How to Insource Payment Integrity Audits – Part 2: Finding the Right New Audits

LeadershipAIPayment Integrity
Written By Lyric Admin
Lyric logo on a digital circuit board background with the text ‘How to Insource Payment Integrity Audits — Part 2: Identifying Essential New Audits.’ A glowing lock icon within a digital interface represents security and integrity

In Part 1 of our series, [Maximizing What You Have], we talked about making the most of your existing audits. If you haven’t checked it out yet, we recommend starting there—it’s the foundation for everything else.

Now, let’s move on to the next step: figuring out which new audits you should bring in and how to prioritize them. With the healthcare world changing so quickly, the key to staying ahead is building an audit strategy that adapts to new challenges and opportunities.

Spotting the Right Audits

When adding new audits, the focus should always be on the highest return on investment (ROI) and what matters most to your organization. Some key areas to consider include:

  • Pre-Payment Fraud Detection

  • Coordination of Benefits

  • Clinical Validation Audits

  • Contract Compliance Audits

These areas can quickly drive value while strengthening your overall audit strategy.


The BOT Model: A Smarter Way to Scale

A practical way to bring in new audits is the BOT (Build, Operate, Transfer) model. It gives you the benefit of outside expertise while still setting you up for long-term success.

  • Build: Start with a strong payment integrity platform—something that supports multiple audit types, has a centralized document repository, AI-powered analytics, automated workflows, and robust reporting.

  • Operate: In the beginning, you can outsource operations or use augmented staff. This helps you launch audits quickly, tap into expert knowledge, and test ROI before fully committing.

  • Transfer: Once you’ve validated success, you can start moving operations in-house. That means training your team, building internal expertise, and creating repeatable best practices

Setting Priorities

When it comes to sequencing your audits, a few guidelines help:

  • Start with pre-payment audits—they prevent costly post-payment recoveries later.

  • Prioritize audits that address your organization’s biggest pain points first.

  • Keep regulatory and compliance needs front and center.

  • Evaluate how each audit type might affect provider relationships.

Using Technology to Your Advantage

The right tech can make all the difference. Think:

  • RPA (robotic process automation) to handle repetitive tasks

  • AI and machine learning for predictive analytics and anomaly detection

  • Strong data analytics for ongoing risk assessment and smarter planning

By blending technology with a strategic rollout, health plans can boost efficiency, reduce errors, and drive better financial results

What to Look for in a Platform

For insourcing to work long-term, you’ll need a platform that can do it all:

  • Centralized data management

  • AI and machine learning analytics

  • Automated workflows

  • Customizable rules and edits

  • Strong reporting and insights

  • Easy integration with your existing systems

A platform like this keeps everything streamlined, cuts costs, and makes audits more effective across the board. And it already exists. Introducing Replay

Ready to Take the Next Step?

By combining the right audits, a smart rollout strategy, and the right technology, health plans can take control of their audit programs—and see serious savings.

Curious how Lyric can help with your payment integrity challenges?

Contact Us


About Lyric

Lyric, formerly ClaimsXten, is a leading AI healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated, expert teams, and top technologies help deliver up to $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric is investing in AI driven technology to ease implementation and speed to value for customer savings, while offering enhanced and newly available solutions through internal product development and strategic partnerships, including recently announced partnerships with Concert Genetics, Autonomize AI, and now, Codoxo. Discover more at Lyric.ai. 

Lyric Admin

We’re proud to be a leading AI healthcare technology company. With more than 30 years of payment accuracy expertise as ClaimsXten, our solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers to increase payment accuracy and integrity.

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How to Insource Payment Integrity Audits – Part 1: Maximizing What You Have