NASHVILLE — October 28, 2026 — Lyric, the trusted leader in healthcare decision intelligence, today announced new expert review capabilities within the Lyric42 platform that enable health plans to identify and temporarily pend claims for targeted expert review during adjudication.
Lyric has long helped health plans make automated, real-time payment recommendations as claims move through adjudication. The new capabilities expand the range of decisions Lyric42 can orchestrate by adding expert review as another potential decision pathway. Under criteria each health plan defines, Lyric42 intelligently detects and prioritizes claims where expert review can improve the payment decision, routes them for review, and returns a recommendation for the health plan’s final decision.
By bringing expert review into the adjudication process, health plans can move more payment integrity activity upstream, before claims are finalized or paid. It also allows Lyric42 to orchestrate across a broader range of potential actions, connecting automated and expert-driven decisions to help determine the best path for each claim.
“The future of payment integrity isn’t about adding more edits or more reviews. It’s about determining the right action for each claim, at the right point in the process, and continuously learning how to make more of those decisions earlier,” said Brian Berkowitz, Chief Product Officer at Lyric. “These new capabilities bring expert judgment into the set of actions Lyric42 can orchestrate, helping health plans make more accurate decisions while the claim is still being adjudicated.”
Moving More Decisions Upstream
Coding Review is the first product enabled by Lyric42’s new expert review capabilities. It extends automated claims editing with targeted expert review for complex coding scenarios where additional context and professional judgment can improve the payment decision.
Coding Review initially addresses areas that benefit from expert validation, including complex modifier use, procedure relationships, and additional coding scenarios. Lyric42 selects and prioritizes claims for review within each health plan’s rules, surfaces the information needed to support the decision, and routes each claim to the appropriate expertise.
Beyond Coding Review, Lyric plans to extend Lyric42’s expert review capabilities to additional areas of payment integrity, including Coordination of Benefits and medical record review, such as DRG validation and itemized bill review. This creates additional opportunities to move traditionally downstream payment integrity activities into pre-pay workflows.
Learning Today, Shifting Decisions Upstream
Expert review also strengthens Lyric’s continuous learning model. Review outcomes reveal patterns that can be translated into repeatable pre-pay edits, so health plans can move appropriate decisions further upstream while preserving expert review for cases that require additional judgment. The objective is to progressively shift appropriate decisions from post-pay to pre-pay review, and from pre-pay review to pre-pay edits, improving accuracy earlier in the payment process while focusing expert judgment where it adds the greatest value.
Lyric42’s new expert review capabilities are generally available to Lyric42 clients. Coding Review is also available today.
About Lyric
Lyric is the trusted leader in healthcare decision intelligence. Built on more than 35 years of proven results, Lyric combines AI with clinical, payment, and policy expertise to deliver transparent, auditable insights in milliseconds across real-time claims workflows. Lyric augments human decision-making so health plans can make faster, more accurate payments while maintaining full control. Today, Lyric supports 200 million lives, with nine of the top 10 U.S. health plans relying on its platform to reduce waste, improve efficiency, and support accurate payments. To learn more, visit lyric.ai.
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