Cohere Health Brings Pre-Care Insights and Clinical AI to Health Plan Payment Integrity

Acquisition of ZignaAI accelerates Cohere's strategic clinical intelligence 'shift right,' bringing proven capabilities from prior authorization into payment integrity to drive precise AI-driven claims payments

BOSTON, Sept. 9, 2025 /PRNewswire/ -- Cohere Health^®, the leader in clinical intelligence solutions, announced the acquisition of ZignaAI and the launch of its new Payment Integrity (PI) Suite, anchored by Cohere Validate™, an AI-powered near real-time clinical and coding validation solution. Cohere Health's unique approach provides newfound transparency, accuracy, and control to claims payments through the power of clinical intelligence. The payments solution is already delivering faster payments, 30% efficiency gains, and 8-9x ROI to health plans.

This launch marks a milestone for the company's clinical intelligence platform, which connects health plan and provider interactions, bridging the gap between utilization management (UM) and payments to optimize the cost of care. By unifying pre-service authorization data and post-service claims and coding validation, Cohere Health is creating a transparent ecosystem that reduces waste, improves collaboration, and ensures providers are paid promptly and accurately.

"We're thrilled to welcome the ZignaAI team to Cohere Health and to launch our Payment Integrity Suite," said Siva Namasivayam, CEO and co-founder of Cohere Health. "The 'shift right' is a natural evolution of our clinical intelligence platform, allowing us to bring the same precision AI approach that drove our success in UM: real-time approvals; appropriate, high-quality care for patients; and reduced administrative burden for both payers and providers. Our platform bridges the gap between care planning and payments for better healthcare economics, payer-provider partnerships, and patient outcomes."

Addressing longstanding payment integrity challenges

Payment integrity has long been dominated by legacy vendors operating on contingency-based models. While these vendors can deliver savings, their "black box" algorithms lack transparency and provider education opportunities, and retroactive denials often strain payer-provider relationships and prevent health plans from continuously improving their payment policies and processes.

Cohere Health's PI Suite addresses these issues by shifting post-payment reviews upstream and improving collaboration. Connecting UM and PI data allows health plans to catch errors before claims are paid, reducing both financial waste and provider friction. Providers benefit from faster payments and improved transparency, while plans gain clearer insights into root causes of billing and coding errors, enabling proactive fixes and education, rather than repeated disputes.

Cohere Validate at the center of Cohere Health's PI Suite

Cohere Validate modernizes complex claims reviews across inpatient, outpatient, and professional programs by enabling health plans to bring high-value reviews in-house. "Our precision AI is trained on reimbursement policies, codes, and clinical data for faster, more accurate validation with clear audit rationale," added Krishna Kottapalli, chief growth officer of Cohere Health. "We're helping health plans move away from legacy models–reducing dependency on stacked audit vendors and replacing them with transparent, evidence-based, and automated in-house processes."

The new PI Suite includes Cohere Validate and two complementary offerings:

• Cohere Validate: The in-house AI-driven audit solution for clinical and coding validation covers inpatient, outpatient, and professional programs. It automates clinical and coding validation with a cohesive workflow, leverages proprietary reimbursement-grade extraction for medical record processing, provides evidence-backed outputs, and improves efficiency while strengthening payer-provider trust.
  
  
• Cohere Match™: A proprietary claims-to-authorization reconciliation offering that uses pre-care authorizations to identify mismatches before payment, preventing overpayments and reducing provider abrasion through accurate, proactive adjudication.
  
  
• Cohere Complete™ for Payment Integrity (PI): A modernized, AI-powered alternative to legacy outsourced audit vendors, with end-to-end audit management services for transparent findings and Cohere Health's industry-leading delivery model.

The PI Suite offers health plans flexibility in choosing how to manage payment accuracy, whether by insourcing complex audits with AI-driven tools or delegating the work to Cohere Health's managed services, all in one platform.

ZignaAI's role in Cohere Health's expansion

Founded in 2020, ZignaAI specializes in AI-driven payment integrity and revenue optimization solutions. Its flagship technology combines natural language processing and machine learning with clinical insights to automate coding and clinical validation for health plans.

"ZignaAI's mission has always been to make payment integrity reviews smarter and more effective through the combination of advanced AI and coding and clinical expertise," said Lalithya Yerramilli, SVP of payment solutions for Cohere Health and founder of ZignaAI. "We were strongly aligned with Cohere Health's vision and values. By integrating our technology into Cohere Health's platform, we can better help health plans move beyond black-box reviews and toward more accurate, transparent, and faster processes that benefit providers."

For more information, visit coherehealth.com/payment-integrity.

About Cohere Health^®
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its AI auto-approves up to 90% of requests for millions of health plan members. The company has been recognized on the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and is a Top 5 LinkedIn™ Startup for 2023 & 2024.

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SOURCE Cohere Health