**Cohere Health** closes the gap between care planning and payments

Until now, health plan decisionmakingfrom policy and prior authorization to appeals and claimshas been siloed and manual. Cohere Health connects plans and providers across utilization management, payment integrity, and appeals through a single platform built on clinical intelligence–AI that understands clinical context, not just codes.

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  • Purpose-built clinical intelligence platform

  • AI that understands medical policy, anatomy, and coding

  • Augment existing systems or refine entire workflows

  • Expertise and rich analytic insights to support strategic goals

We bridge health plan goals and provider needs

Our clinical-grade innovation ensures we design solutions that deliver wins on both sides

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Optimize the cost of care, from planning to payment

Cohere Health’s unmatched clinical, coding, and quality approach collects rich clinical insights before care to support more accurate, complex decisions and improve downstream workflows.

Drive faster, more accurate decision-making

Going beyond generic automation and generative AI, Cohere Health closes the loop between clinical expertise and automation to support complex clinical and claims reviews (inpatient and outpatient) with built-in guidance.

Illustration of collaborative agreement symbolizing delegated utilization management with clinical intelligence and peer-to-peer physician support
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Get ahead of downstream impacts

Gain early signals and deep insights on medical expense trends, connect medical necessity with complex payment policies, understand and optimize provider performance, and prevent overpayments with pre-care insights and coding validation.

Make the healthcare journey better for everyone

Cohere Health enables plans to get members the right care at the right time, and for the right value by streamlining provider engagement with flexible submission options, tailored experiences, transparency, and effective guidance.

Illustration of collaborative agreement symbolizing delegated utilization management with clinical intelligence and peer-to-peer physician support

Customer impact

  • 85%

    auto approvals

  • 50%

    reduction in review times

  • 30%

    lift in auditor efficiency

  • 93%

    provider satisfaction

Ready to unlock connected clinical decision-making for **your health plan?**

Browse the most common questions we are asked to help you make the most of your decision to modernize your UM operations…and beyond!

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Learn more about Cohere Health

Cohere Health is a clinical intelligence company improving healthcare decision-making for health plans and at-risk providers.

Who uses Cohere Health?

Cohere Health is used by health plans and providers who want to close the gap between care planning and payment. We serve leading national and regional health plans, provider networks, and clinicians who manage utilization management, payment integrity, and appeals decisions–all within one platform.

What are the benefits of Cohere Health’s approach?

Cohere Health’s approach delivers faster, more accurate decisions while reducing administrative burden and medical expense. Uniting policy, prior authorization, appeals, and claims on one platform provides early insights into medical trends, prevents unnecessary costs, and ensures members receive the right care at the right time.

What makes Cohere Health’s AI technology different?

Cohere Health’s AI is purpose-built for healthcare decision-making, designed to understand medical policy, anatomy, and coding in context. Rather than relying on generic automation, our AI embeds guidance that supports experts in complex inpatient and outpatient reviews, improving accuracy upstream to reduce waste downstream. Cohere Health’s AI uniquely balances speed, accuracy, and trust with proven results.

How does Cohere Health improve the provider and member experience?

Cohere Health simplifies provider workflows with flexible submission options, transparent guidance, and built-in clinical intelligence that reduces unnecessary back-and-forth. This creates faster approvals, less administrative burden, and greater trust, ultimately giving members quicker access to appropriate care.

What kind of support does Cohere provide to its health plan partners?

Cohere Health partners closely with health plans to align technology with strategy, offering flexible deployment options, training, and ongoing support. Beyond implementation, Cohere provides rich analytic insights and collaborative guidance to help plans meet strategic goals, ensure compliance, and continuously improve decision quality and cost performance.