Cohere Health vs Rhyme

What it does

• Automates prior auth intake, review, and approval for health plans
• Auto-approves up to 90 percent of eligible auth requests
• Applies evidence-based clinical policies and physician-facing nudges
• Provider performance analytics to steer utilization management
• Payment integrity claims validation via Cohere Validate
• Delegated UM services across MSK, cardiology, imaging, sleep

Where it's strong

• Proven at national scale: over 12 million prior auth requests a year across roughly 600,000 providers, including a nationwide Humana deployment.
• High auto-approval rates (up to 90 percent) materially cut turnaround times and provider abrasion, which matters as CMS-0057 deadlines arrive.
• Well capitalized at $200M raised and expanding beyond prior auth into payment integrity, reducing single-product risk.

What buyers should weigh

• It sells to health plans, not providers; a provider organization only encounters Cohere through a payer that has adopted it.
• Much of its track record is concentrated in the Humana relationship, so plans of smaller size should ask for comparable references.
• Delegated UM and clinical policy alignment make implementations substantial projects with real compliance and integration work, not a light SaaS install.

Named customers

Humana · Geisinger Health Plan · Medical Mutual of Ohio

Integrations

What it does

• Submits and tracks prior auths inside provider EHR workflows
• Connects providers and payers on one shared auth network
• Touchless auth processing with real-time payer decisions
• Gold carding programs that waive auths for trusted providers
• Shared payer-provider dashboard for auth status and collaboration

Where it's strong

• A working two-sided network: 80 to 90 of the largest health systems and over 300 payers processing 4 to 5 million auths a year.
• Auths run inside the EHR workflow staff already use, so adoption requires little retraining.
• Its gold carding model removes prior auth entirely for high-performing providers rather than just speeding up submissions.

What buyers should weigh

• Rhyme is connectivity and workflow, not a clinical decision engine; payers still need their own UM review stack (its Medical Mutual deal paired it with Cohere for exactly that reason).
• Value depends on payer overlap; auths for payers outside the network fall back to portals, fax, and phone.
• At roughly $57M raised and a modest team, it is a smaller vendor than RCM incumbents like Availity or Waystar, so weigh long-term durability and roadmap capacity.

Named customers

Medical Mutual of Ohio · Norton Healthcare · Ohio Hospital Association

Integrations