**Flexible engagement** models and meaningful insights for high-value claims

Shift left with transparency, untapped data, and AI-powered efficiency across the payment continuum.

Scale Payment Integrity
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Scale Payment Integrity

**Flexible engagement** models and meaningful insights for high-value claims

Shift left with transparency, untapped data, and AI-powered efficiency across the payment continuum.

Get a Demo
Blue piggy bank with a gold coin, shield emblem, and checkmark symbol, standing on a computer chip platform, representing secure financial savings, audits, and technology integration.
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The challenge

Traditional opaque payment integrity vendors create dependencies, limit organizational learning, and hinder a health plan’s ability to shift left and correct the root cause of coding and clinical validation errors. Data silos, fragmented processes, and increased provider abrasion are abundant.

Our solution

Smarter PI starts with automation—not vendors. Gain clear visibility into procedural and financial accuracy with precision AI that processes unstructured medical records into structured datasets. Enable your teams to scale complex clinical and coding validation internally with complete transparency, or leverage end-to-end transparent services to reduce traditional vendor dependency while achieving superior efficiency and hit rates.

Revolutionizing Payment Integrity with AI-Powered Precision

Benefits

Key advantages of Cohere's payment solutions

Reduce inaccurate payments and scale in-house operations with automated clinical and coding validation.

End-to-end clinical and coding validation solution

AI automation surfaces relevant insights from medical records that impact payment accuracy and guides teams through structured audit workflows for inpatient, outpatient, and professional claims.

Expedited accurate payment

Leverage pre-service clinical data for enhanced claim risk scoring and audit selection, and automated clinical and coding validation insights for a significantly faster turnaround than traditional prepay PI operations.

UM and PI informed selection

Health plans have a unique advantage when leveraging Cohere’s UM and PI capabilities. Machine learning algorithms analyze claims against pre-service data, plan policies, provider contracts, and exclusions to flag claims most likely to result in audit findings, tailored to your organization's specific needs.

Claims-to-auth matching

Close the gap between your Utilization Management (UM) and Payment Integrity (PI) departments. Match claims to prior authorizations efficiently and accurately, moving from "recovery" to an “avoidance" model that reduces provider abrasion.

Meaningful transparency

Full visibility into AI decision-making with meaningful insights for upstream interventions.

Cohesive AI-powered services

Cohere outperforms traditional vendors with precision AI that uncovers savings and insights others miss—delivering superior results across your complete prospective and retrospective workflows from medical records retrieval through appeals management.

Support for the most complex claims across inpatient, outpatient, and professional settings.

Flexible engagement models to meet you where you are: our configurable payment integrity suite bridges UM and PI operations, enabling health plans to insource complex prospective and retrospective reviews, augment existing in-house operations with precision AI, or delegate PI services to an AI-native and modern service provider.

AI-powered clinical and coding solution

Our intuitive solution surfaces the relevant insights from medical records that impact payment accuracy and guides teams through structured workflows.

Explore Cohere Validate
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Comprehensive services

A modern AI-native approach with transparency and deep coding and clinical expertise offers an evolution of traditional payment integrity services. We leverage our proprietary AI technology specifically trained on reimbursement methodologies to provide a transparent, cost-effective alternative to legacy opaque service vendors..

Learn More About Cohere Complete for PI

Claims-to-auth matching

Bridge the gap between Utilization Management and Payment Integrity departments. Our proprietary reconciliation solution prevents overpayments by identifying authorization mismatches before payments ever happen.

Discover Cohere Match
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Proven results and resources

  • 30-87%

    Lift in auditor efficiency

  • 45-94%

    Improvement in hit rate

  • $4-30K

    Average savings per claim

  • 8-9x

    ROI

Results vary by claim type, including DRG, HBA, IBR, APC, EAPG, and ASC.

Benefits of AI-driven payment integrity

Cohere Health’s payment integrity solution empowers organizations to insource high-value review and audit opportunities and eliminate data silos. By focusing on prevention, operational efficiency, and strategic control, it ensures transparency and seamless coordination across the payment continuum, driving maximum impact for your business.

  • Unique UM-to-PI integration

    Leverage existing UM clinical data to expedite accurate payment with enhanced claim risk scoring and selection. Eliminate redundant clinical reviews across departments.

  • 0% Hidden

    Full visibility into AI decision-making logic with no opaque algorithms. Leverage the transparency model to address the root cause of coding and clinical validation errors

  • Scalable, flexible solutions

    Scale program control with transparent, configurable technology with human safeguards for your in-house team or through Cohere’s end-to-end services. Leverage AI-assisted workflows to automate manual tasks performed by clinicians and coders.

Optimize Payment Integrity
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Become a PI Trailblazer

Payment integrity from the trusted team that revolutionized UM automation

Schedule a call to learn how Cohere Health's transparent AI solution can help you insource complex clinical and coding validation, augment existing in-house operations with precision AI, or delegate PI services to an AI-native and modern service provider - all while improving provider relationships.

Illustration of two large 3D arrows (orange and blue) circling around a pink heart shape, surrounded by three labeled callouts: "Precision AI," "Best-in-class PI solutions," and "In-house scalability."
Become a PI Trailblazer
Illustration of two large 3D arrows (orange and blue) circling around a pink heart shape, surrounded by three labeled callouts: "Precision AI," "Best-in-class PI solutions," and "In-house scalability."
Get a Demo

Payment integrity from the trusted team that revolutionized UM automation

Schedule a call to learn how Cohere Health's transparent AI solution can help you insource complex clinical and coding validation, augment existing in-house operations with precision AI, or delegate PI services to an AI-native and modern service provider - all while improving provider relationships.

Illustration of two large 3D arrows (orange and blue) circling around a pink heart shape, surrounded by three labeled callouts: "Precision AI," "Best-in-class PI solutions," and "In-house scalability."
Get a Demo

More insights below

Explore how Cohere Health’s transparent, AI-powered Payment Integrity Suite transforms traditional operations, reduces vendor dependency, and helps you insource with confidence.

What types of reviews and audits can I insource using Cohere Health’s Payment Integrity Suite?

Cohere Health offers comprehensive support for high-value audits, including inpatient DRG (Diagnosis Related Group), HBA (Hospital Bill High Balance Audit), IBR (Itemized Bill Review), ASC (Ambulatory Surgical Center), and APC (Ambulatory Payment Classification). Our structured AI-powered workflows empower your teams to manage complex audits end-to-end with speed, accuracy, and transparency.

How does Cohere’s solution reduce vendor dependency?

Traditional PI vendors often act as black boxes, limiting visibility and keeping payers reliant on external resources. Cohere Health’s solution gives you full transparency into AI decision-making and audit workflows, enabling internal teams to take control. Our ML-powered claim selection and clinical-grade data processing allow your team to scale audits efficiently in-house.

What makes Cohere Health’s AI “precision?”

Our AI is trained on over 100,000 clinical indications and refined with direct feedback from licensed clinicians and coders. Using a combined approach of small- and large-language models, the AI accurately interprets unstructured medical records and turns them into structured, auditable data that supports decision-making and reduces manual effort.

How is Cohere Health different from other payment integrity vendors?

Cohere stands out by offering a transparent solution—you’ll always know how decisions are made. We also uniquely integrate Utilization Management (UM) data to inform PI workflows, helping you move from "recovery" to a model of "avoidance” and “prevention.” This not only reduces provider abrasion but also allows for real-time interventions and upstream corrections. This “shift left” approach accelerates payment accuracy and enables early identification of issues.