Utilization management suite

**Optimize** the speed and cost of care with clinical AI

Drive high real-time approval rates, guide clinical reviewers, and improve the provider experience with a configurable, clinician-trained AI platform.

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Built for plans. Trusted by clinicians.
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Stats

85%

real-time approvals

50%

faster clinician review time

70%

faster care access

94%

provider satisfaction

Built for the teams managing utilization every day

Cohere Health supports the unique needs of health plans and risk-bearing providers.

  • CMOs & Medical Directors
    Drive greater clinical accuracy and operational efficiency.
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    High real-time approval rates
    Greater clinical accuracy & quality
    Improved operational efficiency
  • Tech & Innovation officers
    Deliver immediate performance gains with configurable solutions.
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    Proven AI for clinical operations
    Flexible deployment options
    Immediate performance gains
  • Provider Engagement teams
    Reduce provider burden and accelerate care delivery.
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    High provider satisfaction rates
    All-channel authorization intake
    Provider-friendly workflow nudges

“The results of Cohere Health’s digital authorization platform have exceeded our expectations.”

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William Shrank
MD, MSHS, Chief Medical Officer at Humana

Scalable utilization management built for all health plans

In-House Utilization

Strengthen your in-house UM operations

Equip your team with clinician-developed AI proven to drive efficiency and quality in UM.
Best for: Organizations that want to keep UM in-house while improving performance.
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Delegated Utilization

Deliver quality with delegated UM expertise

Outsource UM operations for select specialties while ensuring control and transparency.
Best for: Organizations looking to focus internal resources elsewhere.
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APIs & Compliance

Interoperable workflows ready for 0057-F

Support interoperable prior authorization while reducing provider burden.
Best for: Organizations seeking FHIR APIs and policy digitization expertise to support interoperability.
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How it Works

A simpler way to manage utilization

Cohere Health combines clinical intelligence, flexible workflows, and operational expertise to support faster, more consistent care decisions.
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All-channel intake

Meet providers where they are

Authorization requests are submitted through EHRs, fax, and every other provider channel–including our intake app with a 94% provider satisfaction rating.
Real-time approvals

Automate authorizations with accurate clinical AI

Highly accurate AI can dig into unstructured attachments to find the clinical criteria to satisfy policy–enabling upwards of 80% real-time approvals.
AI-guided reviews

Drive quality and efficiency in clinical reviews

In-house clinical reviewers get case summaries, AI-surfaced indication data, and an expert AI assistant to accelerate high quality decision-making.

“Working with Cohere Health is transformational in Geisinger’s long history of clinical innovation…”

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John B.
MD, CMO for Geisinger Health Plan

Why health plans (of all sizes) choose Cohere Health

  • Lower administrative costs

    Achieve 47% reduction in administrative costs powered by responsible, clinically-derived AI and approval automation.

  • Automate approvals

    Your policies, rules, and UM population strategy are automated through Cohere Health's clinical intelligence platform.

  • Support compliance needs

    CMS-0057 compliant and proven. More than nine million authorizations have already run through Cohere’s APIs.

Impactful results

Cohere in action

  • 73%

    Faster access to patient care

    Driven by real-time clinical intelligence at the point of diagnosis.

  • 63%

    Decrease in denial rates

    Driven by evidence-based intelligence that guides clinically appropriate requests before submission.

  • 18-43%

    Decrease in adverse outcomes

    Driven by AI/ML-based clinical suggestions (“nudges”) and analytic features in the prior authorization workflow.

Abstract stylized circuit-board arrow and workflow visual illustrating AI-driven utilization management
Abstract stylized circuit-board arrow and workflow visual illustrating AI-driven utilization management

See how **Cohere Health works** for your utilization management model

Get a personalized walkthrough based on your in-house, delegated, orhybrid approach.

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Frequently asked questions

Stuck on something? We're here to help with all your questions and answers in one place.

What makes Cohere different from other prior authorization solutions?

Unlike traditional prior auth solutions, Cohere combines technological and clinical expertise to pioneer innovative and responsible AI-powered workflows. Informed by real-time analytics and a team with decades of real-life clinical experience, our approach streamlines UM processes while improving care access and provider relationships.

How long does implementation typically take?

A full implementation is typically completed within 6 months. Implementation timelines can be shortened depending on the complexity of your solution and the availability and readiness of internal resources.

How does Cohere ensure compliance with changing regulations?

Our dedicated compliance team continuously monitors regulatory changes and updates our platform accordingly. Our solution is fully compliant with CMS-0057-F, and the Cohere team is actively involved with the Da Vinci Project to ensure alignment with evolving implementation guides and industry standards.

Can my health plan start working with Cohere in one clinical specialty area and expand later?

Absolutely! Many clients begin with high-volume specialties like cardiology or orthopedics before expanding. We can also blend in-house and delegated offerings to help health plans on the path to insourcing specialty management. Our modular approach meets plans where they are and supports them in achieving their long-term goals.

How do you maintain clinical quality while automating decisions?

Our clinical intelligence is built on evidence-based guidelines developed by practicing clinicians, who also ensure our AI models reflect best clinical practice. Our technological and clinical expert teams work hand-in-hand to drive continued innovation while supporting responsible AI practices and clinical accuracy.

Resources

Thought leadership & research

Utilization management
,
AI/ML
,

White papers

The Tech-Powered Shift from Transactional to Transformational Prior Authorization

Utilization management
,
AI/ML
,
Provider experience
,

White papers

How AI and Machine Learning are Transforming Prior Authorization Today

Utilization management
,
Specialities
,

White papers

How episodic prior authorizations position health plans to transform MSK care management

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Whitepaper

Download whitepaper

In 2021, national health expenditure amounted to $4.3 trillion - $12,914 per person -and now represents 18.3% of the gross domestic product (GDP).1 So, it’s understandable that so many stakeholders, health plans, providers, and patients, are eager to reduce unnecessary utilization

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