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AI Claims Auditing

Helping Payers reduce costs, increase compliance, and improve operational efficiency for 30 years with AI-powered Claims Auditing solutions.

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The #1 AI Medical Coding and Claims Software

AI Automation for Healthcare

If you pay out claims and don't have Virtual Examiner®, you are losing money and time, period. For over 30 years, we've helped 164 payers, ranging from 1-200 lines of business, 15,000 to over 5 million lives per client, with partial to full risk, manage the endless new and current requirements that CMS, AMA, and Medicaid place on you. It's too much for one person to know, so we created the world's #1 AI medical coding and compliance database with all of the answers and suggested edits you need never pay out a incorrect claim again and improve your encounter data.

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Which AI Solution Do You Need?

Built on AI and 30 Years of Success

Naperville Healthcare Associates

Initial 56% percent savings on fee-for-service...

Physicians Integrated Medical Group

Immediate $30,000 check-run claims reduction...

Tuality Health Alliance

10% overpaid claims reduction in first month...

Case Studies

The PCG Healthcare Blog

cpt code 82310,82310 cpt
By Will Schmidt 11 Sep, 2024
CPT code 82310 description, modifiers, case uses, bundled codes, and images illustrating everything you need to know to process claims or submit claims within compliance.
cpt code 88365,cpt 88365,88365 cpt
By Will Schmidt 06 Sep, 2024
CPT Code 88365 descriptions, usages, modifiers, places of service, bundled codes and tips on how to adjudicate or submit cleaner claims. Backed by AMA licensing info.
cpt code 88323
By Will Schmidt 27 Aug, 2024
CPT code 88323 descriptions, case usages, financials, bundled codes, CCI edit considerations, and more. Learn about the code as well as how AI coding scrubbers can help with efficiency, accuracy, and compliance.
ai prior authorization,ai health prior authorization
By Will Schmidt 12 Aug, 2024
Guidance on the usage of AI for healthcare prior authorizations for payers and providers in 2024-2025 and beyond. We will continually update and improve this blog as new developments occur.
cpt code 51703,51703 cpt
By Will Schmidt 16 Jul, 2024
CPT Code 51703 definition, usage, modifiers, financial details, and more. Click to learn about the complicated insertion of bladder tube.
cpt code 01996,what is 01996 cpt
By Will Schmidt 11 Jul, 2024
01996 cpt code is Daily hospital management of continuous spinal drug administration. Learn about it's history, definitions, cms statuses and more.
medical coding changes 2024,medical coding changes right now
By Will Schmidt 01 Jul, 2024
Latest medicla coding changes, latest medical coding claims information, a look at our quarterly newsletter to our clients, all information obtained from; CMS, AMA, and the WHO.
cpt code 99214,cpt 99214
By Andria Jacobs 30 Apr, 2024
CPT code 99214 defined, explained per CMS and AMA guidelines, with pictures and helpful tips on how to avoid denials.
change healthcare,change healthcare ransom attack,change healthcare cyber attack
By Will Schmidt 04 Mar, 2024
The history and latest updates on the cyber attack of ChangeHealthcare owned by United Healthcare Group.
pre-payment claims audit,post-payment claims audit
By Will Schmidt 12 Feb, 2024
Explore how AI can help your health plan reduce costs and increase compliance with AI claims auditing.
cano health,cano health bankruptcy
By Will Schmidt 06 Feb, 2024
Cano Health files for bankruptcy. Who are they? Why did it happen? What's the fallout?
AI and EI,EI and AI,AI with EI,AI vs EI
25 Jan, 2024
AI and EI discussion. Can it happen? Yes, find out how. Should it happen? Here what we, an AI company, say about it.
cpt 20220,cpt code 20220,20220 cpt code,20220 cpt,cpt 20220 definition,cpt 20220 explained
By Will Schmidt 12 Jan, 2024
CPT 20220 definitions, case uses, bundles, financials, and how to get clean claims through the use of AI.
uhg fraud,unitedhealth group fraud,united healthcare fraud
By Andria Jacobs 13 Dec, 2023
Violation tracker of UnitedHealth Group's continued fraudulent activities and fines.
mental health fraud
By Andria Jacobs 12 Dec, 2023
Explore how a 2014 article on mental health fraud still has the same issues in today's healthcare. Read it and be amazed that 9 years later the same problems exist. Examine history or you're doomed to repeat it.
ai in healthcare,ai history in healthcare,ai claims compliance
By Michael Lubao 12 Dec, 2023
AI has been in healthcare since 1995. Learn how it has grown and how PCG software's predictions were spot on. Also includes statistics on denials, fraud, and compliance.
ai healthcare law,ai executive order
By Will Schmidt 30 Oct, 2023
Summary of Biden's new AI Executive Order for healthcare and how it will impact your plan.
modifier 79,modifier 79 description,modifier 79 definition
By Will Schmidt 12 Oct, 2023
Learn the basics, definitions, and rules regarding Modifier 79.
cms r 131
By Will Schmidt 11 Oct, 2023
Description of the CMS R 131 form with FREE download of the form.
modifier 78,modifier 78 description,modifer 78 definition
By Will Schmidt 09 Oct, 2023
How and when to use modifier 78 to ensure optimal approval rates and compliance.
49000 cpt code,cpt code 49000
By Will Schmidt 04 Oct, 2023
CPT Code 49000 description, usages, modifers, bundled codes, and guidance.
57410 cpt code,cpt code 57410,57410 cpt definition
By Will Schmidt 26 Sep, 2023
57410 cpt code definitions, pictures explaining the code, and usages.
cpt code 00952
By Will Schmidt 23 Aug, 2023
Full description and case usage examples of cpt code 00952.
IPA audit,claims auditing,free claims audit
By Will Schmidt 23 Aug, 2023
Brief overview of the benefits of having a full 3-year claims audit can do for your independent physician association (IPA).
ai in healthcare billing
By Will Schmidt 22 Aug, 2023
10 reasons why AI in healthcare billing will only grow; benefits, examples, and the #1 ai in healthcare billing option for clinics, dentists, and FQHCs.
inflation reduction act,part D spending reduction
By Will Schmidt 22 Aug, 2023
Short summary on the latest Biden strategy to reduce Part D spending with an out-of-pocket enrollment option for medicare advantage part D plans.
cpt code 99386,cpt 99386
By Will Schmidt 21 Aug, 2023
Comprehensive Guide to CPT Code 99386: Meaning, Usage, definitions, examples, visuals, and AI-Driven Advantages.
cpt code 99213,code 99213,99213 cpt code,99213 code
By Will Schmidt 17 Aug, 2023
CPT Code 99213, everything you need to know; usage, modifiers, places of service, bundled codes, who uses it and how to use it. AI medical coding options that can help with code look-ups as well.
What is an IPA healthcare?
By Will Schmidt 02 Aug, 2023
What is an IPA healthcare? IPA definition, examples, guides, and information for providers to choose the right IPA as well as IPAs to implement new changes to be more attractive to new providers.
cpt code 11104
By Will Schmidt 06 Jul, 2023
Become a pro with 11104 cpt code, learn the impact of cpt code 11104 and get examples. Learn how AI can help you with cpt 11104.
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