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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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Run UM with your own clinical team
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Manage clinical policy at scale
Flexible, connected payment integrity
Catch errors upstream and reduce post-pay disputes with a 9x return on investment.
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Run payment integrity internally
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Fully managed audit operations
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Reconcile claims against authorizations
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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.
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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.
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How Cohere Unify surfaces rising-risk members and closes care gaps
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Automated claims rule management
Automatically maintain claims rules and drive more accurate claim outcomes across the payment lifecycle.
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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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How to leverage CMS interoperability rules for prior auth innovation
Utilization management
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Improving provider experience
Utilization management
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2025 Intelligent prior authorization trends
Utilization management
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Compliance and regulatory
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How health plans are leveraging intelligent prior authorization to proactively understand their utilization trend
Utilization management
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How episodic prior authorizations position health plans to transform MSK care management
Utilization management
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Your compliance roadmap for the CMS prior authorization rule
Utilization management
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Transform your utilization management with the increased use of advanced AI technology
Utilization management
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How keeping up with CMS regulatory changes will drive better patient outcomes, care collaboration, and interoperability
Utilization management
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The health plan’s guide to interoperability
Utilization management
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Key 2023 prior authorization benchmarks: How does your plan stack up?
Utilization management
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How to go from transactional to transformational utilization management
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Post-Acute Care Will Never Be the Same: How COVID-19 catalyzed a value-based care approach and brought post-acute care to the home
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