Emergency Department (ED) Program
Precision, performance, and proven expertise, Lyric’s Emergency Department Program delivers the next generation of pre-payment accuracy for emergency department coding.
Built on over 30+ years experience in payment integrity, we help health plans improve consistency, support fair outcomes, and strengthen provider relationship through transparency and explainable logic.
Emergency department claims remain one of the most complex and costly areas in healthcare payment. Volumes are rising, clinical profiles are changing, and coding variability continues to impact reimbursement accuracy. Health plans need a scalable, intelligent solution that drives accuracy while supporting fairness and collaboration.
Lyric’s ED Program was purpose-built for this challenge—combining automation, analytics, and human expertise to evaluate E/M levels holistically. The result: consistent, explainable, clinically aligned recommendations, backed by decades of payment accuracy experience.
The evolving challenge of ED claims
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Automated pre-pay recommendations, governed by you.
Lyric recommends edits, and your experts approve what gets deployed, aligned to your configured strategy.
How our ED Program works
Explainable pre-payment recommendations for E/M levels using plan-configurable rules and multi-step assessment framework.
Transparent logic and rationale for every recommendation, building confidence with providers and partners.
Ongoing rule optimization and performance tuning guided by Lyric’s expert clinical and data science teams
Comprehensive review of diagnosis type, diagnostic and treatment service thresholds, and comorbidities for complexity assessment.
Comparative analytics and peer benchmarking to reveal insights and promote consistent coding behavior
Fast, scalable implementation with minimal IT lift and seamless alignment to existing payment workflows
Why leading health plans trust Lyric
Accuracy at scale
Drive consistent, explainable ED facility E/M recommendations across high-volume claims.
Collaboration built-in
Our teams support transparency and alignment between health plans and providers.
Confidence in every decision
Powered by data-driven logic and
backed by decades of payment
integrity expertise.
Our legacy of leadership in payment accuracy
Lyric has spent decades advancing the science and technology behind payment integrity. From pioneering
pre-payment accuracy to developing industry-leading edit and rule engines, we’ve helped shape the standards of modern payment integrity programs. The Emergency Department Program represents the next evolution—purpose-built for today’s challenges and tomorrow’s innovations.
Continuous leadership in payment accuracy across multiple lines of business.
Decades of innovation
Proven results and partnerships with 9 of 10 top payers in the U.S.
Trusted by the top plans
Analytics and insights refined through millions of claims evaluated each year.
Data that drives impact
Built on trust and compliance
Lyric’s Emergency Department Program is SOC2 Type 2 certified and HITRUST r2 compliant to protect the confidentiality, integrity, and availability of client data.
Implementation made simple
From setup to optimization, our team partners closely with your organization to configure, deploy, and fine-tune the ED Program to your strategy. Built for speed, scale, and sustainability, it integrates seamlessly into your workflow to deliver measurable outcomes from day one.
Experience the next generation of payment accuracy
Join the nation’s leading health plans who trust Lyric to transform their payment integrity operations. Our Emergency Department Program combines technology, expertise, and innovation to help deliver consistent outcomes.