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 But too often, efforts are held back by fragmented data, outdated systems, and strained provider relationships.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.