Clinical Intelligence Company Cohere Health Announces Acquisition Of ZignaAI

Prior authorization and clinical intelligence technology enablement company Cohere Health announced today that it will be acquiring ZignaAI to move into the world of clinical payment integrity.

With this new acquisition, the company will be launching an entire suite dedicated to payment integrity and optimizing revenue for stakeholders, marking a “shift right” from purely pre-care into payments, as CEO Siva Namasivayam and CGO Krishna Kottapalli note.

Specifically, the company is bringing together two often separated ecosystems into one seamless workflow, welding the gap between prior authorizations and post-service claims and coding validation. By doing so, Cohere believes it can inch closer to real-time approvals and better economics for all involved parties. The problem in the current system is that the provider’s services and the payment for those services are often on two very different timelines; despite having prior authorization, providers often do not receive reimbursement immediately after executing services. Essentially, connecting these two worlds can help mitigate errors before claims are reimbursed, meaning that service providers can ultimately enjoy more swift reimbursements.

Namasivayam explains that the goal is to bring the same level of competency to payment integrity as Cohere brought to the world of prior authorization. Right now, the system is fractured, leading to dissatisfaction and frustration between stakeholders. But ideally, a combined ecosystem will: help foster better relationships between payers and providers, improve administrative procedures and efficiencies across the board and ultimately, enable stakeholders to focus on their core competencies rather than workflow burdens.

As Kottapalli further explains, payer and provider collaboration is foundational to the company, and moreover, a tech first approach is necessary for this foundation: “We’re helping health plans move away from legacy models by reducing dependency on stacked audit vendors and replacing them with transparent, evidence-based and automated in-house processes.”

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