Cohere Health

Cohere Health provides prior authorization automation for health plans, alongside utilization management, payment integrity, appeals, care management, claims operations and quality products. Its stated goal is touchless prior authorizations, meaning requests approved without human review.

Prior authorization is the process by which a health plan approves a treatment before it is delivered, and it is among the most criticised administrative burdens in American healthcare. Physicians spend substantial time submitting requests, patients wait while decisions are made, and plans employ large teams to review them. Automating the requests that clearly meet criteria removes work from all three parties at once, which is rare in healthcare administration where saving usually shifts cost rather than removing it.

Touchless approval is the meaningful measure. A system that merely speeds up human review still requires the reviewer, while approving straightforward requests automatically eliminates the wait entirely for the majority that were always going to be approved.

Extending into appeals and payment integrity follows the same authorisation decision downstream, since a denial may be appealed and an approval eventually becomes a claim. Keeping the reasoning in one place means the appeal reviewer can see why the original decision was made.