Cohere Health

Intelligent prior auth platform for payers

Our take

Cohere Health sells clinical intelligence software to health plans, with prior authorization as its anchor product. Its Cohere Unify platform sits inside a payer's utilization management operation, applies evidence-based clinical policies to incoming auth requests, and auto-approves up to 90 percent of eligible cases in near real time while routing the rest to clinical review. The company also runs delegated UM programs in specialties like musculoskeletal care, cardiology, imaging, and sleep, and in 2025 added a payment integrity suite (built on its ZignaAI acquisition) that validates clinical and coding accuracy on claims before payment.

Founded in 2019 in Boston, Cohere is one of the most heavily backed companies in the payer-side prior auth market, with $200M raised including a $90M Series C led by Temasek in May 2025. Its scale claims are concrete: more than 12 million prior auth requests processed annually for over 600,000 providers, a Humana relationship that grew from a 12-state musculoskeletal pilot in 2020 to a nationwide, multi-specialty deployment, and additional named customers in Geisinger Health Plan and Medical Mutual of Ohio. With CMS-0057 forcing payers to modernize prior auth by 2026-2027, Cohere is positioned as one of the default choices for plans that want to buy rather than build.

What it does

Automates prior auth intake, review, and approval for health plans
Auto-approves up to 90 percent of eligible auth requests
Applies evidence-based clinical policies and physician-facing nudges
Provider performance analytics to steer utilization management
Payment integrity claims validation via Cohere Validate
Delegated UM services across MSK, cardiology, imaging, sleep

Where it's strong

Proven at national scale: over 12 million prior auth requests a year across roughly 600,000 providers, including a nationwide Humana deployment.
High auto-approval rates (up to 90 percent) materially cut turnaround times and provider abrasion, which matters as CMS-0057 deadlines arrive.
Well capitalized at $200M raised and expanding beyond prior auth into payment integrity, reducing single-product risk.

What buyers should weigh

It sells to health plans, not providers; a provider organization only encounters Cohere through a payer that has adopted it.
Much of its track record is concentrated in the Humana relationship, so plans of smaller size should ask for comparable references.
Delegated UM and clinical policy alignment make implementations substantial projects with real compliance and integration work, not a light SaaS install.

Latest

In 2025 Cohere raised a $90M Series C led by Temasek in May and acquired ZignaAI in September to launch an AI payment integrity suite anchored by Cohere Validate.