Cohere Health

AI prior auth that speeds care

Boston, Massachusetts, United States

Healthcare Infrastructure Payer InnovationsSeries C

Cohere Health is an AI-driven prior authorization platform that automates a significant portion of prior authorizations and integrates with EHRs for in-workflow authorization.

✓Source: HealthTech Alpha by Galen Growth

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Check out Cohere Health on @MedStartr Today Cohere Health is an AI-driven prior authorization platform that automates a significant portion of prior authorizations and integrates with EHRs for in-workflow authorization. #Musculoskeletal #CardiovascularDisease #HealthcareInfrastructure #PayerInnovations #MedMo #MedStartrVentures

https://www.medstartr.ai/s/OA94o96s6og

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How We Help

Why it matters

Prior authorization is a major administrative bottleneck. Cohere targets payer-provider collaboration, specialty UM, and faster care decisions.

What the company reports

Claims are attributed to their source and not independently verified unless noted.

Cohere raised $50M in equity in February 2024.
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Cohere offers AI-powered prior authorization and payment integrity solutions.
Company statessource →
Humana expanded its Cohere partnership after an MSK pilot expanded to all 50 states.
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Who it's for

Health Plan COOUtilization Management LeaderMedical DirectorProvidersPlan ReviewersCare Managers

Problem Statement

The inefficiency and burden of prior authorizations in healthcare, which often lead to delays in patient care and increased administrative costs.

Core Technology

AI-driven prior authorization platform, FHIR API-enabled authorizations

Key Differentiators

Automates up to 90% of prior authorizations; Integrates with EHRs for in-workflow authorization; 85% of authorizations receive immediate determination (approved or flagged) by AI; No claim denial made exclusively by AI; all final denial decisions include human review by peer doctors or nurses; Supports FHIR-based electronic PA across in-house, delegated, and API offerings; Compliant with CMS Interoperability & Prior Authorization Final Rule (CMS-0057-F)

Clinical Focus

Musculoskeletal Care; Cardiology; Pain Management; Physical Therapy; Diagnostic Imaging; Sleep

Company Info

Business Model: B2B2C
Founded: 2019
Total Funding: Only accessible to MedStartr community members. Join now
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Website: www.coherehealth.com/

Disease Areas

Musculoskeletal Cardiovascular Disease

Technologies

FHIREHR IntegrationAI & Machine Learning

Clinical & IP

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Clinical Validation

CMS-0057-F compliant with FHIR API. Validated through real-world deployment: 12 million prior auth requests annually, 94% provider satisfaction, 85% real-time approval rate. No formal FDA trials (platform is not a medical device).

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MedStartr Engagement Score

The MedStartr Index is a reflection of how the crowds that come to MedStartr everyday to find healthcare innovations reacted. Calculated by our AI agent Fyggy based on algorithms we have been building since 2012 and over 100 different factors, the math is proprietary and complex. Suffice to say, it has been found to be highly correlative with early stage company growth. What you see here is the public version. To learn more or to get deeper access to our predictive data on startup success for your fund or company, click here.

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