Cohere Health Pricing: What Health Plans Pay and What Providers Pay

To the plan, in two reported shapes. A per member per month fee ties Cohere's revenue to the size of the plan's book regardless of how many authorizations flow, which suits plans that want a predictable platform cost. A per authorization fee ties it to volume, which suits plans piloting one service line, such as musculoskeletal or imaging, before a wider rollout. Larger agreements combine a platform fee with usage bands and, where Cohere runs the review work itself rather than only the software, a service component.

Cohere also sells a payment integrity product and an in house utilization management offering, each priced separately, and its site contrasts its payment integrity terms with what it calls expensive vendor stacks charging contingency fees of 30 percent or more. That is a competitive claim about others' pricing, not a disclosure of its own.

What this means for a provider is simple: the plan's pricing model shapes the plan's incentives, and those incentives arrive at your front desk as policy. A plan paying per authorization has a reason to route more requests through automated approval; a plan paying per member has a reason to expand the scope of what requires authorization. Neither is visible to you, but both affect your queue. The prior authorization automation use case explains how to measure that queue from your side.

Where a plan in your payer mix uses Cohere, you get the portal, status checking, published clinical criteria for the covered service lines, and in some deployments an automated decision at submission. Cohere's health plan page cites 85 percent real time approvals and a 94 percent provider satisfaction rate as vendor figures. Training webinars and the learning centre are free. There is no provider licence, no per submission fee and no contract for you to sign, other than the portal terms of use.

What costs you is integration and staff time, and both are yours to pay. If you want submissions to originate in your EHR rather than the portal, that connection is built on your side or through your existing network or clearinghouse, and the cost lands with your EHR vendor or integration team. Staff still assemble the clinical packet the plan's policy demands, and a plan's move to Cohere often comes with a change in what the plan asks for, which is a retraining cost nobody invoices.

The other cost is duplication. A practice with six plans on six different platforms has six interfaces, and Cohere is one more unless it arrives through a network you already use. That is the problem provider side platforms such as Waystar and networks such as Availity are paid to solve.

It does not compete with the products a provider buys, so a price comparison against them is a category error. The right comparison for a provider is between the tools that submit into Cohere and other plan platforms: Availity, whose free Essentials portal and vendor stated 25 USD a month Essentials Plus tier are the only published prices in the category, Waystar, which quotes against transaction volume, and Rhyme, which sells network connectivity to both sides.

The one vendor Cohere does compete with in this set is Anterior, also sold to health plans, which reports a value based model with task fees per auto approved authorization according to its chief executive in a February 2026 MedCity News interview. If you are a health plan reading this, that is your comparison. If you are a provider, the useful fact is that both plan side vendors are automating review, and the prior authorization software comparison explains what that does to the value of provider side rules guessing.

For a provider, the question is not whether to buy it but whether a plan's deployment of it reduces your cost, and that can be measured. A worked example. A specialty group submits 300 authorizations a month to a plan that has moved to Cohere, and before the change staff spent 30 minutes per request across submission and follow up, which is 150 hours a month. If automated decisions at submission now resolve 60 percent of requests in minutes and the remaining 40 percent still take 30 minutes, the monthly hours fall to about 60 plus a few minutes per automated request, roughly 75 hours in total. At a loaded 28 USD an hour that is a saving of about 2,100 USD a month that arrived without a purchase.

The figure to watch is the share of requests that resolve automatically for your service lines, because the vendor's 85 percent is a plan wide figure and yours may be very different. Run the prior authorization cost calculator on your current state, then rerun it after a plan changes platform, and you have the number. Where the plan's decisions are slower or denials rise, the denial rate benchmark gives you the comparison to raise in the payer contract discussion.

For a health plan, the worth question turns on medical expense and administrative cost per authorization, and that is a different analysis from anything on this site.

Your leverage is in the payer contract, not with Cohere. When a plan in your top ten by volume moves to a Cohere platform, raise these points at the next contract or joint operating committee discussion.

• Decision timeframes in writing. CMS-0057-F requires impacted payers to decide standard requests within seven calendar days and expedited ones within 72 hours, and to publish metrics, as explained on our CMS prior authorization rule page. Ask the plan to commit to the same for commercial lines the rule does not cover.
• The service lines and codes in scope, with notice periods before scope expands.
• EHR submission. Whether the plan will accept requests through your existing network or clearinghouse so your staff avoid another portal.
• Gold carding. Whether high approval rate providers are exempted from review, and the criteria.
• Published criteria. Access to the clinical policies the platform applies, so your packets match the first time.

None of that costs you a licence fee. All of it changes your queue more than any software purchase would.

Most provider organisations do not know which of their plans run which utilization management platforms, and so they buy submission tools without knowing what they are submitting into. An independent review maps your payer mix against the plan side platforms, measures the queue by plan and service line, and works out whether the pain sits with a plan, with your process or with a tool you lack. That determines whether the answer is a purchase, a payer negotiation or a workflow change, and the three cost very different amounts.

Clunic takes no commissions or referral fees from Cohere Health or any vendor. Our vendor selection service covers the provider side shortlist, and the AI readiness audit is the right starting point when the problem is not yet quantified. Book a call if a plan has just changed platform and your authorization queue changed with it.