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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
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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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Compliance and regulatory
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White papers
Four Ways the CMS Prior Authorization and Interoperability Rule Will Drive Better Patient Outcomes
Utilization management
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Compliance and regulatory
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Webinars
Your questions about the new CMS rule answered live
Utilization management
,
Provider experience
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Compliance and regulatory
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Webinars
Improving Physician and Member Prior Auth Experience: Cohere & Humana
Utilization management
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AI/ML
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White papers
The Tech-Powered Shift from Transactional to Transformational Prior Authorization
Utilization management
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Compliance and regulatory
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Webinars
Utilization Management & Prior Authorization Transformation for Medicaid Plans
Utilization management
,
Specialities
,
Provider experience
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White papers
Streamlining Cardiovascular Care: Aligning Physicians and Health Plans to Reduce Waste and Improve Outcomes
Utilization management
,
Provider experience
,
Webinars
Utilization Management: The New Front Door for Health Plans
Utilization management
,
Specialities
,
White papers
Physical Therapy & Value-Based Care: An Opportunity for Innovation
Utilization management
,
Specialities
,
White papers
AAOS & Cohere are reimagining prior authorization for musculoskeletal care
Utilization management
,
AI/ML
,
Webinars
Improving Member Care with AI and Machine Learning
Utilization management
,
White papers
A Needed Transformation - Changing Prior Authorization From an Obstacle to a Cornerstone of Better Care
Utilization management
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Specialities
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Provider experience
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Webinars
Transforming Prior Authorization into True Care Management
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