How Lyric’s 42 Platform is Reshaping Payment Integrity and Beyond
In an era where healthcare technology is rapidly evolving, Lyric's platform, 42, stands out as a game-changer in the industry. This innovative 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.
Let's dive into how 42 addresses some of the most pressing challenges faced by health plans today, while continuously pushing the envelope with future capabilities.
The Power of AI in Payment Integrity
At its core, 42 is Lyric’s platform has Lyric's ClaimsXten (CXT) solution, the flagship pre-pay editing product used by 100 health plans, including 8 out of the top 9 payers in the U.S., collectively covering 185 million lives. Beyond this, it provides an incremental evolutionary step for health plans, through the ability to select, configure, and deploy best-in-class PI solutions from our platform partners.
Built on this foundation, 42 offers:
Greater medical savings
Reduced administrative costs for achieving those savings
Proactive thinking to reduce provider abrasion
Improved financial transaction experiences for both members and providers
Perhaps most impressively, 42 has been developed to deliver incremental savings, with estimates as high as an additional 8% annually for health plans. This starts with Lyric’s market leading prepay claim edits and extends across the entire payment integrity value chain, incorporating capabilities like coordination of benefits, as well as future PI capabilities and offerings for our valued customers.
Seamless Integration and Extensibility
One of the biggest hurdles health plans face when adopting new technologies is integration. 42 overcomes this challenge through a single, bidirectional integration with a health plan’s core system. In practical terms, this means:
Claims data flows through the platform’s prepay editing and other PI capabilities
A consolidated set of recommendations is delivered back into the core system
Effective integration and scalability across different data types
This approach not only streamlines implementation but also allows health plans to experiment with turning solutions on and off without significant investment. The platform's extensibility, built on a modern data platform with robust data management capabilities, enables the development of custom solutions for areas such as care management and further automation of claims workflows.
Driving Operational Efficiency and Savings with AI
The AI-generated insights within 42, offered through a service called LyricIQ, are designed to create customized solutions that reduce the timeline for data collection, review, and time to savings realization Some of these AI-as-a-service offerings may include:
Improving auto-adjudication rates
Identifying additional duplicate claims using configurable thresholds
Matching authorizations to claims
Predicting the likelihood of approval for high-dollar audit claims
Streamlining prior authorization processes using large language models (LLMs)
These AI-driven efficiencies not only benefit health plans but also can create greater satisfaction and improved experience for providers and members alike.
The 42 Advantage: A True Game-Changer
What makes 42 a true game-changer for health plans? It's a comprehensive platform that:
Brings all your data together
Enables deployment of a variety of customized, plan-based digital solutions
Transforms transactions between plans and providers
Improves outcomes and experiences for members
By bringing together data, AI-driven insights, and customizable solutions, 42 is not just addressing current challenges in healthcare; it's laying the groundwork for future innovations.
Looking Ahead
As healthcare continues to evolve, platforms like 42 will play an increasingly vital role in shaping the industry's future. By providing health plans with the tools to improve efficiency, reduce costs, and enhance member experiences, 42 is helping to create a more sustainable and effective healthcare system for all.
For health plans looking to stay ahead of the curve and drive meaningful change in their operations, exploring the capabilities of Lyric's 42 platform could be the next big step towards a more efficient, member-centric future. To learn more about the innovations and solutions offered by the 42 platform, contact us here or reach out to your account executive at Lyric.
About Lyric
Lyric is the payment integrity Al company trusted by the nation's leading health plans at the beginning of the claims payment workflow. The Lyric platform is built on Al from the ground up and trained on 35 years of clinical expertise with real time integrations across 190 million lives. Lyric reduces wasted healthcare spending and ensures fast, accurate payments that drive transparency between payers and providers. Lyric is recognized as the 2025 Best in KLAS for Pre-payment Accuracy and Integrity.
