Cohere Health acquired ZignaAI in September 2025 and launched the Cohere Payment Integrity Suite, extending its clinical AI from pre service prior authorization into post service claims and coding validation. The company subsequently launched specialized audit agents for high cost conditions including sepsis, reporting a 58 percent findings rate, and states the combined pre and post service view achieves up to 9x return on investment.
Our readTwo things matter here beyond the acquisition itself. First, scope creep across the claim lifecycle: a platform that decides authorization before care and then audits payment after care sits on both sides of the same clinical event, which is efficient for the plan and worth examining for providers, since the evidence surfaced at authorization is explicitly reused to validate the claim. Second, the audit agents carry a stated 58 percent findings rate on conditions like sepsis. A findings rate is a measure of how often the model flags something, not how often it is right, and sepsis coding is among the most contested areas in payment integrity. Plans should establish the confirmation rate on appeal, not just the findings rate, before treating that number as savings.