#1 AI Medical Claims Auditing Software for Health Plans, MSOs, and IPAs

Imagine saving millions every year with cleaner claims, more productive employees, and less turnover by eliminating complex software applications. Virtual Examiner® is an AI Software that reviews every claim, every line item, taking a deep dive into the patient's billing history and episode of care. After Virtual Reporter® runs the night before, your team comes into work the next morning and they have reports on the specific claims that need their attention, why it should be reviewed and/or denied, leading to operational excellence and cost containment.

Cost Containment

Operational Efficiency

Compliance

The AI Claims Editor

AI Claims Editor with Reason Codes Serves as Instructor to Employees

Virtual Examiner® will not only tell you why a claim should be denied, the CMS definitions and coding suggestions,  as well as a layman’s term of what the information provided means. It’s not just a Claims Editor or Claims Auditor, it’s a guiding tool to optimizing your Claims Department process and helpful in onboarding new employees.

Guaranteed ROI and Data on Future Cost Containment

In less than 10 days, PCG’s Claims Expert and Virtual Examiner® will conduct a full 3-year claims analysis identifying codes and processes that produced overpayments and claims that should have never been paid in the first place. Your Audit will show you how to reduce risk, what to recover first, and what to immediately address with your teams. Lastly, we go over how we make our Claims Editor, Auditor, Authorizations Tool, and Support, provide you an ROI in 90 days or less from a signed contract.

Modules and Benefits of Virtual Examiner®

Increased Efficiency of Claims Department

Our AI Engine, Virtual Examiner® has a reporting module called Virtual Reporter®. Every night Virtual Reporter® will run all of your unpaid claims against the latest CMS, AMA, and State Medicaid guidelines and your pre-set exclusions. When your team comes into work the next day, they have reports of only the claims that have one of 400 possible reason codes for denial. Your team can then review those claims and find the reasons for each suggested denial or pending, and not only make that decision but also learn from the reason codes for faster future reviews and decision making.

The Clear Claim Connection

The Perfect Claims Audit Tool

With your new Virtual AuthTech® module, your Medical Management and Authorizations teams will be equipped to review complex authorizations and run mock adjudications to avoid erroneously approving claims that are not medically necessary, fall under a CCI edit, or hundreds of other reasons to which Virtual AuthTech® within it’s Machine Learning AI Knowledge base will advise you on next steps.

Claims Automation AI

PCG and your IT Department will work hand in hand to identify the possibility of auto-adjudication with Virtual Examiner® and your current in-house or commercial recognized claims software already in place. Integrations can lead to auto-posting capabilities, expedited speed in AI claims tasks, AI generated tracking of retro-rate reconciliation, AI generated eligibility review, AI generated co-pay / co-insurance correction, and can be installed in a single day.

SymKey is a registered trademark owned by HealthCare Information Management, Inc (HCIM) and integrates with Virtual Examiner® To get a listing of integrated systems book a FREE consult with PCG.

Knowledge is Power

What does your data tell you?

Virtual Examiner is your Data Analyst, Compliance Officer, and CMS and AMA Expert,  all rolled into one.

• Top 40 unbundling by group
• Top 40 unbundling by provider
• Double Billing
• Improper and Fraudulent usage of Modifiers
• Improper or Abusive Medication Prescribing
• Place of Service errors
• Billing submission frequency, aka "Spiking"
• E&M graph provider and group error trends.
• Every code, every scenario, its there for you!

And about a million other things we'll get into during our FREE Consult

Virtual Examiner Client Support Programs

Virtual Examiner® Implementation

At PCG, we believe in Clients first. That’s why we fly out to your headquarters, train your claims and medical management teams, your provider relations, and your fraud, waste, and abuse teams. While we’re training you and your team, we’re also training on live claims that require editing and denials pre-check runs and paid claims that require review and recovery.  PCG and Virtual Examiner save you money from Day 1.

Virtual Examiner® Support Team

Once we get your team live, you have the full support from our IT Team, our Certified Professional Coders, Nurses on Staff, and even our Executives. We are a hands on, results and support driven company.

PCG Newsletter

All Virtual Examiner® (VE) and VEWS clients of PCG get our quarterly Newsletter and regular updates on the latest Code Edits, Lawsuits, and Tactics for higher profitability. The PCG Newsletter is also located within Virtual AuthTech® and can be downloaded at any time.

Provider Relations: Operation Clean Claims

PCG Software’s Virtual AuthTech® has a twin sister that we call iVECoder ® that can be used by clinics to submit cleaner claims. Our CSO would happily walk your provider relations through your provider letters, outreach and possibly iVECoder adaption.