**Real time approval** 85% of prior authorization decisions with AI-powered intelligence

We combine health plan-preferred policies with advanced AI to deliver 85% of prior authorizations approved in real-time with fewer appeals and overturns.

See Decision in Action
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See Decision in Action

  • 85% of prior authorizations approved in real-time

  • More than 350 proprietary AI/ML models

  • Up to 47% administrative savings

  • Tailored decisioning against health plan business rules

Clinically trained AI at work

Our AI-powered automation handles the majority of prior authorization decisions

Reduce manual decision workload (dramatically)

Our AI-powered automation handles the majority of prior authorization decisions, freeing your team to focus on complex cases that truly require human expertise. With 85% of authorizations approved in real-time depending on specialty, you'll see immediate impact on operational efficiency.

Base decisions on more complete and accurate data

Unlike other solutions, Cohere Decision combs through structured and unstructured clinical records to identify medical necessity data. Our clinically-trained AI sources this information with greater accuracy than off-the-shelf LLMs and even experienced UM nurses.

Flexible policy digitization and codification

Cohere offers expert digitization services to ensure every automated decision aligns perfectly with your coverage guidelines and clinical standards. Our solution decisions against NCDs, LCDs, Cohere proprietary guidelines, custom health plan medical policies, and even third-party guideline vendor policies (with mutual agreement by the third party).

  • 350+

    proprietary AI/ML models deployed

  • 85%

    of authorizations approved in real-time (varies by specialty)

  • 47%

    up to

    administrative savings

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Integrations

Seamlessly integrates with your existing systems

Cohere Decision works within your technology ecosystem, connecting with major EHR systems, UM systems, and administrative tools to ensure smooth data flow and minimal disruption to existing workflows.

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Get a Custom Business Case

Ready to **automate** prior authorizations while keeping your rules and policies intact?

Join leading health plans that have experienced 85% of prior authorizations approved in real-time, while reducing administrative costs by nearly half.

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Get a Custom Business Case

Frequently asked questions

Get answers to common questions we hear from health plans looking to automate decisions while ensuring quality.

How does the product improve over time?

Our Cohere Health Unify platform, which powers our Decision product, continuously monitors performance against key performance indicators (KPIs). It tests results against historical data and refines rules to maximize accuracy while upholding your quality standards. This ongoing optimization ensures that your customized decision automation becomes more effective over time.

What happens to cases that can't be automatically approved?

Complex cases that require manual review and can’t be automatically approved are pre-processed by our AI to extract and structure all relevant clinical information, making the manual review process much faster and more efficient for your clinical staff.

How do you ensure decision accuracy and reduce appeals?

We continuously monitor rule performance against KPIs and use historical authorization data to test and refine our models. This ongoing optimization helps maintain high accuracy rates while reducing appeals and overturns.

Is Cohere Decision compliant with CMS-0057-F requirements?

Yes, Cohere Decision produces all the necessary reports for authorization determinations made within the platform, and is API-ready to support the DTR workflow. In addition, Cohere Decision helps plans accelerate TAT to meet the updated timelines. Learn more on our Cohere Connect page.

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Cohere Unify Platform

Cohere Health’s clinical intelligence platform

Cohere Decision is part of a comprehensive platform that transforms the entire authorization ecosystem for both providers and payers.

  • Real-Time Collaboration Tools - Seamless communication between health plans and providers and their patients.
  • Advanced Analytics & Reporting - Comprehensive insights into authorization patterns and outcomes with Cohere Analyze
  • Regulatory Compliance Management - Automatic updates for changing healthcare regulations
  • Multi-Payer Network Support - Single platform handles authorization workflows across the leading health plans and is in use by more than 600,000 providers nationwide
Group of software interface screenshots showing patient summary, request submission, and clinical guidelines