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AI-powered prior authorization automation
Touchless prior authorizations and faster medical necessity reviews, with up to 18x return on investment.
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Offerings
In-House
Run UM with your own clinical team
Delegated
Specialty-specific care management
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Embed UM into existing systems
Policy Studio
Manage clinical policy at scale
Flexible, connected payment integrity
Catch errors upstream and reduce post-pay disputes with a 9x return on investment.
Explore Payment Integrity
Offerings
In-House
Run payment integrity internally
Services
Fully managed audit operations
Auth Match
Reconcile claims against authorizations
Data Mining
Surface high-value audit targets
Streamlined appeals workflows
AI-assisted review and evidence gathering help reviewers complete appeals in half the time, with full auditability.
Explore Appeals
Press
Cohere Unify expands into appeals: reviewers close cases in half the time
Connected clinical intelligence
Surface rising-risk members, close care gaps, and generate compliant care plans within existing workflows.
Explore Care Management
How Cohere Unify surfaces rising-risk members and closes care gaps
Explore Platform
Automated claims rule management
Automatically maintain claims rules and drive more accurate claim outcomes across the payment lifecycle.
Explore Claims Operations
Press
Cohere Surface brings transparency to claims data mining
AI-powered clinical evidence extraction
Automated HEDIS gap closure across unstructured records, with 20–25% closure rates for high-value measures.
Explore Quality
Blog
Hybrid season is over: Why year-round quality measurement is the new reality
Utilization Management
+
AI-powered prior authorization automation
Touchless prior authorizations and faster medical necessity reviews, with up to 18x return on investment.
Explore UM
Offerings
In-House
Run UM with your own clinical team
Delegated
Specialty-specific care management
API-Based
Embed UM into existing systems
Policy Studio
Manage clinical policy at scale
Payment Integrity
+
Flexible, connected payment integrity
Catch errors upstream and reduce post-pay disputes with a 9x return on investment.
Explore Payment Integrity
Offerings
In-House
Run payment integrity internally
Services
Fully managed audit operations
Auth Match
Reconcile claims against authorizations
Data Mining
Surface high-value audit targets
Appeals
+
Streamlined appeals workflows
AI-assisted review and evidence gathering help reviewers complete appeals in half the time, with full auditability.
Explore Appeals
Press
Cohere Unify expands into appeals: reviewers close cases in half the time
Care Management
+
Connected clinical intelligence
Surface rising-risk members, close care gaps, and generate compliant care plans within existing workflows.
Explore Care Management
How Cohere Unify surfaces rising-risk members and closes care gaps
Explore Platform
Claims Operations
+
Automated claims rule management
Automatically maintain claims rules and drive more accurate claim outcomes across the payment lifecycle.
Explore Claims Operations
Press
Cohere Surface brings transparency to claims data mining
Quality
+
AI-powered clinical evidence extraction
Automated HEDIS gap closure across unstructured records, with 20–25% closure rates for high-value measures.
Explore Quality
Blog
Hybrid season is over: Why year-round quality measurement is the new reality
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Utilization management
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AI/ML
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Guides
Utilization Management Vendor Analysis Guide
Compliance and regulatory
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Utilization management
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AI/ML
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Provider experience
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Webinars
Policy in action: End-to-end traceability and automation for CMS-0057-F
Payment Integrity
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Compliance and regulatory
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AI/ML
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Provider experience
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eBooks
Reclaiming Control Vol. II: A modern approach to payment integrity
Payment Integrity
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AI/ML
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Compliance and regulatory
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Provider experience
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Specialities
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White papers
Defining sepsis together: A collaborative approach to improving care
Compliance and regulatory
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Utilization management
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Guides
Guide to Meeting AHIP Prior Authorization Commitments
Provider experience
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Utilization management
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AI/ML
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Compliance and regulatory
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White papers
The Hidden Cost of Prior Authorization
Utilization management
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Payment Integrity
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Webinars
Unifying Utilization Management and Payment Integrity
Utilization management
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Compliance and regulatory
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AI/ML
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Provider experience
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Specialities
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eBooks
Take Back Control of Utilization Management
Utilization management
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Compliance and regulatory
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Webinars
CMS-0057-F Compliance: What Health Plan Leaders Need to Know
Utilization management
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Provider experience
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Case studies
How Humana Transformed Prior Authorization to Improve Care & Collaboration
Utilization management
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Provider experience
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AI/ML
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Webinars
From burden to benefit: a payer-provider discussion on prior authorization
Utilization management
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White papers
How AI and Machine Learning are Transforming Prior Authorization Today
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