Lyric42
Healthcare Decision Intelligence for Payment Accuracy
Multiple signals in. One optimal recommendation. Your decision.
Multiple signals on every claim
One reconciled recommendation
Lyric42 reconciles signals from every Lyric® solution and connected partner into one recommendation, with the rationale attached. Your decision.
Our Solutions
Accurate Payments Explainable Intelligence More Confidence
More signals. Faster recommendations. Optimal decisions.
Verify every claim before payment moves
Catch errors before the dollar goes out, across millions of claims a day.
- Execute in Real Time: Lyric42 evaluates claims in milliseconds, at the scale you run.
- Source, Govern, and Maintain: Lyric tracks guidance from CMS, AMA, specialty societies, and hundreds of other authorities on a continuous cadence, turning regulatory changes into production-ready content.
- Adapt to Your Health Plan: You configure the rules, policies, thresholds, and carve-outs on one source of truth, built around how your plan operates.
- Deliver Comprehensive Coverage: Tens of millions of curated edits and mappings span professional, facility, inpatient, and specialty claims, continuously validated and maintained.
Every finding ends an error
Identify what automated editing missed. Then stop the same error from surfacing again.
- Target the risk: Lyric surfaces the claims most likely to carry coding inaccuracies, and other scenarios.
- Validate the finding: Nurses, auditors, certified coders, and data analysts apply established methodologies, standards, plan requirements, and investigative workflows through governed processes. Findings carry their rationale.
- Continuously shift left: Findings that repeat can move from post-pay into pre-pay and can become automated edits over time.
- Keep pre-pay claims moving: Intelligent triage routes and prioritizes pended claims, so complex cases get attention without slowing adjudication.
Run payment integrity on your own terms
Operate your own program on one data set and one view.
- Author the content: Policy Studio turns your policies, contracts, and plan documents into deployable content.
- Expose the rationale: C3 gives providers transparency into the policy and reasoning behind a recommendation, for fewer avoidable billing errors before submission.
- Execute Smarter Audits: Replay combines analytics, prioritization, and configurable workflows to identify what matches your audit criteria. Audit yield and productivity rise without adding headcount.
- Control your program: Virtuoso centralizes audits, recoveries, appeals, documents, outcomes, and vendor activity in one environment.
Execute multiple workflows from one evidence base
Operate from one source of truth, so the same claim gets the same answer everywhere.
- Keep pace with innovation: Clinical and coding experts turn emerging evidence into structured policy.
- Deploy across workflows: One policy set supports payment integrity, provider engagement, and other policy-driven workflows.
- Trace the answer: Answers carry the policy behind them, so systems, teams, and vendors can work from the same source.
- Govern the updates: Lyric's clinical experts revise policies as evidence changes, and version the changes.
Independently Certified, Continuously Audited
Security and Privacy
Lyric is entrusted with Protected Health Information. Our cybersecurity program is built to meet the security, compliance, and regulatory expectations of health plans.
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What We're Building Next
Building the intelligence layer for all healthcare decisions. Lyric42 will predict emerging trends, optimize actions in real time, extend decision intelligence across the care journey, and continuously learn from every outcome to drive better performance.
Learn From Every Outcome
Every decision, action, appeal, and result will strengthen the platform, continuously improving guidance for each health plan through a closed-loop system.
Predict, Don't React
Advanced anomaly detection will identify emerging trends before they impact costs, enabling interventions and policies to be in place before the first claim arrives.
Self-Optimizing Decisions
AI will continuously refine orchestration, adapting actions and recommendations as priorities, conditions, and outcomes evolve so that your decisions are always optimized.
Intelligence Across the Care Continuum
Lyric42 extends upstream to create a unified intelligence layer, using machine-readable policy to drive consistent decisions before, during, between, and after care.
Frequently Asked Questions
Lyric42 is Lyric's healthcare decision intelligence platform. It reconciles signals from every Lyric solution and connected partner against your configurations and objectives, then produces one recommendation with the rationale attached. Edit, Review, Enhance, and Guide all run on it.
Legacy programs route a claim through one solution at a time, each evaluating without the context of the others. Lyric42 orchestrates them together, and sequences the work. When findings overlap or conflict, Lyric42 resolves them against your configurations and objectives rather than passing several competing answers downstream.
Cloud-native architecture, evaluating claims in milliseconds at 2M transactions per hour with 99.9%+ uptime. Configuration, sequencing, and thresholds are yours to set.
AI searches and organizes at a scale people cannot match. Clinical experts, including RNs, MDs, and PharmDs, apply the expertise and judgment no machine can replicate.
No. Lyric42 produces the recommendation and the rationale behind it. A human expert stays in the loop, and the determination is made by a person.
