Company Overview

Cohere Health is an AI-powered prior authorization platform that automates clinical review for post-acute care, specialty procedures, and durable medical equipment. Founded in 2019 and having raised approximately $160 million, Cohere addresses one of the most friction-intensive workflows in healthcare: the prior authorization process that gates patient access to skilled nursing, home health, physical therapy, and other post-acute services.

The platform works with health plans and providers simultaneously — using AI to analyze clinical documentation and recommend authorization decisions in real time, reducing manual review burden while surfacing clinically appropriate care pathways. As Medicare Advantage plans increasingly require prior authorization for post-acute services — and CMS implements new prior authorization transparency requirements — Cohere's position in the authorization workflow becomes increasingly strategic.

Prior AuthorizationAIPost-Acute CareHealth PlansCare PathwaysMedicare AdvantageBoston

Products & Platform

Intelligent Prior Authorization
AI-powered authorization platform — automating clinical review, reducing manual burden for providers, and accelerating approval decisions for payers.
Clinical Pathway Analytics
Aggregate analysis of authorization patterns, approval rates, and care pathway utilization — identifying opportunities for more appropriate care delivery.
Provider Portal
Provider-facing authorization request management — streamlining submission, tracking, and appeal workflows for post-acute providers.
Payer Integration
Health plan prior authorization management — AI-assisted clinical review, criteria standardization, and audit-ready documentation.

Market Position

Cohere Health positions at the intersection of payer and provider workflows — strategically valuable as CMS's new prior authorization transparency rules (effective 2026) increase payer incentives to streamline authorization. For families navigating post-acute care, Cohere's platform affects whether and how quickly a loved one receives approval for skilled nursing, home health, or therapy services.

Key Data & Metrics

MetricDetail
Total Funding~$160M raised
Founded2019
HeadquartersBoston, MA
Regulatory DriverCMS prior authorization transparency rules (2026)

Recent News & Developments

2024–2025
CMS prior authorization transparency rules drive platform adoption
New CMS requirements for prior authorization transparency and decision timelines create financial incentives for health plans to adopt AI-powered authorization platforms.
2024
Medicare Advantage prior authorization expansion drives Cohere demand
Growing MA prior authorization requirements for post-acute services drive payer interest in automation — expanding Cohere addressable market.

How Dorthea Uses This Technology Category

Dorthea's AI co-pilot helps families understand how platforms like Cohere Health affect the quality and accountability of senior care facilities and home care agencies they are evaluating. Our free guidance helps families ask the right questions.