**Flexible engagement** models and meaningful insights for high-value claims
Shift left with transparency, untapped data, and AI-powered efficiency across the payment continuum.
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.
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.
Proven results and resources
30%
Lift in auditor efficiency
14%
Improvement in hit rate
98%
Overall selection approval rate
8-9x
ROI
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.
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.
