Lyric Launches Emergency Department Program to Improve Facility E/M Coding Accuracy
Lyric launched its new Emergency Department Program to help health plans control rising ED facility costs through accurate, consistent, and transparent level determinations.
The program uses a structured, policy-aligned framework to assess each facility E/M claim at the appropriate level. Leveraging clinical logic based on emergent diagnoses, patient services, and complicated conditions, the program ensures defensible and consistent outcomes.
Health plans can easily configure rules and thresholds to match their reimbursement policies, operational goals, and provider relationships—while staying aligned with CMS and ACEP guidance.
Built on Lyric’s proven payment accuracy infrastructure, the program deploys quickly through existing Lyric integrations, requiring minimal IT effort.
Once live, real-time analytics and expert consultation help plans measure impact, benchmark provider behavior, and continuously optimize performance.
“As ED coding intensity continues to rise, health plans need support - not guesswork. Our Emergency Department Program uses clinically grounded criteria to ensure each claim reflects its true complexity and aligns with each health plan’s unique needs,” says Dr. Meera Atkins, Chief Medical Officer at Lyric. “We built this solution to help plans make confident decisions and strengthen provider trust through transparency.”
Product Highlights
Automated Pre-Pay Editing: Ensures accurate, defensible facility E/M coding before payment—reducing costly rework and overpayments.
Comprehensive Clinical Evaluation: Applies structured logic across diagnoses, services, and patient condition to assess true visit complexity.
Plan-Configurable Framework: Aligns with your reimbursement policy and provider strategy for consistent, policy-driven results.
Transparent Analytics & Reporting: Empowers health plans to track program impact, identify trends, and benchmark provider behavior.
Full-Service Support Model: Includes analytics, reporting, and expert consultation to guide continuous performance optimization.
Ready to ensure accurate, defensible emergency department reimbursement?
Visit the Emergency Department Program Page or Contact Us to learn how Lyric can help you reduce ED costs without adding administrative friction.
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.