Cohere Health Brings Pre-Care Insights and Clinical AI to Health Plan Payment Integrity

Acquisition of ZignaAI Accelerates Cohere’s Strategic Clinical Intelligence ‘Shift Right,’ Bringing Proven Capabilities from Prior Authorization into Payment Integrity to Drive Precise AI-Driven Claims Payments

Cohere Health, the leader in clinical intelligence solutions, announced the acquisition of ZignaAI and the launch of its new Payment Integrity (PI) Suite, anchored by Cohere Validate, an AI-powered near real-time clinical and coding validation solution. Cohere Health’s unique approach provides newfound transparency, accuracy, and control to claims payments through the power of clinical intelligence. The payments solution is already delivering faster payments, 30% efficiency gains, and 8-9x ROI to health plans.

This launch marks a milestone for the company’s clinical intelligence platform, which connects health plan and provider interactions, bridging the gap between utilization management (UM) and payments to optimize the cost of care. By unifying pre-service authorization data and post-service claims and coding validation, Cohere Health is creating a transparent ecosystem that reduces waste, improves collaboration, and ensures providers are paid promptly and accurately.

“We’re thrilled to welcome the ZignaAI team to Cohere Health and to launch our Payment Integrity Suite,” said Siva Namasivayam, Co-Founder and CEO at Cohere Health. “The ‘shift right’ is a natural evolution of our clinical intelligence platform, allowing us to bring the same precision AI approach that drove our success in UM: real-time approvals; appropriate, high-quality care for patients; and reduced administrative burden for both payers and providers. Our platform bridges the gap between care planning and payments for better healthcare economics, payer-provider partnerships, and patient outcomes.”

Addressing Longstanding Payment Integrity Challenges

Payment integrity has long been dominated by legacy vendors operating on contingency-based models. While these vendors can deliver savings, their “black box” algorithms lack transparency and provider education opportunities, and retroactive denials often strain payer-provider relationships and prevent health plans from continuously improving their payment policies and processes.

Cohere Health’s PI Suite addresses these issues by shifting post-payment reviews upstream and improving collaboration. Connecting UM and PI data allows health plans to catch errors before claims are paid, reducing both financial waste and provider friction. Providers benefit from faster payments and improved transparency, while plans gain clearer insights into root causes of billing and coding errors, enabling proactive fixes and education, rather than repeated disputes.

Cohere Validate at the Center of Cohere Health’s PI Suite

Cohere Validate modernizes complex claims reviews across inpatient, outpatient, and professional programs by enabling health plans to bring high-value reviews in-house. “Our precision AI is trained on reimbursement policies, codes, and clinical data for faster, more accurate validation with clear audit rationale,” added Krishna Kottapalli, Chief Growth Officer at Cohere Health. “We’re helping health plans move away from legacy models–reducing dependency on stacked audit vendors and replacing them with transparent, evidence-based, and automated in-house processes.”

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