Virtuoso
Your Payment Integrity Command Center
Virtuoso is your Payment Integrity Command Center, unifying PI operations into one intelligent, automated, and scalable platform. Virtuoso maximizes operational efficiency, reduces provider abrasion, and delivers the enterprise insights that health plans need to enforce compliance, manage vendors, and capture sustainable savings.
Core Principles
Centralization
All payment integrity data, processes, and documentation live in a single hub, giving every stakeholder—from auditors to call center reps to finance leaders—real-time access to the truth.
Insights Management
Out-of-the-box dashboards, drill-down reporting, and ad hoc analytics transform data into actionable intelligence for affordability teams, provider relations, and executive leadership.
Automation
A robust engine of rules, workflows, and edits eliminates manual effort, accelerates vendor implementations, enforces consistency, and ensures accountability across all claims and appeals.
Platform Capabilities and Details
Virtuoso is a modular, flexible platform designed to support the full spectrum of payment integrity operations end to end. The sections below provide a detailed overview of the core modules included within the Command Center.
Rules, Workflow, and Edits Engine.
Virtuoso offers unparalleled precision control over the entire payment integrity operation because of its robust engine system designed specifically to maximize compliance, accuracy, quality, throughput, and savings. There are three types of engines: Rules, Workflow, and Edits.
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Rules Engine
The Rules Engine is the backbone for automating the flow of claims across the lifecycle of the PI process. Rules act as a “traffic cop” before a claim moves from one status to the next. If a claim fails a rule, an error message is sent to the stakeholder involved. Rules are customized and managed by the customer in real-time. Examples include Provider Exclusions, Concept Hierarchy, Vendor Lag, State Rules, and more.
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Workflow Engine
The Workflow Engine is tightly integrated with the Rules Engine and based on the rules; the workflow engine moves the claims to the next stage or status. For example, if a validation rule is turned on, the workflow engine will move the claim/claims file to validation for review. Workflow is highly customizable and managed by the customer.
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Edits Engine
The Edits Engine can turn on edits on the post-pay side and can be the first line of defense against overpayments. When an edit is configured and turned on, the moment a claims file is loaded, the edit will flag the claim and route it to the audit team for review.
Lyric is proud to be
Virtuoso adheres to HIPAA, HITRUST, SOC2, and ISO standards for handling sensitive healthcare data.
Next Steps
Connect with our team or download the Virtuoso fact sheet to learn more about our Payment Integrity Command Center.