Physicians are increasingly spending time on administrative tasks and non-clinical activities.
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Prior authorization and clinical intelligence technology enablement company Cohere Health announced today that it will be acquiring ZignaAI to move into the world of clinical payment integrity.
With this new acquisition, the company will be launching an entire suite dedicated to payment integrity and optimizing revenue for stakeholders, marking a “shift right” from purely pre-care into payments, as CEO Siva Namasivayam and CGO Krishna Kottapalli note.
Specifically, the company is bringing together two often separated ecosystems into one seamless workflow, welding the gap between prior authorizations and post-service claims and coding validation. By doing so, Cohere believes it can inch closer to real-time approvals and better economics for all involved parties. The problem in the current system is that the provider’s services and the payment for those services are often on two very different timelines; despite having prior authorization, providers often do not receive reimbursement immediately after executing services. Essentially, connecting these two worlds can help mitigate errors before claims are reimbursed, meaning that service providers can ultimately enjoy more swift reimbursements.
Namasivayam explains that the goal is to bring the same level of competency to payment integrity as Cohere brought to the world of prior authorization. Right now, the system is fractured, leading to dissatisfaction and frustration between stakeholders. But ideally, a combined ecosystem will: help foster better relationships between payers and providers, improve administrative procedures and efficiencies across the board and ultimately, enable stakeholders to focus on their core competencies rather than workflow burdens.
As Kottapalli further explains, payer and provider collaboration is foundational to the company, and moreover, a tech first approach is necessary for this foundation: “We’re helping health plans move away from legacy models by reducing dependency on stacked audit vendors and replacing them with transparent, evidence-based and automated in-house processes.”
Why is all of this important?
Because this entire ecosystem is the epicenter of administrative burdens. A recent RAND study discusses how “on average, physicians complete 43 prior authorizations per week, dedicating over 16 hours filling out forms, waiting on hold, and appealing denials.” Furthermore, despite increasing physician burnout, there are increasing administrative tasks being placed upon physician workflows. For the average consumer and patient, this entire arena of the healthcare ecosystem is largely a blackbox of mystery, leading to an overall perception of poor quality and increased frustration: “Public satisfaction with the total cost of healthcare in the U.S. is fairly typical of what it has been over the past two decades, with just 24% satisfied and 76% dissatisfied.”
This is another reason why technology companies are rushing to innovate in this field. Epic, one of the largest EMR providers in the space, announced numerous new advancements in their recent UGM conference especially focused in the prior authorization space. Even Oracle and Cerner have started to approach this as necessary offerings. The demand is clearly self-evident.
For Cohere, the equation is simple: bring the entire stack together in one continuum as a means to help providers and payers alike achieve revenue success.
Nevertheless, the key will be execution; the challenges of this field have persisted and inflated significantly over the last decade, and are slowly reaching a tipping point of no return. Therefore, while the ambitions are high and the technology has finally advanced to a point of potential success , the work is just getting started.
Source: https://www.forbes.com/sites/saibala/2025/09/09/clinical-intelligence-company-cohere-health-announces-acquisition-of-zignaai/
