Cohere Health® has introduced its Sepsis Audit Agent, the configurable agentic AI solution designed to transform sepsis clinical and coding validation for health plans, one-size-fits-all auditing. Early adopters are already realizing significant financial and operational gains, including $4k–$5k in savings per claim, a 58% findings rate, and throughput equivalent to 2–3 full-time auditors-expanding audit capacity without increasing headcount. Sepsis remains one of the costliest and most complex conditions to validate, representing 56% of Medicare audits and up to 9% of inpatient spend for a typical Medicare Advantage plan, due in part to competing diagnostic frameworks that drive inconsistency and disputes.
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Integrated within the Cohere Validate™ payment integrity platform, the Sepsis Audit Agent combines clinical intelligence. “The Sepsis Audit Agent reflects our focus on clinical intelligence: AI that truly adapts to your unique policies,” said Siva Namasivayam, CEO and co-founder of Cohere Health. “Similar to how we led the industry transformation of prior automation, Cohere Health is now reimagining payment integrity.” Operating autonomously, the Agent aligns with five sepsis policy frameworks, analyzes medical records, calculates clinical scores, validates diagnoses, assigns DRGs, and calculates reimbursement, cases requiring expert review. As Lalithya Yerramilli noted, “The Agent fundamentally modernizes workflows,” delivering AI-driven auditing with accuracy and efficiency.