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What is Virtual Examiner?

The Virtual Examiner®, developed by PCG Software, serves as a comprehensive tool for overseeing an organization’s internal claims process, efficiently tracking provider data to identify fraudulent or abusive billing practices while enhancing financial recovery. This advanced software enables healthcare organizations to optimize their claims adjudication systems, processing over 31 million edits per claim, which significantly streamlines operations. By meticulously monitoring the internal claims processes, it effectively pinpoints and mitigates payments made for incorrect or erroneous codes, ultimately preserving premium dollars. Beyond mere claims management, the Virtual Examiner® acts as a robust cost containment solution that analyzes claims for not only abusive billing patterns but also those that may require attention to third-party liability coordination, case management opportunities, physician billing education, and various other valuable cost recovery insights. Its multifaceted approach provides healthcare organizations with the tools they need to navigate complex billing landscapes and improve overall financial health.

What is Adjudicator?

Adjudicator functions as an innovative platform designed for the administration of plans and the evaluation of prescription claims, catering to a diverse range of entities, including pharmacy benefit managers, hospitals, health systems, managed care organizations, and retail pharmacies. This platform boasts customizable plan configurations and benefit structures, supports multi-tenant environments, and facilitates the oversight of pharmaceutical networks, drug formularies, and maximum allowable cost (MAC) pricing. Users gain access to a member portal that provides real-time information on benefit statuses and the ability to track pending claims, along with options for secure document uploads and timely alerts. Moreover, a prior authorization dashboard offers insights into claims data while fostering secure communication among various stakeholders. An integrated API framework allows for efficient data exchange with both internal systems and external partners, ensuring smooth interoperability. By equipping organizations with these robust tools, Adjudicator enables effective management of pharmacy benefits and prescription claims, significantly improving operational efficiency and the quality of service provided to members. Ultimately, the comprehensive features of Adjudicator allow stakeholders to remain agile in response to the dynamic landscape of healthcare and pharmacy management, ensuring they are well-prepared for future challenges.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

API Availability

Has API

Pricing Information

Pricing not provided

Pricing Information

Pricing not provided

Supported Platforms

SaaS

Supported Platforms

SaaS

Customer Service / Support

Standard Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support

Training Options

Documentation Hub

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

PCG Software

Date Founded

1984

Company Location

United States

Company Website

pcgsoftware.com/product-offerings/virtual-examiner/

Company Facts

Organization Name

Cervey

Date Founded

1978

Company Location

United States

Company Website

cervey.com

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Medical Billing

Claims Processing
Claims Scrubbing
Code & Charge Entry
Compliance Tracking
Customizable Dashboard
Dunning Management
Invoice History
Patient Eligibility Checks
Practice Management
Quotes/Estimates
Remittance Advice

Medical Coding

Not specified

Categories and Features

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