What You Should Know:
– Cohere Health, a leader in clinical intelligence solutions, has acquired ZignaAI and launched a new Payment Integrity (PI) Suite, which is anchored by Cohere Validate™. Financial details of the acquisition were not disclosed.
– Cohere Health’s approach is designed to provide transparency, accuracy, and control to claims payments through clinical intelligence. The new solution is already delivering faster payments, 30% efficiency gains, and 8-9x ROI to health plans.
ZignaAI Background
Founded in 2020, ZignaAI specializes in AI-driven payment integrity and revenue optimization solutions. Its flagship technology uses natural language processing (NLP) and machine learning with clinical insights to automate coding and clinical validation for health plans. Lalithya Yerramilli, SVP of payment solutions for Cohere Health and founder of ZignaAI, noted that 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”.
Acquisition Impact
The acquisition allows Cohere Health to launch its new PI Suite, which addresses longstanding payment integrity challenges. Historically, payment integrity has been dominated by legacy vendors with “black box” algorithms that lack transparency and often strain payer-provider relationships. The Cohere Health PI Suite addresses these issues by shifting post-payment reviews upstream and improving collaboration. This allows health plans to catch errors before claims are paid, which reduces financial waste and provider friction. Providers benefit from faster payments and improved transparency, while plans gain clearer insights into the root causes of billing and coding errors.
Post-Acquisition Plans and New Offerings
The new PI Suite is anchored by Cohere Validate™, an AI-powered near real-time clinical and coding validation solution. Cohere Validate modernizes complex claims reviews across inpatient, outpatient, and professional programs, allowing health plans to bring high-value reviews in-house. The platform’s precision AI is trained on reimbursement policies, codes, and clinical data for faster, more accurate validation with clear audit rationale.
The new PI Suite also includes two complementary offerings:
- Cohere Match™: A proprietary claims-to-authorization reconciliation offering that uses pre-care authorizations to identify mismatches before payment.
- Cohere Complete™ for Payment Integrity (PI): A modernized, AI-powered alternative to legacy outsourced audit vendors, with end-to-end audit management services.
The PI Suite offers health plans the flexibility to choose 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 within one platform.
“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.”
