Operational Utility (Workflow Impact)

• For the Clinician:
  • During Ordering: Shifts the workflow from a "submit and hope" model to an interactive process. If a request deviates from the optimal path (e.g., ordering an MRI before physical therapy), the tool suggests the policy-compliant alternative immediately, reducing the likelihood of a denial.
  • Reduced Friction: Minimizes the need for peer-to-peer phone reviews by ensuring clinical documentation satisfies medical necessity criteria before submission.
• For the Administrator:
  • Reduced Follow-up: Significantly lowers the volume of outbound calls and status checks, as approved authorizations are often issued instantly (up to 90% auto-approval rates reported in deployed environments).
  • Lower Denial Management: Moving upstream to "pre-service" validation prevents the revenue leakage associated with retrospective denials and appeals.
• Workflow Placement:
  • Pre-Service: Occurs at the point of order entry or immediately prior to scheduling.

Implementation & Integrations

• Deployment Model:
  • Cohere is primarily a Payer-side platform. Health plans implement Cohere to manage their utilization management (UM) network-wide.
  • For providers, access is typically granted via a payer-branded portal or through direct EHR integration if the health system has enabled it.
• Integrations:
  • EHR: Maintains presence in major marketplaces (e.g., Epic Connection Hub, athenahealth) to allow data extraction directly from the patient chart, reducing double-entry.
  • Standards: Built on FHIR-native APIs to facilitate interoperability between payer and provider systems.
• The Trade-Off:
  • Adoption Dependency: An independent practice cannot simply "buy" this tool to solve all their prior auth problems. You are dependent on the specific payers you contract with to adopt the platform. If your highest-volume payer uses a legacy vendor, you cannot force them to use Cohere.

Trust Audit

Security & Compliance

Certifications: The company holds HITRUST r2 certification and SOC 2 Type II attestation, indicating a high level of security maturity suitable for handling massive volumes of PHI.

Business & Scale Considerations

• Maturity: Founded in 2019 with over $200M in funding (Series C closed May 2025). This is a well-capitalized, late-stage growth company, not an early experiment.
• Deployment Scale: Currently processing millions of authorizations annually for major entities like Humana and Geisinger Health Plan.

Doxiverse Insight

Cohere Health is one of the few "AI in healthcare" tools that has moved beyond pilot purgatory into enterprise-scale reality. It is highly effective for Risk-Bearing Organizations and Health Systems looking to reduce administrative abrasion with their payer partners.

However, for the average independent clinician, this is not a tool you shop for; it is a tool you encounter. If your payers use Cohere, your workflow will likely improve through faster approvals and fewer peer-to-peer fights. If they do not, you remain stuck with legacy portals. The real value here is for CIOs and Payer Executives who need to cut administrative bloat (SG&A) while maintaining provider network satisfaction.

Doxiverse Disclaimer

Doxiverse provides independent, informational content for healthcare professionals. Tool descriptions and insights reflect Doxiverse’s editorial analysis and professional opinion based on publicly available information at the time of publication. Content is not medical advice, does not constitute endorsement, and may change as products evolve. Users should independently verify all clinical, regulatory, security, and pricing details directly with vendors and relevant authorities.