Details
Cohere Validate, launched in September 2025 following Cohere's acquisition of ZignaAI, uses machine learning algorithms to analyze claims against pre-service clinical data, plan policies, provider contracts, and billing codes to flag claims most likely to result in audit findings. The platform includes specialized autonomous agents — such as the Sepsis Audit Agent, launched in November 2025 — that scan hundreds of pages of medical records without human initiation, validate diagnoses against clinical criteria, automatically assign diagnosis-related groups (DRGs), and calculate reimbursement amounts. Early adopter health plans reported the Sepsis Audit Agent matching the throughput of 2–3 full-time auditors. Traditional payment integrity has relied on manual human auditors reviewing claims after payment; Cohere's system shifts this work upstream to catch errors before payment and automates the bulk of initial document review.
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