How Cohere Surface puts payment integrity and claims teams in control

Every payment integrity (PI) team knows the pattern: a claims analyst spots a billing anomaly, hands it to IT to write a rule, and waits. Weeks or even months later–if the rule is usable at all–it finally runs. Then a policy changes, and the cycle starts over. Meanwhile, the overpayment pattern keeps going. 

‍We're introducing a better way.

Cohere Surface™ is an AI-powered data mining solution designed specifically for payment integrity and claims teams who need to move faster, see more, and maintain control.

The real problem isn't finding the money

The challenge for health plans isn't identifying overpayment categories, but acting quickly on them. The gap is operational: non-technical PI and claims teams sit on one side of the workflow, SQL developers sit on the other, and the handoff between them is slow, expensive, and hard to sustain at scale.

For plans that outsource data mining, the visibility problem is even more fundamental. Legacy vendors deliver savings summaries, but their reporting stops there. Which providers are systematically miscoding? Which billing patterns are driving a category of duplicates? What policy change triggered the uptick? Plans rarely get answers to those questions, and contingency-based vendors have little incentive to provide them.

Flexible control is the unlock

Cohere Surface is organized around a single core idea: a non-technical claims analyst should build, test, and iterate on a data mining rule in an afternoon–without IT involvement, without a vendor intermediary, and without sacrificing visibility into the logic. 

The platform's low-code rules builder comes pre-loaded with a Cohere-maintained library of rules across the most common overpayment categories: duplicates, modifier errors, readmissions, bundling issues, contract discrepancies, and more. That library stays current automatically as policies update, fee schedules change, and as CMS guidance evolves. 

Whether a plan operates the platform in-house, in a hybrid model, or through a services-supported arrangement, the underlying capability is the same: speed, transparency, and adaptability that traditional models simply cannot match.

Transparency that enables action, not just recovery

Most data mining programs are built around a single goal: to find overpayments and recover dollars. Cohere Surface is built around a broader one: understand why errors are happening, and give PI teams the insight and tools to address them at the source when it’s within the plan’s control.

When a claim is flagged, teams can see the exact rule logic that drove the finding, the policy documentation that underpins it, and whether the pattern is isolated or part of a broader provider-level trend. The platform's policy catalog links every rule to its governing documentation, monitors for changes, and holds impacted rules for review before they're reactivated, so teams always work from current policy rather than institutional memory.

That level of root-cause visibility is what turns a recovery operation into a proactive intelligence capability.

A program that runs itself and gets smarter

Cohere Surface's agentic AI layer represents a fundamentally different vision of what a data-mining program can be. Each overpayment error category has a dedicated AI agent that identifies errors, surfaces findings, and supports rule maintenance with human oversight.

The result is a continuously operating, self-improving intelligence program. Repricing is automated once overpayments are identified. Reference tables are updated on a scheduled basis in accordance with current coding standards. Policy monitoring flags changes before they create compliance gaps. Over time, the program requires less manual maintenance and surfaces more of what plans can act on.

How it compares

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‍Where it fits

Cohere Surface is a standalone product, but it's designed to complement the broader Cohere Payment Integrity suite. For plans not yet ready for complex clinical audits, it offers an accessible entry point to a modern PI program. For existing Cohere Validate, Cohere Complete for PI, or Cohere Match customers, it extends coverage into rule-based, no-medical-record-required overpayment categories. And for plans that want a unified view across their entire payment accuracy lifecycle, it integrates across the full suite.

Ready to empower your PI and claims team to stop waiting on IT and start closing the gap between what you know and what you can act on? Learn how here.