**Transform payment** integrity from recovery to prevention

Cohere Health helps payment integrity leaders connect clinical, authorization, and claims intelligence to identify errors before payment, reduce costly vendor dependency, and build a more transparent, scalable PI program.

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Up to

87

%

increase in auditor efficiency

1

 in 4

no-finding audits converted to findings through second-pass AI review

Up to

9

x

ROI

150

+

combined years of PI leadership experience

Why Cohere Health

Opaque workflows and reactive recoveries limit payment accuracy

Payment integrity leaders are under growing pressure to deliver measurable medical expense savings, but most programs still depend heavily on post-pay recovery and opaque vendor logic. That limits visibility, makes ROI difficult to independently validate, and leaves the root causes of payment errors unaddressed. Add fragmented vendor ecosystems, duplicate reviews, and provider abrasion, and PI leaders are left managing complexity rather than driving accuracy.

Opaque vendor ROI
Duplicate work across teams
Difficulty scaling limited PI resources
Provider abrasion from audits
Fragmented pre- and post-pay visibility

Payment integrity solutions designed for prevention, transparency, and control

Cohere Validate
AI-powered clinical and coding validation to identify payment inaccuracies before and after payment across complex claims
Cohere Complete for PI
Flexible audit services that combine Cohere's next-gen technology with clinical expertise
Cohere Match
The only solution bridging clinical and payment intelligence to prevent overpayments before they happen
Cohere Surface
Data mining 2.0 enabling self-service rule management with complete visibility into overpayment patterns

How Cohere Health supports payment integrity leaders

Cohere helps health plans transition toward proactive payment integrity by connecting clinical intelligence, policy logic, and transparent audit workflows to prevent avoidable errors upstream.

Shift validation upstream

Detect errors earlier by connecting authorization, clinical, and claims data before they become downstream recoveries.

Improve audit transparency

Support defensible, evidence-backed audit trails that clearly show which criteria were applied, when, and why a finding was surfaced.

Reduce provider abrasion

Use consistent, explainable findings to minimize unnecessary friction and support more collaborative provider relationships.

Reduce vendor dependency

Gain greater control over payment integrity operations to evaluate where vendors add value and where internal teams can drive efficiency.

One platform powering every stage of health plan operations

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Featured Guide

The Payment Integrity Transparency Guide

Explore how transparency in payment integrity programs can help health plans evaluate vendor models, uncover root causes, and build scalable, effective operations.

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Connect clinical intelligence to payment accuracy

Effective payment integrity requires more than claims data. Cohere helps teams surface potential payment errors earlier by connecting upstream clinical evidence, prior authorization data, and policy logic to downstream payment and claims operations, supporting more informed reviews and fewer avoidable recoveries.

Reduce appeal volume through transparent audit rationale

Opaque audit logic creates unnecessary provider friction and drives up appeal volumes. Cohere provides clear visibility into the rules and clinical rationale applied to every finding, helping reduce duplicate work, support provider education, and minimize avoidable disputes.

Give teams control over workflow logic and outcomes

Fragmented PI operations and heavy vendor reliance make it difficult to measure true ROI. Cohere provides health plans with the configurability and reporting visibility needed to independently verify savings, optimize rules, and shift the focus from one-time recoveries to sustainable prevention strategies.

Ready to improve payment accuracy?

See how Cohere connects clinical and payment workflows

Discover how our transparent, intelligence-driven approach helps health plans reduce operational waste, maximize medical expense savings, and take control of payment integrity.

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Frequently asked questions

Answers to common questions from payment integrity and financial operations leaders evaluating Cohere Health.

How does Cohere help shift payment integrity upstream?

Cohere connects clinical, authorization, claims, and policy information earlier in the process. This shared visibility allows health plans to identify and address issues before claims are paid, reducing the reliance on downstream, reactive recoveries.

How does Cohere support clear ROI and savings visibility?

We help health plans move away from opaque vendor reporting by supporting transparent workflows, configurable audit logic, and clear reporting capabilities that allow teams to independently validate performance and measure defensible savings.

Will Cohere replace our existing payment integrity vendors?

Our goal isn't to replace what's already working. Cohere gives health plans the visibility and control needed to evaluate where existing vendors add the most value, and where internal teams may be positioned to manage certain work through a more configurable, payer-led model. The intent is informed flexibility, not vendor replacement.

How does Cohere help reduce provider abrasion in PI audits?

By supporting transparent, evidence-backed findings and clear documentation rationale, Cohere helps reduce confusion and duplicate reviews. This transparency supports more productive provider education and a more collaborative approach to payment accuracy.