**AI-powered** accuracy for streamlined clinical and coding validation

Intelligent selection, automated edits, and accelerated, clinically accurate workflows to empower your in-house team across prospective and retrospective reviews

Reduce Vendor Dependency
Screenshot of a healthcare platform interface titled "Inpatient DRG Clinical." The coding worksheet displays a paid amount of $17,215.56, with diagnosis codes and validation indicators. Callouts highlight "30% Improvement in provider efficiency" on the left and "8–9x Return on investment" on the right.

Reduce inaccurate payments. Scale in-house PI operations.

Strategically enhance your internal team’s capabilities to drive better outcomes.

  • Modernize PI operations using configurable technology with human safeguards

  • Reduce vendor dependence - shift more volume in-house

  • Improve provider relationships through consistent, accurate reviews

  • Leverage automated medical record review and editing for unmatched efficiency

Proven performance

Real results from health plan implementations

  • 30%

    Increase in auditor efficiency

  • 14%

    Improvement in hit rate

  • 8x

    ROI

Benefits

Modernize your payment integrity operations with transparent AI technology

Replace vendor dependency with in-house capabilities that deliver superior results while strengthening provider relationships

Comprehensive complex coverage

Handle the most challenging prospective and retrospective reviews across all settings - inpatient, outpatient, and professional, with automated clinical and coding validation.

Advanced precision AI technology

Leverages AI, natural language processing, and machine learning to intelligently identify claims, validate clinical evidence, and cross-reference diagnosis and procedure codes with supporting documentation - with human safeguards embedded throughout the workflow.

Configurable in-house control

Customize workflows, exclusions, and audit criteria to your organization's needs. Maintain complete operational control while scaling your team's capabilities.

Enhanced productivity

Enables auditors to perform at the top of their license, increases auditor productivity while maintaining quality standards, reduces manual review time up to 30% through automated validation, and scales processing capacity efficiently.

Illustration of two large 3D arrows (orange and blue) encircling a pink heart shape, accompanied by three callouts: "Precision AI," "Best-in-class technology," and "Scale in-house PI."
Explore Audit Modernization

**Accelerate payments** with consistent, proactive, accurate actions.

See how our transparent AI solution can help your team perform complex clinical and coding validation with unprecedented efficiency and accuracy.

Illustration of two large 3D arrows (orange and blue) encircling a pink heart shape, accompanied by three callouts: "Precision AI," "Best-in-class technology," and "Scale in-house PI."
Explore Audit Modernization

Your questions, answered

Explore how we help health plans insource and scale complex prospective and retrospective reviews, achieving up to 30% efficiency gains and 14% hit rate improvements while reducing vendor dependency and gaining full control over their PI operations.

What types of reviews/audits are supported with this payment integrity suite?

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

How does the AI technology validate clinical and coding evidence?

Our solution uses advanced small- and large-language models, NLP, and machine learning to analyze claims against medical records, cross-referencing diagnosis codes with supporting documentation while providing transparent output.

Can the product be customized for our specific requirements?

Yes, while maintaining global rules for baseline compliance, our solution offers extensive client-specific configuration for unique policies and procedures, ensuring flexibility while maintaining consistency across your organization.

 How does the end-to-end audit solution improve auditor productivity?

By automating routine validation tasks, providing clear evidence-based outputs, and reducing manual review time, auditors can focus on complex cases while maintaining high-quality standards and processing more claims efficiently and consistently.

What reporting and analytics capabilities are included?

The solution includes built-in reporting mechanisms, real-time performance feedback, user performance evaluation tools, provider assessment capabilities, and continuous monitoring of output accuracy and relevance.