Scalable solutions for utilization management and payment integrity that meet you and your providers where you are, driving efficiency on patient care and value decisions while giving you control.
Built for plans. Trusted by clinicians.
90%
automated prior authorizations
47%
admin-cost savings
70%
faster care access
8x
return on investment for payments
93%
provider satisfaction
Status quo of UM
Our UM transformation solution
Traditional prior authorization platforms and portals simply process approval requests or deny authorizations to meet quotas, delaying care and creating downstream impact that builds administrative friction.
Cohere leverages responsible AI for data collection and interpretation, enabling real-time, clinically oriented care decisions that enhance efficiency, quality, and patient outcomes.
Status quo of PI
Our approach to payment precision
Traditional cost containment relies on opaque vendor models with high contingency fees and opaque algorithms that prevent health plans from addressing root causes of payment inaccuracy.
Cohere’s PI solutions reduce dependency on legacy opaque payment integrity vendors with AI-powered tech that strengthens provider relationships, maximizes financial performance, and offers visibility into decision-making processes.
Digitize care requests in a single workflow, including building detailed patient profiles, to automate decisioning for up to 90% of care needs.
Reduce burden with intelligent insights and guidance for 50% faster inpatient and outpatient reviews, and 30% more accurate decisions.
Guide providers to patient and cost-optimized decisions, such as site-of-service changes, for 15% incremental medex savings.
Leverage AI-powered intelligence to identify inappropriate payments and automate audit decisioning, delivering 30% lift in auditor efficiency and 50% faster documentation.
Deploy transparent algorithms with root cause analysis, achieving 14% improvement in hit rate with full visibility into decision rationale.
Shift payment integrity upstream with pre-pay capabilities that prevent overpayments while reducing provider abrasion, generating 8-9x return on investment through streamlined processes.
