AI Claims Auditing
Helping Payers reduce costs, increase compliance, and improve operational efficiency for 30 years with AI-powered Claims Auditing solutions.
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.
Which AI Solution Do You Need?
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Virtual Examiner® Suite
Payer AI ClaimsVE® is the world's #1 claims auditing, compliance, and cost containment software suite that over 164 payers use every day.
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Virtual Reporter®
Targeted Payer AuditPowered by VE, Virtual Reporter is nightly audit of all the day's claims that require your attention. Learn more about VR now.
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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...
The PCG Healthcare Blog
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 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 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.
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 definition, usage, modifiers, financial details, and more. Click to learn about the complicated insertion of bladder tube.
01996 cpt code is Daily hospital management of continuous spinal drug administration. Learn about it's history, definitions, cms statuses and more.
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 defined, explained per CMS and AMA guidelines, with pictures and helpful tips on how to avoid denials.
The history and latest updates on the cyber attack of ChangeHealthcare owned by United Healthcare Group.
Explore how AI can help your health plan reduce costs and increase compliance with AI claims auditing.
Cano Health files for bankruptcy. Who are they? Why did it happen? What's the fallout?
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 definitions, case uses, bundles, financials, and how to get clean claims through the use of AI.
Violation tracker of UnitedHealth Group's continued fraudulent activities and fines.
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 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.
Summary of Biden's new AI Executive Order for healthcare and how it will impact your plan.
Learn the basics, definitions, and rules regarding Modifier 79.
Description of the CMS R 131 form with FREE download of the form.
How and when to use modifier 78 to ensure optimal approval rates and compliance.
CPT Code 49000 description, usages, modifers, bundled codes, and guidance.
57410 cpt code definitions, pictures explaining the code, and usages.
Full description and case usage examples of cpt code 00952.
Brief overview of the benefits of having a full 3-year claims audit can do for your independent physician association (IPA).
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.
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.
Comprehensive Guide to CPT Code 99386: Meaning, Usage, definitions, examples, visuals, and AI-Driven Advantages.
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? 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.
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.