End-to-end prior authorization automation **you control**

Empower your in-house team with a modern clinical intelligence platform.

Reinvent Your UM
Three screens showing the process of auto - translation.
Reinvent Your UM

You don’t have to settle for the status quo

In-house hodgepodge of legacy solutions

  • Administrative costs/complexity
  • Broad expertise needed
  • Outdated provider portals with low adoption rates

Delegated legacy vendors

  • Largely denial-based approach
  • Lack of transparency
  • Negative provider and member experience

Features

Break free from legacy vendors and outdated solutions

Discover healthcare operations powered by clinical intelligence and flexibility. Our innovative approach combines the best of insourcing with precision AI + a modular approach.

  • Powerfully scalable

    Build an integrated technology stack with products that scale with you.

  • Smarter approvals & faster access

    Reduce care delays by 73% through policy transparency and streamlined approvals.

  • Trusted by providers

    Achieve 94% provider satisfaction with an expert experience and integrated guidance.

Benefits

Key advantages of Cohere Health

Cohere streamlines the prior authorization process, making it efficient and effective. With our platform, health plans can leverage real-time approvals to enhance clinical decision-making.

Support until you’re ready

Cohere has a clear pathway to full insourcing at your pace. If you're poised for change, we're here to help you achieve it.

Clinician-trained precision AI

Leverage AI to automate authorizations and extract insights from unstructured data in attachments, expanding your team’s capabilities and confidence.

Dynamic prior authorization

Experience the power of a fully digitized, AI-enhanced prior authorization solution that puts efficiency and member care first.

Download Playbook Now

Take back control of UM

A step-by-step guide to smarter, in-house UM

Learn how to reduce administrative costs by up to 70% and improve care delivery with a proven strategy for in-house utilization management.

Download Playbook Now
Download the Guide

Guide

Not sure how to evaluate your options?

Our utilization management vendor analysis guide helps you drive focused vendor discussions and make informed decisions that deliver long-term operational value.

Download the Guide
See Case Study

Case study

Explore the Humana experience

Humana partnered with Cohere Health® to transform prior authorization and improve patient care.

See Case Study

Impactful results

Cohere in action

  • 90%

    Auto-approval rate

  • 35%

    Reduction in portal input time

  • 5

    days faster to appropriate care

  • 93%

    provider satisfaction

Platform overview

Free your team from the status quo and achieve remarkable results

A comprehensive, intelligent platform solution and composable products to meet you and your providers where you are for scalable, long-term success.

  • Lower administrative costs

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

  • Real-time approvals

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

  • Support compliance needs

    CMS-0057-F compliant and proven. Cohere APIs have been leveraged for over 15 million authorizations to date

Digital interface displaying an approved prior authorization request for knee arthroplasty, with automation features such as EMR integration and dashboard actions.

Intake

Digitizes all prior authorization requests into a single automated workflow.

  • Omni-channel intake: fax, phone, app, EHR
  • Real-time prior auth requirement checks
  • Intelligent missing info nudges in the provider submission workflow
Learn more about Intake

Decision

Real-time prior authorization decisions using health plan-preferred policies and accelerates manual review.

  • 85% of prior authorizations approved in real-time* with fewer appeals and overturns
  • Medical policy codification and management (NCDs, LCDs, custom policies, etc.)
  • Advanced rule design & configuration for automation workflows‍

‍*The remaining prior authorization submissions are reviewed by a clinician before final determination.

Learn more about Decision
Patient summary interface displaying automated approval for knee arthroplasty with detailed provider and diagnosis information.
Clinical note and guideline view showing AI-assisted extraction of relevant medical information to assess knee pain treatment and match LCD coverage criteria.

Review

Helps clinical reviewers adjudicate complex requests with clinician-trained AI/ML and automation capabilities.

  • Available as a platform product or lightweight add-on to your existing utilization management solution
  • Leverages clinician-trained AI to source indications from unstructured attachments
  • Supports a longitudinal view of member health with authorization & claims history
Learn About Review Assist
Learn About Review Resolve
Explore Cohere Align

Explore Cohere Align

Create a tailored provider experience aligned to performance or to replace gold carding and out-of-date exemption programs, allowing you to:

  • Identify and dynamically manage provider cohorts-rewarding stars, addressing outliers
  • Engage cohorts with provider-friendly communication tactics
  • Continuously monitor to ensure sustained improvements and reduce risk of overutilization
Explore Cohere Align

Why choose our end-to-end solution?

Our clinical intelligence platform powers an end-to-end solution that doesn't lean on denials to drive savings.

  • Operational efficiency

    Reduce administrative overhead and streamline prior authorization processes.

  • AI-powered insights

    Leverage advanced clinical intelligence for smarter decision-making.

  • Real-time optimization

    Continuously improve workflows with intelligent tracking and analytics.

  • Seamless integration

    Proven interoperability with existing healthcare systems and workflows.

Modern layered shield and arrow graphic symbolizing efficiency, speed, and security in prior authorization workflows
Modern layered shield and arrow graphic symbolizing efficiency, speed, and security in prior authorization workflows

**Ready to modernize** your approach to prior authorization?

Contact Cohere today to:

  • Discuss your specific utilization management challenges
  • Learn how health plans have successfully transitioned from legacy solutions
  • Understand what it takes to bring a solution in-house
Control your UM
Control your UM

Smarter UM starts with the right questions

Explore common questions about how Cohere helps health plans modernize utilization management with automation, flexibility, and clinical intelligence.

Why should we consider insourcing utilization management (UM) when our current delegated model works?

Insourcing UM gives your health plan greater control, transparency, and long-term cost efficiency. It eliminates dependency on third-party vendors that may not be aligned with your regulatory, operational, or clinical goals, especially as CMS and other regulators increase scrutiny. With the right partner and platform, insourcing enables faster decisions, better provider satisfaction, and more intelligent automation.

What makes Cohere Health different from other automation vendors?

We offer more than software. Our platform is built with clinical depth, designed to scale with your in-house team, and backed by real-world outcomes including 85% approvals in real time* and 96% provider adoption. Plus, our configurable approach means we adapt to your policies, not the other way around.

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*The remaining prior authorization submissions are reviewed by a clinician before final determination.

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How do we build an in-house UM program if we don’t have existing clinical or operational teams?

You don’t need to go from zero to full capacity overnight. A phased approach allows you to gradually build your clinical team specialty-by-specialty, while leaning on a technology partner for support. The right platform will help you scale intelligently, with workflows, automation, and staffing strategies that grow with your organization.

Can we insource some parts of UM while keeping others delegated?

Absolutely. Cohere’s modular platform and flexible operating model let you insource at your own pace. Keep delegated support for clinical areas you're not ready to manage internally, while building internal capabilities step by step.

How do you help ensure compliance with regulations like CMS-0057-F?

Cohere helps you build compliant processes from day one, including configuration tools to codify policies and audit-ready tracking for transparency. Our team stays current on evolving regulatory requirements so your workflows don’t fall behind.

How does Cohere handle unstructured data like clinical attachments?

Our platform uses clinician-trained, precision AI to extract insights from unstructured data, such as notes in faxes or uploaded documentation. This enables faster, more accurate decisions without manual digging or delays.

What kind of support will our team receive during the transition?

We don’t believe in “plug-and-play.” Cohere provides white-glove implementation support, clinician-informed best practices, and ongoing guidance to help your team adopt new workflows, build internal confidence, and drive provider engagement.