Cohere Health vs Xsolis (2026)
Cohere Health sells to health plans. Its Cohere Unify platform runs prior authorization and the rest of a plan's utilization management, and adds payment integrity, appeals, care management, claims and HEDIS quality work. Models trained on clinical records approve requests that meet criteria in real time, up to 85 percent of routine requests by Cohere's count. Every request they do not approve goes to a clinician. Humana has used it since 2021 across all 50 states. Xsolis sells mainly to hospitals, with a payer side built in. Its Dragonfly platform scores each admitted patient's likelihood of needing inpatient care or observation, and the hospital's review nurses work their cases by that score. Through Align, the same clinical view reaches the patient's health plan for concurrent authorization, across more than 850 payer connections. Xsolis also staffs physician advisors and denial teams for hospitals that want the work done for them. The two meet at the same decision from opposite ends. Cohere automates the plan's review of a request, so a plan buys it to approve faster with fewer nurse hours. Xsolis gives the hospital a status score it can share with the plan, so a hospital buys it to get inpatient status right and lose fewer days to denials. A health plan rebuilding its prior authorization operation fits Cohere. A health system that wants its review team and its payers working from one score fits Xsolis.
- Models approve requests that meet criteria in real time, and every request they do not approve goes to a clinician before a decision.
- Requests arrive through Epic, Availity, NaviNet, Cohere's own portal or the CMS prior authorization APIs.
- Plans can run it with their own clinicians, hand musculoskeletal, cardiac, gastrointestinal, sleep and imaging review to Cohere, or embed it through APIs.
- Medical and drug utilization management run on one platform, beside payment integrity, appeals and HEDIS work.
- Cohere has announced URAC accreditation, NCQA utilization management reaccreditation and a 2024 HITRUST recertification, and its privacy policy states its business associate status.
- Every admitted patient carries a continuously updated score for inpatient or observation status.
- The hospital and its health plans review the same clinical view through Align, across more than 850 payer connections.
- Teams at Baylor Scott & White and Yale New Haven Health published evaluations of the score in 2025.
- Xsolis physician advisors can cover nights and weekends or run the whole function.
- A generative AI feature drafts a clinical synopsis before each peer to peer call with the payer.
This comparison is published by AI Health Index, an independent research platform that compares healthcare AI vendors objectively. Cohere Health and Xsolis are each graded against the same capability taxonomy, from each vendor's own public materials and the regulatory record, under the AI Health Index verification standard. No vendor pays for placement, and no vendor has reviewed this page. How this evidence is graded
Plain facts
| Fact | Cohere Health | Xsolis |
|---|---|---|
| Primary category | RCM & Prior Auth AI | RCM & Prior Auth AI |
| Founded | Not recorded | 2013 |
| Headquarters | Boston, Massachusetts | Franklin, Tennessee |
| Website | coherehealth.com | xsolis.com |
Side by Side
Select any grade to read the note behind it.
Product updates
The latest logged changes from each vendor, newest first, each linked to its source.
Cohere Health
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Product / capability
Cohere Health extended its intake, decision and review tools on Cohere Unify to medical benefit drugs, the specialty and provider administered drugs that run through a plan's medical benefit rather than its pharmacy benefit.
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Clinical evidence
Cohere Health published performance results for Cohere Capture, which extracts HEDIS gap closures and denominator exclusions from clinical data a health plan already holds, including prior authorization notes, imaging reports and EHR data.
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Product / capability
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.
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Xsolis
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Product / capability
Xsolis launched GenAI Peer-to-Peer Clinical Synopsis as an add on inside Dragonfly Advise.
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Each vendor in one paragraph
Written to be quoted whole. Each paragraph states what the AI Health Index verified about the vendor, with the caveats attached.
Cohere Health sells Cohere Unify, a clinical intelligence platform, to health plans for prior authorization and the wider utilization management job, along with payment integrity, appeals, care management, claims and HEDIS quality work. Requests arrive through Epic, Availity, NaviNet, a portal or APIs. Cohere's models approve those that meet criteria in real time and send the rest to a clinician. Plans can run it with their own reviewers or hand specialty review to Cohere's nurses and physicians, and Humana has used it since 2021. The evidence is Cohere's own Humana case study, which reports 89 percent automatic approval and 54 percent fewer nurse review hours, with no outside evaluation and no published price.
Source: AI Health Index, October 2026
Xsolis sells Dragonfly, an AI utilization management platform, mainly to hospitals and health systems, with a payer side for concurrent authorization. Machine learning over the hospital record gives each admitted patient a score for inpatient or observation status, called the Care Level Score in published studies. Review nurses, physician advisors and the patient's health plan then work from that shared view. Xsolis also sells staffed physician advisor and denial services, and reports more than 615 hospitals. Studies by Baylor Scott & White and Yale New Haven Health teams in 2025 support the score, but Xsolis publishes no HIPAA position, hosting details or prices.
Source: AI Health Index, October 2026
Questions buyers ask
How does Cohere Health compare to Xsolis?
Cohere Health and Xsolis both work on utilization management, from opposite sides of the request. Cohere sells Cohere Unify to health plans, where its models approve prior authorization requests that meet criteria and send the rest to a clinician. Xsolis sells Dragonfly mainly to hospitals, scoring each admitted patient for inpatient or observation status and sharing that view with the patient's health plan. Cohere is built for a plan automating its own review.
Xsolis is built for a hospital that wants its review team and its payers working from one score. From the AI Health Index, drawn from each vendor's own published materials and the regulatory record, verified October 25, 2026. No vendor pays for placement.
How much do Cohere Health and Xsolis cost?
Neither Cohere Health nor Xsolis publishes a price. Cohere sells to health plans as a platform, a delegated review service or APIs, and it publishes returns of up to 18x for prior authorization rather than fees. Xsolis sells the Dragonfly platform and, as a separate line, staffed physician advisor and denial services. Xsolis reports an average customer return of 5 to 7 times. From the AI Health Index, drawn from each vendor's own published materials and the regulatory record, verified October 25, 2026. No vendor pays for placement.
What evidence is there that Cohere Health and Xsolis work?
Xsolis has peer reviewed studies written by its customers' own staff. At Baylor Scott & White, a retrospective study published in 2025 sampled 11 days between August 2023 and October 2024, and a Care Level Score of 76 or higher classified status correctly 86 percent of the time. At Yale New Haven Health, a 2025 study reports monthly observation discharge rates falling from 16.69 percent to 12.75 percent. Neither study gives a patient count.
Cohere Health's evidence is its own Humana case study from August 2026, covering 5.1 million members, with 89 percent of requests approved automatically and no outside evaluation. From the AI Health Index, drawn from each vendor's own published materials and the regulatory record, verified October 25, 2026. No vendor pays for placement.
Are Cohere Health and Xsolis FDA cleared, accredited or HIPAA covered?
Neither Cohere Health nor Xsolis claims FDA clearance, and both position their products as support for status and authorization decisions that people make. Cohere has announced URAC accreditation, NCQA utilization management reaccreditation and a HITRUST recertification in 2024, and its privacy policy states its business associate status. Xsolis announced HITRUST r2 certification in March 2022 and no renewal since.
It states no accreditation and publishes no HIPAA or business associate statement, and its privacy policy covers website visitors only. From the AI Health Index, drawn from each vendor's own published materials and the regulatory record, verified October 25, 2026. No vendor pays for placement.
How do Cohere Health and Xsolis connect to EHRs and payers?
Cohere Health takes prior authorization requests inside Epic through Epic's Payer Platform, through Availity and NaviNet, through its own portal and through the CMS prior authorization APIs. It runs as a hosted service on AWS. Xsolis says its score reads patient data directly from the hospital's record and reaches health plans through more than 850 payer connections. Xsolis names no record system, interface standard or hosting provider. From the AI Health Index, drawn from each vendor's own published materials and the regulatory record, verified October 25, 2026. No vendor pays for placement.
Related comparisons
Other published head to head assessments involving these vendors or their closest peers.
Cohere Health is a private company based in Boston. Xsolis, founded in 2013, is based in Franklin, Tennessee. Neither publishes a price, and neither publishes subgroup results, so nothing shows whether either model treats some patients, practices or diagnoses differently. Cohere has not said what confidence threshold decides which requests it approves automatically, how a wrong automatic approval is caught, or which base models its own models were built from.
Xsolis has not said where Dragonfly is hosted, which record systems it connects to, what a health plan can see through Align, or how many patients its studies covered. Its HITRUST certification dates from March 2022, with no renewal announced.