Cohere Health®, a leading provider of clinical intelligence solutions, has announced its acquisition of ZignaAI and the introduction of its new Payment Integrity (PI) Suite, anchored by Cohere Validate™, an AI-powered solution for near real-time clinical and coding validation. Designed to enhance claims payment accuracy, transparency, and control, the PI Suite is already delivering faster payments, 30% efficiency gains, and 8–9x ROI for health plans.
This launch represents a significant milestone for Cohere Health’s clinical intelligence platform, which bridges the gap between health plan and provider interactions, connecting utilization management (UM) and payment processes to optimize the cost of care. By unifying pre-service authorization data with post-service claims and coding validation, Cohere Health creates a transparent ecosystem that reduces waste, strengthens collaboration, and ensures providers are paid accurately and promptly.
“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
Traditionally, payment integrity has been dominated by legacy vendors operating on contingency-based models. While these vendors deliver savings, their “black box” algorithms lack transparency and fail to educate providers, with retroactive denials often straining payer-provider relationships and limiting health plans’ ability to improve payment policies proactively.
Cohere Health’s PI Suite tackles these challenges by shifting post-payment reviews upstream and enhancing collaboration. By connecting UM and PI data, health plans can identify errors before claims are paid, reducing financial waste and provider friction. Providers benefit from faster, transparent payments, while plans gain actionable insights into the root causes of billing and coding errors, enabling proactive education and fewer disputes.
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Cohere Validate at the Core of the PI Suite
Cohere Validate™ transforms complex claims reviews across inpatient, outpatient, and professional programs, allowing health plans to perform high-value audits 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 PI Suite comprises three key offerings:
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Cohere Validate™: An AI-driven in-house audit solution for clinical and coding validation that automates workflows, leverages proprietary reimbursement-grade extraction for medical record processing, provides evidence-backed outputs, and strengthens payer-provider trust.
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Cohere Match™: Proprietary claims-to-authorization reconciliation using pre-care authorizations to identify mismatches before payment, preventing overpayments and reducing provider friction.
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Cohere Complete™ for Payment Integrity (PI): An AI-powered alternative to legacy outsourced audits, offering end-to-end management services with transparent findings through Cohere Health’s proven delivery model.
The suite allows health plans flexibility in managing payment accuracy, whether by insourcing audits with AI tools or leveraging Cohere Health’s managed services, all within a single platform.
ZignaAI’s Role in Expanding Cohere Health’s Capabilities
Founded in 2020, ZignaAI specializes in AI-driven payment integrity and revenue optimization solutions, using natural language processing and machine learning combined with clinical insights to automate coding and 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.”