Appeals
AI-assisted appeals review completing cases in half the time
Software · Cloud SaaSCompany source
Company profile
About Cohere Health
Cohere Health is a healthcare technology company that delivers connected clinical intelligence solutions for health plans through its Cohere Unify™ platform. The company specializes in automating and streamlining complex health plan operations including utilization management, payment integrity, appeals processing, care management, quality measurement, and claims operations. Cohere Health's platform combines domain-specific AI with human clinical expertise to help health plans improve operational efficiency, clinical quality, and financial performance while maintaining human oversight of critical decisions. The company serves 17 health plan clients covering 25 million lives and has processed 47 million plan-provider interactions. Their solutions deliver measurable returns including up to 18x ROI for utilization management, 9x ROI for payment integrity programs, and 5x ROI for quality/Stars programs. Cohere Health achieves 85% real-time prior authorization approvals, 50% faster clinical reviews, and 94% provider satisfaction. The platform offers flexible deployment models including in-house, delegated, API-based, and fully managed services, enabling health plans to reduce vendor dependency while improving care coordination and provider relationships.
Company description Cohere Health official website
Primary marketHealthcare Operations & Administration
Commercial modelCommercial information available on request
Company presenceLinkedIn
Work at Cohere Health?
Claim this listing Claim this profile to manage Company information and connect with the Health AI Central audience.
01 · Operating footprint
Where the Company operates
Company-profile context for clinical focus, customers, deployment, integration, milestones, and partnerships.
Clinical focus
- Cardiovascular
- Diagnostic imaging
- Gastrointestinal
- Musculoskeletal
- Sepsis
- Sleep disorders
Who it serves
- Health Plans
- Payers
- Providers
Deployment & integration
Api Only · Cloud Saas · Hybrid deployment with recorded integration context.
Recorded integration context: Cerner, Claims systems, EHR systems via APIs, Epic.
Geographic context
MarketsUnited States
Company sourceOfficial website
Company milestones
Platform expansion
Platform has processed millions of authorizations, expanded product suite to include Cohere Unify platform connecting UM, payment integrity, appeals, care management, quality and claims operations. Launched agentic AI capabilities for payer strategy.
Partnerships
Recorded partners
- Geisinger Health Plan
- Humana
02 · Flagship portfolio
Products, workflows, and platform capabilities
Selected source-backed Company products and the available commercial context.
Appeals Management
AI-assisted appeals review with automated evidence gathering
Software · Cloud SaaSCompany source
Care Management
Connected clinical intelligence for coordinated care and member insights
Software · Cloud SaaSCompany source
Claims Operations
Automated claims rules maintenance for accurate claim outcomes
Software · Cloud SaaSCompany source
Cohere Complete
Fully delegated utilization management for precision medex management
Service · Cloud SaaSCompany source
Cohere Connect (APIs)
CMS-0057-F compliant APIs for interoperability and prior authorization
Api · Api OnlyCompany source
Cohere Match (Auth Match)
Proactive payment accuracy by bridging UM and PI data
Software · Cloud SaaSCompany source
Cohere Unify
Connected clinical intelligence platform for health plan operations
Platform · Cloud SaaSCompany source
Payment Integrity
Flexible payment integrity with 9x ROI, catching errors upstream
Software · HybridCompany source
03 · Research intelligence
Research Intelligence evidence
Publications, preprints, clinical validation, and regulatory records in Evidence Position order.
Evidence position
Publications, clinical validation, and regulatory records connected to this Company appear here.
Research
Publications & preprints
Clinician- and Patient-Directed Communication Strategies for Patients With Cancer at High Mortality Risk: A Cluster Randomized Trial.JAMA network open · Jul 1, 2024
A Randomized Encouragement Trial to Increase Mail Order Pharmacy Use and Medication Adherence in Patients with Diabetes.Journal of general internal medicine · Jan 1, 2021
Hospital centralization and performance in Denmark-Ten years on.Health policy (Amsterdam, Netherlands) · Apr 1, 2018
Clinical validation
Clinical-trial records
No linked records are currently available.
Regulatory
Regulatory records
No linked records are currently available.
04 · Company-reported outcomes
Outcomes and case studies
Company-reported outcomes and customer stories are distinct from linked Research Intelligence evidence.
85% prior authorizations approved in real-time
Automated approval rate
47% admin-cost savings
Administrative efficiency
70% faster care access
Time to care delivery
9x return on investment
Payment integrity operations
5x return on investment
Quality programs
18x return on investment
Utilization management
94% provider satisfaction
Provider experience
50% faster inpatient and outpatient reviews
Review efficiency
30% more accurate decisions
Clinical decision quality
15% incremental medex savings
Medical expense management
30% lift in auditor efficiency
Payment integrity
14% improvement in hit rate
Audit accuracy
40% reduction in decision TAT
Appeals turnaround time
20-25% closure rates
HEDIS gap closure for high-value measures
NPS Score of 67
Provider satisfaction
Aggregate Customer Results
Prior authorization automation and operational efficiency
85% prior authorizations approved in real-time, 47% admin-cost savings, 70% faster care access, 94% provider satisfaction
Aggregate Customer Results - Appeals
Appeals management workflow optimization
40% reduction in decision turnaround time, 50% faster appeal reviews
Aggregate Customer Results - Payment Integrity
Payment integrity and audit automation
9x return on investment for payments, 30% lift in auditor efficiency, 50% faster documentation, 14% improvement in hit rate
Aggregate Customer Results - Quality
HEDIS gap closure and quality measure improvement
5x return on investment for quality, 20-25% closure rates for high-value measures
Aggregate Customer Results - Utilization Management
Utilization management optimization
18x return on investment for UM, 50% faster inpatient and outpatient reviews, 30% more accurate decisions, 15% incremental medex savings
Geisinger Health Plan
Clinical innovation and evidence-based care suggestions for network providers
Transformational partnership enabling better health outcomes and reduced administrative burden
Health plan client
Quality and Stars program
5x return on investment for quality for Stars program
Humana
Digital authorization platform implementation to improve prior authorization efficiency
Results exceeded expectations according to Chief Medical Officer
Regional health plan
Utilization management optimization
18x return on investment for UM
05 · Leadership
Leadership team
Leadership profiles and professional links from the current Company record.
John DeLay
Data Scientist II
Toby Rogers
Executive Vice President, Clinical Operations
Matt Parker
Senior Vice President Product
Daniel DeSantis, MBA
Vice President, Commercial Strategy
Mujtaba Habib
Vice President of Engineering
Debbie Kreisher
Vice President, Provider Management
Craig Bagley
Vice President, Commercial Strategy
Robert Shepardson
Chief Financial Officer
06 · Company updates
Updates from Cohere Health
Recent articles published on Cohere Health's official website.
Cohere Health Helps Health Plans Unlock Revenue by Closing Hidden HEDIS® Gaps
Read on Cohere HealthCohere Health Named to TIME’s World’s Top HealthTech Companies 2026 List for Second Consecutive Year
Read on Cohere HealthHow clinical intelligence eliminates health plan friction
Read on Cohere HealthCMS tech rules and AI benefits for primary care, patients and ‘touchless’ prior auths
Read on Cohere Health07 · HAIC coverage
Coverage and analysis
Health AI Central reporting that mentions this Company.
08 · Official presence
Company sources and channels
Curated official destinations from the active Company record.
09 · Market pathway
Additional Companies in this Market
Other active Companies in the same market, selected alphabetically from the HAIC directory.
Market context
Healthcare Operations & Administration
Companies using AI to optimize hospital operations, automate administrative workflows, improve scheduling, manage healthcare resources, coordinate care delivery, or reduce operational inefficiencies. Includes prior authorization automation, credentialing, billing, care coordination, and AI tools that help health systems run more efficiently.
Explore the full market directory or compare this Company with additional active profiles.
View all Companies in this market
10 · Pro research
Coming soon
Expanded Company research is in development.
Health AI Central Pro · Coming Soon
Deeper Company research is coming soon.
Pro Research will introduce expanded technical context, linked evidence analysis, and comparative Company research.
Linked research, clinical, and regulatory source pathways.
Expanded product, deployment, integration, and partnership research.
Record-level provenance and review context.