Optimize Your Pre-pay Payment Integrity Strategy

Cohere helps Blue plans stand up and optimize pre-pay programs without building an entirely new operation. With proven technology, PI expertise, and flexible engagement models, we help plans improve efficiency, increase savings, and evolve their pre-pay strategy as priorities change.

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Is your pre-pay strategy delivering what you need?

Whether you're shifting from post-pay to pre-pay or looking to optimize an existing program, the right approach should help you:

  • Improve efficiency by directing auditor resources toward claims with potential findings
  • Increase transparency with clear, clinically grounded rationale behind review decisions
  • Strengthen payment accuracy with clinical and coding validation before payment
  • Improve the provider experience with more informed, defensible findings and targeted education
  • Scale your operation without simply adding more manual review resources

Cohere works collaboratively with Blues plans to assess what's working today, identify opportunities to optimize, and determine the right balance of technology, services, and internal capabilities.

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Stats

Move to pre-pay quickly. See impact sooner.

8 weeks

pre-pay program implementation timeline

2 months

time plans can begin to
see savings

Up to 87%

increase in auditor efficiency

Up to 95%

improvement in hit rate (HBA / IBR)

Up to 9x

Return on investment

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The Payment Integrity Transparency Guide

Learn what transparent payment integrity looks like and how to evaluate whether your current vendor delivers it.

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Make every review count

The goal isn't to have auditors review more claims. It's to help them focus on the claims that matter most–while making your pre-pay operation faster and more efficient.

Hourglass

Intelligent claims selection

Identify the claims most likely to yield savings, so your team can focus its time where it can have the greatest impact.

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Automated no-finding resolution

When the medical record supports the billed claim, Cohere automatically closes the review–reducing unnecessary manual work and increasing auditor capacity.

Puzzle

Transparent clinical and coding validation

Give auditors visibility into why a claim is flagged, what documentation supports the determination, and where clinician review is needed.

Balance

Root-cause and provider insights

Understand the patterns behind findings to support targeted provider education and more informed conversations–helping reduce unnecessary provider abrasion.

Build the right model for your organization

There's no one-size-fits-all approach to pre-pay payment integrity.
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Cohere supports flexible engagement models designed around where your organization is today and where you want to go:

End-to-end Services

Leverage Cohere's technology and expertise to support the full pre-pay workflow.

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Insourcing

Bring more payment integrity operations in-house with technology that automates time-intensive workflows.

Hybrid

Combine internal capabilities, technology, and external support to create the right balance of control and scale.

Start where you are today and evolve your model as your program matures and priorities change.

Proven automation success at scale

  • 85

    %

    of prior authorization approvals in real time

  • 93

    %

    provider satisfaction rating

  • 4000

    +

    digital policies supported

  • 15

    M+

    authorizations leveraging APIs

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Shift upstream. Move quickly. Optimize over time.

Cohere helps plans move upstream quickly, choose the engagement model that fits their organization, and continuously optimize performance as their needs evolve.

Let's talk about your approach.

Whether you're evaluating an existing pre-pay program, looking to improve auditor efficiency, or exploring a new operating model, Cohere can help you identify the next opportunity to improve.

Talk to a Cohere Expert