EDIT
Verify every claim before payment moves
Tens of millions of curated pre-pay edits run against claims in flight in milliseconds. Clinical, coding, and reimbursement experts maintain the content as evidence and guidelines evolve. Lyric surfaces the recommendations and the rationale. You decide what to act on.
More than 180 million edits built over 35 years
10B+
Claims Validated Annually for Accuracy
>$30B
Of Potential Overpayments Identified
>95%
Of Findings Persist
The Payment Integrity Shift
From pay-and-chase to proactive prevention
Legacy payment integrity was built around recovery. A claim pays, an auditor finds the error months later, and the plan asks the provider for the money back. Every one of those requests costs provider trust. First-pass accuracy requires current content, high- performance execution, and a source policy on every recommendation.
What Lyric delivers
Clinical expertise, regulatory surveillance, and execution at claim speed run against millions of claims a day. Findings carry the reasoning behind them. That is healthcare decision intelligence in practice: accurate, explainable, and traceable.
Pre-Pay Edit Solutions
One platform. Accuracy before the payment moves.
Authoritative Content Continuous Maintenance Proven Accuracy
Source, Govern, and Maintain
Lyric continuously monitors guidance from CMS, AMA, specialty societies, and hundreds of other authoritative sources. Clinical, coding, and reimbursement experts translate each update into production-ready content, so plan content stays current as the guidance changes.
Deliver Comprehensive Coverage
Lyric provides one of the industry's most comprehensive primary editing libraries, with tens of millions of curated edits spanning professional, facility, and specialty coding and reimbursement scenarios. Lyric validates and tests the content continuously, across all lines of business.
Execute in Real Time
Lyric42 evaluates claims in milliseconds, enabling health plans to process high volumes while maintaining the accuracy, quality, consistency, and performance required for adjudication. Recommendations are designed to support both payment integrity and operational efficiency.
Adapt to Your Health Plan
No two health plans operate the same way. Lyric serves as the system of record for client-specific configurations, enabling plans to tailor policies, thresholds, provider carve-outs, sequencing logic, and business rules to meet unique objectives while preserving a single source of truth.
Emerging Opportunities Advanced Policies & Content Go Beyond the Standard
Identify Emerging Opportunities
Advanced analytics continuously evaluate claims patterns, reimbursement trends, and utilization behaviors to uncover cost drivers in addition to primary edits. Stay ahead of emerging payment integrity risks and cost-of-care trends.
Convert Knowledge into Traceable Policy
Doctors, clinicians, certified coders, and reimbursement specialists turn medical literature, regulatory guidance, and payer experience into differentiated policies that hold up clinically and operationally.
Deliver Tailored Client-Specific Content
Lyric develops configurable policies reflecting your objectives, state requirements, and risk tolerance. Address opportunities unique to your environment.
Capture Value Beyond Primary Editing
Secondary editing identifies gaps between standard reimbursement rules and real-world payment behavior. Capture additional value through targeted policies that improve accuracy and address emerging trends.
Specialized Domains Continuous Optimization Aligned Objectives
Address Complex, Specialized Domains
Some categories need deeper expertise than standard coding guidance provides. State Medicaid, Emergency Department Leveling, and other specialized domains carry unique regulatory requirements, clinical considerations, and reimbursement methodologies.
Continuously Optimize Outcomes
Regular performance reviews, analytics, market monitoring, and collaborative governance keep programs current. Lyric fine-tunes content, improves accuracy, and reduces provider abrasion.
Align Programs to Client Objectives
Lyric works with you to configure policies, thresholds, and execution strategies balancing payment accuracy, provider experience, regulatory compliance, and business objectives. Define success on your own terms.
the lyric difference
Curated Content
Millisecond Execution
Traceable Findings
- Authoritative Content: Tens of millions of curated edits, mappings, and reference tables from CMS, AMA, specialty societies, and hundreds of other authorities.
- Real-Time Performance at Scale: Lyric42 evaluates claims in milliseconds, stopping incorrect payments before they happen.
- Differentiated Policy Intelligence: Analytics, clinical expertise, and coding knowledge convert emerging opportunities into auditable policies.
- Configurable for Every Plan: Configure policies, workflows, thresholds, sequencing, and provider carve-outs to your operating model.
- Transparency by Design: Recommendations carry clear rationale, authoritative sourcing, and explainable logic.
- Continuous Optimization: Dedicated experts, analytics, and governance refine policies as regulatory, clinical, and reimbursement requirements change.
HEALTHCARE DECISION INTELLIGENCE FOR PRE-PAY EDITS
Multiple signals on every claim
One reconciled recommendation
Pre-pay edits run on Lyric42 reconciling against reviews, partner signals, and your configuration before they reach you.
Frequently Asked Questions
Edit is a pre-pay claims editing solution. Tens of millions of curated edits, mappings, and reference tables run against claims in milliseconds, before payment moves. Clinical, coding, and reimbursement experts maintain the content as guidance changes.
Pre-pay editing evaluates a claim against clinical, coding, and reimbursement policy before payment is released. The error gets caught before the dollar moves, so there is no recovery request to send a provider later.
Lyric continuously monitors guidance from CMS, AMA, specialty societies, and hundreds of other authoritative sources. Additionally, Lyric's clinical, coding, and reimbursement experts develop proprietary policies where gaps exist in published guidance, so that you always have comprehensive coverage available with Lyric edits.
Yes. Configure policies, thresholds, exclusions, provider carve-outs, sequencing logic, and business rules against a single source of truth.
No. Lyric surfaces the finding and the rationale and returns a real time recommendation. You decide what to act on.
