Cohere Health

Cohere Health is an enterprise-grade medical intelligence platform engineered to modernize utilization management, payment integrity, and care collaboration for health plans and providers. Instead of viewing prior authorization as a rigid administrative bottleneck, the platform treats it as a collaborative clinical decision-making process. By replacing legacy manual channels like fax machines and telephone calls with digital workflows, Cohere connects payers and clinicians on a single network to accelerate care delivery, reduce friction, and lower administrative overhead.

Cohere Unify is the core clinical intelligence operating system that drives end-to-end automation across multiple healthcare payer functions. The platform utilizes an advanced agentic framework built on a clinician-trained clinical context layer that safely processes symptoms, treatments, and evidence-based policies. This architecture deploys specialized AI agents across separate operational modules to automate real-time prior authorization approvals, guide human clinicians through complex appeals in half the time, and proactively scan unstructured health records to close critical care gaps.

Cohere Surface is a specialized, transparent claims intelligence solution built into the platform's broader Payment Integrity Suite to optimize healthcare data mining. Unlike legacy retrofitting tools that rely on opaque, rigid rules, this system connects structured and unstructured data streams—including medical claims, provider contracts, member benefits, and clinical notes—into a single data fabric. This gives health plans complete visibility into overpayment patterns and root-cause logic, allowing internal teams to configure, iterate, and deploy updated adjudication rules in hours without heavy IT dependencies.

The platform features an interoperable, vendor-neutral architecture that integrates natively with existing health plan systems of record and provider Electronic Health Records via standardized healthcare APIs. By utilizing HL7 FHIR-based frameworks, provider submissions can flow directly from their primary clinical charting workspaces into the utilization review stream without requiring manual portal data entry. To ensure total enterprise security, Cohere Health maintains a strict private data posture, achieves full HITRUST certification, and scales its electronic workflows in complete alignment with strict global regulations and federal compliance acts.