Cohere Health utilizes the Cohere Unify™ Platform, which employs artificial intelligence and machine learning to automate the prior authorization process, integrating with electronic medical records for streamlined workflows. The platform addresses delays in patient care access and high denial rates by digitizing requests and providing evidence-based decision support, resulting in faster approvals and improved clinical outcomes.
Funding
$121.1M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
The prior authorization process in healthcare often leads to delays in patient care, high denial rates, and administrative burdens for both providers and payers. Traditional methods are often manual, fragmented, and lack transparency, hindering efficient communication and collaboration between stakeholders.
Solution
Cohere Health offers the Cohere Unify™ Platform, an AI-powered solution designed to streamline and automate the prior authorization process. The platform integrates with electronic medical records (EMRs) and digitizes prior authorization requests from various sources, creating a single, automated workflow. By using AI and machine learning, the platform provides evidence-based decision support, guiding providers toward clinically appropriate requests and automating clinical reviews. This results in faster approvals, reduced denial rates, and improved patient outcomes by ensuring timely access to necessary care.
Target Audience
The primary target audience includes health plans and providers seeking to streamline the prior authorization process, reduce administrative costs, and improve patient access to care.
Features
- Digitizes prior authorization requests from various sources, including EMR integration and optical character recognition (OCR) for faxes
- Automates prior authorization decisions using health plan-preferred policies
- Provides AI-assisted manual review with automated queue management and letter generation
- Offers trend monitoring, PAL recommendations, care choice guidance, and clinical policy optimization
- Supports personalized care path authorizations and episodic authorizations
- Reduces the need for peer-to-peer reviews
- Provides a single sign-on portal for providers to submit requests
- Offers a prior authorization check to scan for completeness