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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 ClaimAction?

Harnessing the power of intelligent automation for managing substantial volumes of medical claims allows organizations to achieve significant efficiency that transcends simple cost savings. In contrast, those still relying on traditional manual methods find the processing of medical claims documents and data to be labor-intensive and susceptible to errors, which can create unnecessary risks within their workflows. With Artsyl's ClaimAction software for medical claims processing, organizations can improve profit margins, minimize manual interactions, and remove barriers in their processing chains. This innovative software facilitates the effortless capture of medical claims data without the need for complex custom coding, ensuring that claims data and documents are routed directly to the designated claim examiner in line with predetermined business rules. Furthermore, it allows for the establishment of detailed benefits and reimbursement protocols that help streamline processing times and reduce payment delays. This system also equips organizations to quickly adjust to changing government regulations, thus maintaining compliance throughout their data, documentation, and procedures. By embracing this cutting-edge solution, businesses can fundamentally revolutionize their claims processing practices, leading to enhanced operational effectiveness and a more agile response to market demands. The transition to such advanced technology not only positions organizations for current success but also sets a solid foundation for future growth and innovation.

Media

Media

Integrations Supported

Integrations Supported

ArtsylPay
InvoiceAction
OrderAction
docAlpha

API Availability

API Availability

Pricing Information

Pricing not provided

Pricing Information

Pricing not provided

Supported Platforms

SaaS

Supported Platforms

SaaS
Windows

Customer Service / Support

Standard Support
Web-Based Support

Customer Service / Support

Standard Support
Web-Based Support

Training Options

Documentation Hub

Training Options

Documentation Hub
Webinars
Online 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

Artsyl Technologies

Date Founded

2002

Company Location

Canada

Company Website

www.artsyltech.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

Medical Billing

Compliance Tracking
Customizable Dashboard
Dunning Management
Invoice History
Quotes/Estimates

Medical Coding

Not specified

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