomes
Driven by AI/ML-based clinical suggestions (“nudges”) and analytic features in the prior authorization workflow.
Get a personalized walkthrough based on your in-house, delegated, orhybrid approach.
Stuck on something? We're here to help with all your questions and answers in one place.
Unlike traditional prior auth solutions, Cohere combines technological and clinical expertise to pioneer innovative and responsible AI-powered workflows. Informed by real-time analytics and a team with decades of real-life clinical experience, our approach streamlines UM processes while improving care access and provider relationships.
A full implementation is typically completed within 6 months. Implementation timelines can be shortened depending on the complexity of your solution and the availability and readiness of internal resources.
Our dedicated compliance team continuously monitors regulatory changes and updates our platform accordingly. Our solution is fully compliant with CMS-0057-F, and the Cohere team is actively involved with the Da Vinci Project to ensure alignment with evolving implementation guides and industry standards.
Absolutely! Many clients begin with high-volume specialties like cardiology or orthopedics before expanding. We can also blend in-house and delegated offerings to help health plans on the path to insourcing specialty management. Our modular approach meets plans where they are and supports them in achieving their long-term goals.
Our clinical intelligence is built on evidence-based guidelines developed by practicing clinicians, who also ensure our AI models reflect best clinical practice. Our technological and clinical expert teams work hand-in-hand to drive continued innovation while supporting responsible AI practices and clinical accuracy.
Resources
Whitepaper
In 2021, national health expenditure amounted to $4.3 trillion - $12,914 per person -and now represents 18.3% of the gross domestic product (GDP).1 So, it’s understandable that so many stakeholders, health plans, providers, and patients, are eager to reduce unnecessary utilization





