Cohere Health, a leader in clinical intelligence solutions, has announced the acquisition of ZignaAI and the launch of its new Payment Integrity (PI) Suite, which is centered around Cohere Validate, a near real-time solution for clinical and coding validation. This advanced tool is designed to improve transparency and accuracy in the claims process, and it is already delivering measurable results. Health plans using the solution have seen payments processed faster, gained 30 percent efficiency improvements, and reported returns of eight to nine times their investment. The move reinforces Cohere Health’s commitment to modernizing how claims are handled using data-driven insights and clinical context.
This launch marks a new phase for Cohere Health’s clinical intelligence platform, which is now expanding its role beyond utilization management into the payments space. By connecting data from pre-service authorizations to post-service claims validation, the company aims to build a transparent and efficient ecosystem for both health plans and providers. This integrated approach helps eliminate redundancy, reduce administrative friction, and ensure timely and accurate payments. It also offers a more collaborative framework that benefits all parties by aligning care decisions with reimbursement processes.
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Siva Namasivayam, co-founder and Chief Executive Officer at Cohere Health, shared that the acquisition of ZignaAI and the new Payment Integrity Suite reflect a natural progression of the company’s platform. He explained that just as Cohere Health helped bring real-time approvals and better patient care to utilization management, the new solution brings those same strengths to the claims process. According to Namasivayam, this expansion bridges the gap between clinical decision-making and payment, supporting improved healthcare economics, more productive relationships between payers and providers, and better outcomes for patients. He emphasized that Cohere Health’s goal is to deliver a platform that removes unnecessary delays and supports value-based care.
The payment integrity space has traditionally been led by legacy vendors using retrospective audits and opaque methods. While these vendors do reduce costs, they often leave providers in the dark and cause tension between payers and clinicians. The process is typically inefficient and lacks the feedback loops necessary for long-term improvements. Cohere Health’s approach is different. The PI Suite shifts the review process to earlier stages, identifying issues before payments are made. This change allows health plans to reduce waste, resolve billing errors proactively, and build trust with providers. By focusing on accuracy upfront, rather than after the fact, the solution helps health plans gain better insights into coding patterns and streamline provider education.
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Cohere Validate, the centerpiece of the new suite, is designed to modernize how complex claims are reviewed across various care settings, including inpatient and outpatient services. Krishna Kottapalli, Chief Growth Officer at Cohere Health, explained that the platform allows health plans to bring audits in-house, using a system trained on reimbursement policies, codes, and clinical records. The result is faster and more accurate validation, with clear rationale that supports audits and encourages cooperation. He stated that Cohere Health is helping plans reduce their reliance on outdated vendor stacks by offering a transparent and automated process.
In addition to Cohere Validate, the new PI Suite features two other solutions: Cohere Match and Cohere Complete. Cohere Match ensures alignment between claims and prior authorizations, identifying inconsistencies before payment is made. This helps prevent overpayments and reduces disputes. Cohere Complete, on the other hand, offers a fully managed audit service that serves as a modern alternative to outsourced legacy vendors. These three components together give health plans the flexibility to either manage audits internally with AI-enabled tools or delegate them to Cohere’s team using a consistent platform and methodology.
ZignaAI, founded in 2020, brings deep expertise in AI-based payment integrity and revenue optimization. Its technology uses natural language processing and machine learning to automate the validation process for claims. Lalithya Yerramilli, the founder of ZignaAI and now Senior Vice President of Payment Solutions at Cohere Health, said that the two companies shared a vision of making claims audits more intelligent and transparent. She noted that by integrating ZignaAI’s technology into Cohere’s platform, they are able to help health plans move away from outdated methods toward faster, more reliable, and more educational review processes that ultimately benefit providers and patients alike.
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