Cohere Health offers Cohere Unify, an AI platform that connects clinical intelligence across health plan operations. It covers utilization management and prior authorization, payment integrity, appeals, care management, quality and HEDIS, and claims. The company reports 85 percent real-time prior authorization approvals, 50 percent faster inpatient and outpatient reviews and 30 percent more accurate decisions, with remaining submissions reviewed by a clinician. AI handles administrative work while humans make the critical decisions.
Cohere Unify is sold to health plans, including regional and national insurers, and to the clinical, operations and finance leaders inside them. Utilization management directors, payment integrity and audit teams, appeals reviewers, and quality and Stars program managers each have a dedicated solution. Providers interact with the system through a portal, an authorization status check and a resources area, but the buyer is the plan. Cohere reports 17 clients, 25 million covered lives and 47 million plan and provider interactions, with 94 percent provider satisfaction.
Concrete uses include digitizing prior authorization requests in one workflow so approvals reach patients faster, guiding providers to site-of-service changes that lower medical expense, and flagging inappropriate payments before they go out through pre-pay capabilities. Audit teams get transparent algorithms with root cause analysis, and appeals reviewers can close cases in roughly half the time, according to the company. Quality teams use year-round measurement for HEDIS and Stars programs. The company cites returns such as 9x on a payments program and up to 18x for utilization management at a regional plan.
