AI Medical Coding Integration for EMRs, EHRs, and Clearinghouses

Virtual Examiner Web Services (VEWS)

Imagine your EMR or EHR system having real-time coding accuracy on every medical code in America. Now imagine how much your clients would love to have less denials because AI was in the background helping them understand how to properly submit a claim and avoid a denial.

• VE uses multi-pass AI to review each episode of care
• 100% Audit of all claims (no more sampling or reporting)
• 55 million edits, 2.5 million Medi-Cal specific edits
• Maintain CMS, Health plan and Medi-Cal compliance
• Edits backed by PCG Policy and Procedures Manual
• Targeted Workflow with VR Audit Queues
• All edits customizable
• VE trains and teaches
• Provider profiling
• Provider–Payor transparency with iVECoder
• Stay informed of coding rules with PCG’s newsletter
  

Real-time Code Editing

VEWS™ adds real-time code review capabilities to your software platform. With 65 million core, non-frivolous CMS, AMA and/or Medicaid edits, VEWS automatically examines each line item and reports back to your software errors, omissions, suspicious and dubious coding. 

VEWS gives your software immediate, real-time feedback related to line item claim/bill issues on unbundling, mutually exclusive, incidental procedures, multi-dimensional duplicate checks, modifier applicability, multiple/bilateral procedure reductions- and this is just a general summary; VEWS has over 480 edit determination categories. 

VEWS is a powerful enhancement tool for software vendor applications targeting at-risk claims payment or facility/professional billings or bill submission. The VEWS advanced analytics engine is the power behind PCG’s software suite Virtual Examiner®, VirtualAuthTech® and iVECoder®.  In the last 25 years, over 107 payor organizations have employed PCG’s claim auditing tools.  “Know what the payors know…”

While VEWS compliments your system with ready to go, out-of the-box edits, VEWS DOFR module allows total control, customization and creation of edits. Development of proprietary business rules unique to the organization can be implemented in a few mouse clicks. Your logic and any user defined determinations or rules can be instantly tested, audited and put into production.   

VEWs knowledgebase set is updated daily via SFTP with major updates occurring quarterly. PCG’s CPC, clinical and government relations staff review industry (CMS, AMA, Medicaid etc) regulations, rules and policies governing claim coding on a daily basis.  Within 24 hours- and sometimes the same day- the VEWS knowledgebase is updated and changes deployed to all customers.