Emergency Department (ED) Program
Precision, performance, and proven expertise, Lyric’s Emergency Department Program delivers the next generation of pre-payment accuracy for emergency department coding. Built on over 30 years experience in payment integrity, we help health plans ensure fairness, transparency, and savings while building stronger provider relationships.
Emergency department claims remain one of the most complex and costly areas in healthcare payment. Volumes are rising, clinical profiles are changing, and coding variability continues to impact reimbursement accuracy. Health plans need a scalable, intelligent solution that drives accuracy while supporting fairness and collaboration.
Lyric’s ED Program was purpose-built for this challenge—combining automation, analytics, and human expertise to evaluate E/M facility levels holistically. The result: consistent, defensible, and clinically aligned payment outcomes that reflect our unmatched history in payment accuracy innovation.
The evolving challenge of ED claims
→
→
→
→ → →
How our ED Program works
Automated pre-payment evaluation of E/M levels using configurable rules and scoring thresholds
Transparent logic and rationale for every decision, building confidence with providers and partners
Ongoing rule optimization and performance tuning guided by Lyric’s expert clinical and data science teams
Comprehensive review of diagnosis type, diagnostic service thresholds, and comorbidities for accurate complexity assessment
Comparative analytics and peer benchmarking to reveal insights and promote consistent coding behavior
Fast, scalable implementation with minimal IT lift and seamless alignment to existing payment workflows
Why leading health plans trust Lyric
Accuracy at scale
We ensure consistent and defensible
E/M coding across every claim.
Collaboration built-in
Our teams foster transparency and alignment between health plans and providers.
Confidence in every decision
Powered by data-driven logic and supported by decades of expertise in payment integrity.
Our legacy of leadership in payment accuracy
Lyric has spent decades advancing the science and technology behind payment integrity. From pioneering
pre-payment accuracy to developing industry-leading edit and rule engines, we’ve helped shape the standards of modern payment integrity programs. The Emergency Department Program represents the next evolution—purpose-built for today’s challenges and tomorrow’s innovations.
Continuous leadership in payment accuracy across multiple lines of business.
Decades of innovation
Proven results and partnerships with 9 of 10 top payers in the U.S.
Trusted by the top plans
Analytics and insights refined through millions of claims evaluated each year.
Data that drives impact
Built on trust and compliance
Lyric’s ED Program is built with the same security and compliance foundations trusted across all of our solutions. Our programs are HIPAA, HITRUST, SOC2, and ISO certified, ensuring protection, privacy and reliability for every client and every claim.
Implementation made simple
From setup to optimization, our team partners closely with your organization to configure, deploy, and fine-tune the ED Program to your strategy. Built for speed, scale, and sustainability, it integrates seamlessly into your workflow to deliver measurable outcomes from day one.
Experience the next generation of payment accuracy
Join the nation’s leading health plans who trust Lyric to transform their payment integrity operations. Our Emergency Department Program combines technology, expertise, and innovation to help you achieve sustainable savings and better outcomes.