REVIEW
Every finding ends an error
Lyric unifies multiple review types on a common technology platform. Workflow automation and intelligence improve outcomes and transparency, while experts focus where judgment matters most. Every finding is evaluated for opportunities to codify or shift upstream, creating a continuous path from recovery to prevention.
Findings that hold
$20
per member per year savings
>95%
accuracy rate
<2%
Overturn Rate
The Payment Integrity Shift
From manual audits to technology-driven reviews
Legacy reviews relied on labor-intensive audits to improve payment accuracy. This model creates inconsistent decisions, slower cycle times, higher costs, and growing abrasion as volumes increase. More reviews do not necessarily create more value. Health plans need a better way to target the right opportunities, apply expertise consistently, and improve outcomes at scale.
what lyric delivers
Intelligent selection surfaces the claims most likely to carry inaccuracy. Nurses and certified coders review the recommendations to make a decision. Recovery turns into prevention over time. Patterns that repeat become edits.
Automation finds it. Experts validate it.
Review Solutions
One platform. Post-pay recovery through pre-pay prevention.
Intelligent Targeting
Expert Judgment
Auditable Findings
Target Complex Risk
Advanced analytics, payment policy intelligence, and configurable review criteria identify the claims most likely to contain coding inaccuracies, modifier misuse, bundling issues, and other high-risk scenarios.
Deliver Consistent, Auditable Determinations
Nurses, auditors, and certified coders apply plan policy, CMS, CPT, NCCI, and your guidelines through governed workflows built to improve consistency, strengthen auditability, and reduce unnecessary appeals. Every finding carries its rationale.
Keep Claims Moving
Coding Review routes, prioritizes, and manages pended claims through workflows that balance accuracy with operational efficiency. Intelligent triage sends complex claims to the right level of review without disrupting claims processing or provider reimbursement.
Turn Expertise into Action
Every review creates intelligence. Outcomes, trends, and validated findings refine targeting models. Repeatable review concepts can move into pre-pay editing, reducing manual intervention and increasing payment accuracy.
Unified Coverage
Automated Primacy Prevented Errors
Unify Every Coverage Signal
Lyric consolidates eligibility files, claims data, MSP information, lead sources, member responses, and other coverage indicators into a single member view, so primacy and coverage are established against one record.
Automate Complex Primacy Decisions
Intelligent rules, automated verification, and configurable primacy logic evaluate coverage relationships to establish the correct order of benefits. Targeted human intervention resolves what automation cannot, preventing payment errors before they occur.
Prioritize by Impact
Advanced prioritization, automated lead processing, and intelligent workflows direct resources to uncover cost drivers, eliminating duplicate effort and accelerating both cost avoidance and recovery.
Operate Across the Full Lifecycle
Lyric unifies eligibility, pre-pay COB, and post-pay recovery, on a single platform. Shared intelligence helps identify and resolve more coverage issues before payment occurs, increasing cost avoidance while reducing reliance on downstream recovery.
Pattern Detection
Expert Validation
Scalable Controls
Identify Hidden Opportunities at Scale
Advanced analytics, deterministic logic, AI-driven anomaly detection, and payment integrity expertise uncover billing, coding, pricing, eligibility, contract, and reimbursement inaccuracies across millions of paid claims. Evaluation surfaces what legacy approaches overlook.
Validate Findings with Precision and Expertise
Lyric combines detection with clinical, coding, reimbursement, and data expertise to validate findings and prioritize the opportunities most likely to benefit from expert review. Higher-quality recoveries, greater confidence in outcomes, reduced administrative burden.
Deliver Complete Transparency
Every finding carries documented rationale, audit trails, and lifecycle reporting. From validation and recovery through disputes, reconciliations, and realized savings, program performance stays visible end to end.
Turn Proven Patterns Into Scalable Controls
Data Mining identifies recurring payment integrity patterns, validates their impact, and converts them into scalable controls deployed across editing, review, and other payment integrity workflows. Value moves upstream from recovery to prevention.
The Lyric Difference
Intelligent Selection
Workflow Automation
Expert Validation
- Intelligent Opportunity Targeting: Advanced analytics, AI, and payment integrity expertise focus reviews on the opportunities most likely to improve accuracy.
- Technology-Enabled Execution: Modern workflows, automation, and workload optimization increase productivity, consistency, and audit performance.
- Pre-Pay and Post-Pay Integration: Opportunities, insights, and interventions move efficiently across the payment lifecycle on one platform.
- Continuous Shift-Left Intelligence: Validated findings become future controls, moving value from recovery to prevention.
- Specialized Expertise at Scale: Nurses, auditors, certified coders, reimbursement specialists, and analysts work alongside automation.
- Auditable Findings: Every finding carries documented rationale, audit trails, and quality controls.
HEALTHCARE DECISION INTELLIGENCE FOR Pre- & POST-PAY REVIEW
Multiple signals on every claim
One reconciled recommendation
Review runs on Lyric42, so findings reconcile against pre-pay edits, partner signals, and your configuration. Reviews shift left and repeat findings are automated over time.
Frequently Asked Questions
Review is a pre- and post-pay payment integrity solution. Intelligence surfaces the paid claims most likely to carry inaccuracy. Nurses, auditors, and certified coders validate what surfaces, and every finding carries its rationale. Review includes Coding Review, Coordination of Benefits, and Data Mining.
Advanced analytics, payment policy intelligence, and configurable review criteria identify the claims most likely to carry coding inaccuracies, modifier misuse, bundling issues, and other scenarios. Expertise goes where it creates the most value, without increasing review volume.
Nurses, auditors, certified coders, and data analysts apply proven review methodologies, coding standards, health plan requirements, and investigative workflows through governed processes. Every finding is supported by documented rationale, audit trails, and rigorous quality controls, creating transparency and defensibility throughout the review lifecycle.
Shift-left moves a validated post-pay finding into pre-pay editing, so the same error stops recurring. Value moves from recovery to prevention.
Review is part of Lyric's unified payment integrity platform. Lyric42 evaluates potential actions across edits, reviews, and partner solutions to determine the best outcome for each claim. As programs mature, successful post-pay findings can be converted into pre-pay prevention and reviews can become automated edits with minimal operational effort.
