What You Should Know:
– Cohere Health®, the leader in clinical intelligence solutions for health plans and risk-bearing providers, today announced the launch of Review Assist, a breakthrough agentic AI solution that improves medical necessity review efficiency by up to 50% with over 99% precision.
– Designed to work seamlessly with health plans’ existing utilization management (UM) workflows and technology stacks, Review Assist reduces review time, eases administrative burden, and improves decision accuracy by helping nurses quickly identify the most relevant clinical information.
Cohere Health’s Review Assist: Advancing Prior Authorization with Clinically Trained AI
Cohere Health is transforming the prior authorization process through AI-powered clinical intelligence that improves collaboration between providers and health plans. Partnering with nearly 600,000 providers and processing over 12 million requests annually, Cohere auto-approves up to 90% of prior authorization submissions, delivering faster, more efficient care access for millions of health plan members. The company has been consistently recognized—featured in the Gartner® Hype Cycle™ for U.S. Healthcare Payers, named a Top 5 LinkedIn™ Startup in 2023 and 2024, and awarded the KLAS Points of Light distinction three times.
As a significant advancement of Cohere’s core Review solution, Review Assist introduces a next-generation, AI-powered assistant that enhances clinical productivity, decision accuracy, and reviewer satisfaction—particularly in complex, high-volume medical review scenarios.
While traditional automation tools offer limited support in navigating unstructured documentation, Review Assist stands out by leveraging Cohere’s clinically trained AI and fine-tuned large language models (LLMs). These models process both structured and unstructured data in real time, extracting relevant evidence and surfacing it with citations aligned to clinical guidelines. The result: streamlined decision-making that supports timely, medically appropriate care delivery without disrupting nurse workflows.
“Unlike legacy tools, Review Assist identifies and cites clinical evidence from even the most complex medical records,” noted Matt Parker, Chief Product Officer at Cohere. “This agentic AI copilot enables health plans to make faster, clinically sound decisions—setting the stage for broader applications across utilization management.”
Designed as a lightweight, intuitive overlay on existing health plan infrastructure, Review Assist is fast to implement and easy to integrate. It drives operational efficiency while reducing administrative burden and enhancing member care outcomes.
Key capabilities and benefits of Review Assist include:
• Real-time extraction and citation of clinical data and source evidence using clinically trained AI
• Seamless integration into existing utilization management workflows or any client case system
• Reduction in review time, error rates, and nursing staff administrative workload
• Accelerated access to medically necessary care for health plan members
By embedding clinical intelligence directly into review workflows, Cohere Health’s Review Assist redefines how health plans can scale quality care, boost reviewer productivity, and improve the member experience.
