Healthcare costs are projected to continue to rise, with fraud, waste, and abuse consuming up to 10% of total spend. The stakes have never been higher for payment integrity teams tasked with curbing these costs. But too often, efforts are held back by fragmented data, outdated systems, and strained provider relationships.  

Artificial Intelligence (AI) is no longer a futuristic concept — it’s here, and it’s transforming healthcare in real time. From clinical decision support to patient engagement, AI is helping organizations deliver better outcomes at lower costs. One of the most promising, yet often overlooked, applications is in payment integrity (PI), where accuracy, efficiency, and provider trust are critical.  

This blog takes a deeper dive—rooted in four key areas (Challenges, Takeaways, Technology, and Potential Areas of Impact)—that integrates the background and insights from the proposed Rule’s Executive Summary; Statutory Authority and Regulatory History; Justification for This Proposed Rulemaking; Section-by-Section Description of the Proposed Amendments to the Security Rule; and Regulatory Impact Analysis.

Explore six key trends shaping the future of prepay claim editing and payment integrity. Learn how AI, regulatory agility, and provider collaboration drive efficiency, accuracy, and value-driven healthcare outcomes. Stay ahead with insights from Lyric’s experts.

Lyric's leadership team offers comprehensive insights into the trends, challenges, and opportunities they predict will become top-of-mind for healthcare organizations in 2025. We hope they provide readers with insights as they plan our evolving world of healthcare technology. These perceptive predictions are not official statements or guidance from Lyric.

Provider abrasion remains a persistent challenge to health plans, often stemming from claim denials, payment delays, as well as administrative processes that are complex and costly. While payment integrity programs protect healthcare resources and ensure appropriate reimbursement, they can also inadvertently strain payer-provider relationships.

Provider abrasion remains a persistent challenge to health plans, often stemming from claim denials, payment delays, as well as administrative processes that are complex and costly. While payment integrity programs protect healthcare resources and ensure appropriate reimbursement, they can also inadvertently strain payer-provider relationships.

For health plan customers, The Learning Portal (TLP) serves as a platform for education, ongoing knowledge, and skill enhancement. It is tool for new product implementation, which is a tailored fit to integrate and enhance Lyric’s customer success and engagement experience.

The Health Information Trust Alliance (HITRUST) provides a framework designed to help organizations effectively manage data security and compliance. Lyric’s Chief Information Security Officer, Kevin Heineman, explores cyber security programs leveraging the HITRUST CSF framework.

Many health plan veterans and industry luminaries shared deep, sophisticated discussions at the 2024 Becker’s Payer Issues Roundtable that unfolded throughout the day, marking what many attendees recognize as a pivotal time for digital transformation and mindset shift for payers.

The Venetian Expo in Las Vegas became healthcare's innovation epicenter as HLTH 2024 welcomed over 12,000 attendees from October 20-23. In his opening address, HLTH Founder, CEO, and Chairman Jonathan Weiner called for "bold thinkers, leaders, and innovators to create real change in healthcare."

As healthcare costs in the United States continue to surge, with projections reaching $7.7 trillion by 2032, health plans face mounting pressure to innovate and adapt.

In an era where healthcare technology is rapidly evolving, Lyric's AI-driven platform, 42, stands out as a game-changer in the industry. This innovative AI solution is not just transforming payment integrity (PI); it's also paving the way for a more efficient, cost-effective, and member-centric healthcare ecosystem.

Listen in as industry trailblazers Julie Hill and Lyric president & COO Carolyn Wukitch engage in a compelling fireside chat on women's leadership in healthcare and AI's impact on payment integrity.

In the dynamic world of healthcare, the integration of advanced payment technology is not merely a trend but a necessity. Here, we explore the critical role of healthcare payment technology in achieving payment integrity, highlighting key trends, challenges, and opportunities for health plans.

In the intricate maze of healthcare administration, where complexity and cost often hinder efficiency and clarity, a revolution looms on the horizon. AI-driven copilots, are set to transform the landscape of health plan call centers.  Learn more in this article written by Akshay Sharma, Chief AI Officer at Lyric, and Steve Ambrose, Director, Thought Leadership, at Lyric.

In the fast-paced digital world where innovation and technology evolve at lightning speed, cybersecurity stands as the silent guardian of our most valuable digital treasures. It's a realm where vigilance meets precision, and the stakes are perpetually high.

Steve Ambrose, Director, Thought Leadership, at Lyric shares his top seven takeaways after attending the AHIP 2024 Conference in Las Vegas, Nevada. With a rich array of speakers, panels, and exhibitions, the three-day event set the stage for meaningful discussions, valuable insights, and practical strategies.

In the evolving landscape of healthcare payment and integrity, claims editing emerges as a pivotal component, ensuring the accuracy and efficiency of bills submitted by care providers and provider organizations (“providers”). For health plans and those vested in payment integrity, understanding the nuances of this process is crucial.

In an era marked by rapid technological advancements and significant shifts in healthcare reimbursement models, the essence and strategic importance of payment integrity (PI) in the U.S. healthcare system have never been more pronounced.