Medical **policy management** that powers operational excellence

Static policy documents create operational chaos across health plans. Without digitized, structured policies, you can't effectively automate authorization workflows, meet CMS interoperability requirements, or maintain transparency across UM, appeals, and payment integrity. Policy Studio converts policies from disconnected documents into core infrastructure that powers your entire operation automatically.

Policy Studio automates the creation of FHIR-compliant policy resources required for DTR workflows. Our AI converts your policies into API-ready JSON and CQL formats, complete with documentation requirements. You can preview both human-readable and code-ready versions side-by-side to ensure accuracy—without requiring deep technical expertise from your team. Through this digitization process, policies become the source code for automated decision-making.

Policy Studio also supports AHIP transparency commitments–the solution powers public transparency websites through API connections, ensuring the policies providers and members see online are automatically synced with the actual policies used in UM decision-making. It includes lookup tools that enable searching by diagnosis, procedure code, or other fields. This approach eliminates the need for manual website updates while supporting accuracy and transparency.

Our AI is trained specifically on medical policies and clinical criteria. Unlike basic digitization tools, Policy Studio actually understands clinical language and can convert narrative text into usable, logic-based criteria. The solution also connects to our broader Unify platform, meaning digitized policies automatically flow into decisioning and review workflows based on effective dates, lines of business, and codes.

Policy Studio maintains a single source of truth with automatic version tracking and structured metadata for effective dates, codes, and lines of business. When policies are activated for UM decisioning or published to transparency websites, the system automatically selects the appropriate version. This eliminates the risk of applying outdated or incorrect policies while maintaining full audit trails for compliance.

Yes. While Policy Studio integrates seamlessly with the Cohere Unify platform for maximum efficiency, it can also connect to other systems through API integrations. The solution generates standardized outputs (FHIR resources, JSON files, work instructions, questionnaires) that can be leveraged across different platforms; however, full automation benefits are optimized within Cohere Health's ecosystem.

Policy Studio comes pre-loaded with digitized versions of all CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), organized with the same structured data model as your custom policies. This means you can immediately deploy Medicare policies across UM operations without manual work—and they stay automatically updated as CMS makes changes.

Policy Studio is a multi-tenant platform where administrators assign role-based access to policy writers and reviewers. Team members can only access policies they're authorized to work on, and the system tracks every change with automatic version control. You can configure approval workflows to match your organizational structure, and the platform prevents unauthorized edits by maintaining clear permissions and complete edit histories throughout the review cycle.