#1 Claims Auditing Software for Payer Organizations

Episode of Care Auditing examines the entire 3-year billing history surrounding a claim — not just today’s line item. VE connects every related visit, procedure, diagnosis, and provider interaction to uncover duplicates, split billing, unbundling, invalid modifiers, and 480+ other reasons a claim should not be paid as submitted. This is the foundational feature that makes VE the most advanced AI claims auditing software on the market and the reason payers see savings immediately.

Duplicate claims are one of the biggest drivers of avoidable overpayments. VE’s AI cross-matches every claim across multiple years, providers, and service dates to detect exact duplicates, near-duplicates, and rebilled claims hidden by modifier changes. VE’s duplicate review logic is updated quarterly with CMS, Medicaid, and AMA rules — ensuring your team flags errors before they’re paid and preventing retroactive recoveries.

VE identifies procedures that should be reduced due to bilateral rules, global periods, mutually exclusive procedures, or incorrect units — all automatically flagged overnight. Every recommendation includes the CMS, AMA, or Medicaid policy behind the reduction so your team can process edits with confidence. These real-time savings are a major reason VE users see 90-day ROI.

Our 72+ million edit library is the largest and most comprehensive in the industry — covering CMS, Medicaid, Medi-Medi, AMA, ASC, CCI, and our proprietary knowledge base. VE analyzes every claim through this engine nightly, ensuring your team receives the most accurate, policy-aligned results possible. This is why VE consistently outperforms other claims editing systems and why payers rely on VE for long-term compliance, cost containment, and audit accuracy.

VA is a next-generation code scrubber that analyzes authorizations and medical management decisions before the claim is paid. It identifies incorrect CPT/HCPCS pairings, medically unnecessary services, missing documentation, invalid modifiers, global period conflicts, and more. This ensures clean, policy-compliant decisions that prevent future denials, appeals, and retroactive overpayment audits.

VA gives Medical Management teams instant policy validation for authorizations. It identifies high-risk services, tests medical necessity, flags inappropriate combinations, and prevents costly misjudgments. This reduces provider abrasion, lowers avoidable medical spend, and keeps your utilization management team aligned with CMS, AMA, ASC, and Medicaid policy rules.

Claims teams use VA to perform mock adjudications on complex claims before payment. VA displays coding conflicts, coverage limitations, bundling rules, and expected reductions so your team can approve or deny correctly the first time. This drastically reduces rework, overturn rates, and downstream audits — strengthening both provider relationships and payment integrity.

You’ll sign a Mutual NDA and BAA, then securely send three years of claims data. We analyze the data for 3–5 weeks and return a full findings presentation including dollar savings, compliance exposure, duplicate trends, and ROI projections. This audit is completely free and requires no commitment.

Most organizations see ROI in under 90 days because VE immediately identifies duplicate payments, incorrect codes, global conflicts, and unbundled procedures. These savings occur before your team even finishes implementation. VE’s combination of automation and accuracy is the reason payers see measurable results faster than any other claims auditing software.

Installation is completed in 1–2 weeks on your secure intranet. We then conduct a 5-day onsite training with your Claims, SIU, and Medical Management teams. Week One you are fully operational, auditing live claims, and generating immediate savings. No lengthy onboarding, no outsourcing, no delays.