**Streamline** claims-to-auth reconciliation for cost avoidance

Get it right from the start; identify authorization to claims mismatches before payment.

Tap Into New Insights
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Tap Into New Insights

Why Cohere Match™?

The only solution bridging UM and PI for proactive payment accuracy.

  • Reduce admin burden associated with auth matching, retro auths, and clinical audits

  • Harness rich clinical authorization data during claims processing

  • Prevent overpayments from incorrect auth attachment

  • Transform authorization data into payment intelligence

  • Improve provider relationships and network satisfaction

Benefits

Shift from recovery to prevention

Cohere Health®’s groundbreaking claims-to-auth reconciliation taps into previously unused authorization insights. Our proprietary algorithm bridges the gap between point-of-care decisions and payment integrity, preventing overpayments before they happen.

Ensure accurate payments

Prevent medical spend loss through proactive identification of authorization mismatches before payment.

Uncover administrative savings

Reduce manual matching and costly retro authorizations, and decrease post-pay audit burden.

Strengthen provider partnerships

Reduce retroactive denials and payment recoveries while minimizing redundant medical record requests to lower provider frustration.

Drive upstream intervention

Identify mismatch patterns and leverage the opportunity to educate providers and optimize your entire authorization and claim workflow.

Proprietary claims-to-auth reconciliation

Health plans struggle with manual auth matching, leading to processing delays, overpayments, and inefficient claim adjudication workflows.

Cohere Health is the only vendor with insights across both utilization management and payment integrity

Our precision clinical intelligence platform integrates prior authorization insights with payment integrity for superior claim selection.

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Infographic showing a vertical workflow process with five connected steps: Claim data mapping, 8-point criteria analysis, Confidence score, Actionable match insights, Improved provider relationships and network satisfaction.

Here’s how it works:

Unlike traditional post-payment recovery, Cohere Match leverages authorization data collected before service delivery to prevent overpayments at the source.

Our proprietary rules engine scores claims against authorizations using 8 key criteria, providing confidence levels and detailed insights rather than black-and-white decisions. Transform pre-service data into real-time payment accuracy.

Utilization management shifts right, and payment accuracy shifts left, where they intersect to enable Cohere Match to accelerate accurate payments while reducing the provider abrasion typically caused by retroactive denials and payment recoveries.

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Book a Discovery Call

Ready to **reduce overpayments** and administrative burden?

Join the health plans improving their payment integrity operations with Cohere Match.

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Book a Discovery Call

Available as an add-on to Cohere UM solutions. Contact us to discuss your specific needs.

More insights below

Learn why Cohere Match is right for your health plan and join the trailblazers forging a new path to connected UM and PI operations.

What problem does the Cohere Match solution solve for health plans?

Cohere Match addresses the inefficiencies and risks in manually verifying whether claims align with prior authorizations (PAs). Today, payer teams frequently depend on time-consuming manual processes, resulting in overpayments, retro auths, post-pay audits, and provider abrasion. Cohere Match automates this reconciliation by identifying mismatches between claims and PAs and providing actionable insights that lead to accurate payments.

How does Cohere Match work?

Cohere’s proprietary reconciliation algorithm evaluates the quality of the match between a claim and a corresponding PA using a multi-factor scoring framework. Claims falling below a confidence threshold are flagged, and clients receive a detailed report highlighting mismatches, trends, and recommendations.

Is my health plan a good candidate for this solution?

The best-fit customers are existing or prospective Cohere clients that have purchased one of our Utilization Management (UM) solutions or Payment Integrity solutions and want to expand the scope of their programs across the healthcare continuum.

How is Cohere Match different from anything else on the market?

Cohere Health is uniquely positioned as the only vendor with visibility across both UM and PI data. This dual vantage point allows us to create match logic and actionable insights that other vendors—who only see one side of the equation—can’t.

What kind of ROI or impact can customers expect?

Customers can expect measurable reductions in:

  • Manual effort for claims and PA matching
  • Retro authorizations and associated delays
  • Post-pay audits and overpayments
  • Provider friction and abrasion