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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.

About Us

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?

Virtual Examiner® Suite

VE® is the world's #1 claims auditing, compliance, and cost containment software suite that over 164 payers use every day.

Payer AI Claims
Virtual Reporter®

Powered by VE, Virtual Reporter is nightly audit of all the day's claims that require your attention. Learn more about VR now.

Targeted Payer Audit
Virtual AuthTech®

Real-time AMA licensed AI Medical Coding tool used by 1,000s of Claims Examiners, Medical Management, and Providers Relations every day.

Payer AI Scrubber
iVECoder®

Helping clinics under the care and supervision of our payer clients decrease denials make their lives and the payer's lives easier.

Provider AI Scrubber
EMR AI Integrations

Imagine offering the #1 real-time code scrubber in the world with your existing EMR/EHR solution. It's possible. Learn more!

EMR AI Scrubber
AI for Billing Companies

The more you bill for your clients, the cleaner the claims you bill, the longer they stay and pay you. Our softwares help!

Grow your RCM

Our Valued Partners

Become a Partner

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 90837 - 60 Min Pyschotherapy

By Will Schmidt • 04 Nov, 2024

CPT Code 90837 description, examples, modifiers, places of services, and helpful tips for cleaner claims for both payers and providers.

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Health Plan Hiring Trends and Guide for 2025

By Will Schmidt • 01 Nov, 2024

Quick and easy to read guide on how to hire, fire, and retain your health plan employees.

CAHP Conference Review (2024)

By Will Schmidt • 24 Oct, 2024

We review the 2024 CAHP Conference, what it is, how it went, and if it's right for your plan to attend the next year.

CPT Code 82310 - Calcium levels in Blood

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

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.

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2024-2025 AI Prior Authorizations Outlook

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

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

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.

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Latest Medical Coding Changes (Q3 2024)

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

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.

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Ransomware, UnitedHealth Group, and Change Healthcare

By Will Schmidt • 04 Mar, 2024

The history and latest updates on the cyber attack of ChangeHealthcare owned by United Healthcare Group.

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Post and Pre-Payment Claims Auditing with AI Solutions

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 Bankruptcy: A Tale of Financial Incompetency

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: Is it a reality? Should it be a reality?

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.

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CPT Code 20220 -Under General Excision Procedures on the Musculoskeletal System

By Will Schmidt • 12 Jan, 2024

CPT 20220 definitions, case uses, bundles, financials, and how to get clean claims through the use of AI.

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UnitedHealth Group Fraud Continues

By Andria Jacobs • 13 Dec, 2023

Violation tracker of UnitedHealth Group's continued fraudulent activities and fines.

Mental Health Fraud Impacts Most Vulnerable Citizens

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.

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AI in Healthcare; 1995 to Present; Preventing Fraud

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.

White House Signs AI Bill

By Will Schmidt • 30 Oct, 2023

Summary of Biden's new AI Executive Order for healthcare and how it will impact your plan.

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79 Modifier Definition, Description, and Usage

By Will Schmidt • 12 Oct, 2023

Learn the basics, definitions, and rules regarding Modifier 79.

ABN CMS-R-131 Form

By Will Schmidt • 11 Oct, 2023

Description of the CMS R 131 form with FREE download of the form.

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Modifier 78: Definitions, Usage, and Pictures

By Will Schmidt • 09 Oct, 2023

How and when to use modifier 78 to ensure optimal approval rates and compliance.

CPT Code 49000 Definitions, Usages, and Guide

By Will Schmidt • 04 Oct, 2023

CPT Code 49000 description, usages, modifers, bundled codes, and guidance.

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CPT Code 57410 and how its used correctly

By Will Schmidt • 26 Sep, 2023

57410 cpt code definitions, pictures explaining the code, and usages.

Full Guide to CPT Code 00952: descriptions, examples, and AI help

By Will Schmidt • 23 Aug, 2023

Full description and case usage examples of cpt code 00952.

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Unlocking Hidden Savings: The Power of a Comprehensive Claims Audit for IPAs

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).

10 Compelling Reasons to Embrace AI Medical Coding Software for Higher Approval Rates, Cleaner Claims, and Faster Collections

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.