Health plans run quality, utilization management, appeals, payment integrity, claims, and care management in silos. Cohere Health connects them—turning clinical signals from UM into actionable intelligence that flows across every function, improving outcomes and reducing operational drag.
Bridge operational silos by integrating workflows, ensuring medical policy aligns with clinical evidence, and streamlining quality and payment decisions.
Extract insights from unstructured clinical data to inform downstream operations.
Equip teams with tools that surface relevant clinical evidence automatically, allowing them to focus on higher-value tasks while improving efficiency.
Providers submit clinical documentation once during authorization. Cohere Health reuses that data across downstream functions such as appeals, quality, payment, and care management—eliminating redundant requests and rebuilding trust at scale.
Featured Guide
This guide provides a practical framework for evaluating, sequencing, and scaling enterprise AI, so your organization can stop retrofitting around legacy systems and start redesigning from within.
Guide
Every new point solution adds another data model, governance process, and integration point. This guide gives health plan executives a framework to evaluate, sequence, and scale enterprise AI so ROI compounds instead of resetting.
Case study
Humana partnered with Cohere Health® to transform prior authorization and improve patient care.
Authorization workflows generate the richest clinical decision data in health plan operations—procedure, site, rationale, timeline. Cohere Health captures those signals at the point of decision and routes them downstream to quality, payment integrity, appeals, and care management. One clinical interaction powers multiple operational outcomes, eliminating redundant data collection and reducing provider burden.
Quality, utilization management, and payment integrity are great examples of functions that often operate as separate silos. Cohere Health's composable and modular platform connects functions through a single intelligence layer, so your investments compound in value as you connect more functions on Cohere Health's platform.
Every authorization, quality determination, and payment decision carries an audit trail grounded in clinical evidence. Cohere Health surfaces the rationale behind each decision in real time—improving transparency, supporting compliance, and giving providers visibility into why decisions were made.
Learn how Cohere Health connects health plan operations with clinical intelligence.
No. Cohere's platform is designed to sit on top of existing infrastructure—connecting to your current systems and workflows rather than replacing them. The intelligence layer integrates with what you already have.
Yes. Cohere’s connected platform uses prior authorization data already flowing through the system to identify quality opportunities and improve payment accuracy without disrupting existing workflows.
The platform is built to make your team more effective, not to replace them. It handles data assembly, evidence surfacing, and cross-functional signal routing—freeing your people to focus on high-value work that requires expertise.
Specific to UM, where there is the most provider engagement, Cohere uses clinical intelligence upstream to help providers get to an appropriate yes as quickly as possible. That means digitized, transparent policies; configurable provider programs like green lighting; real-time nudges that prompt for necessary clinical attachments before submission; and high portal adoption that streamlines intake. The result downstream: fewer missing info requests, fewer peer-to-peers, fewer denials, and stronger provider relationships.
Cohere’s integrated platform aligns clinical intelligence with health plan operations, connecting workflows to improve care quality, streamline operations, and enhance provider trust.
