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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 ClaimsVISION?

The system features customizable workflow components that are intricately woven into its overall architecture. These components, which encompass data pre-filling, quick navigation options, adaptable fields, and tools for managing task loads, work in harmony with adjustors, teams, and supervisors to foster a user-friendly and highly productive experience. A key characteristic of any effective system is its capacity to enable the smooth transfer of precise data for both internal and external reporting and interfacing. To bolster this function, PCIS has heavily invested in a proprietary B2B interface layer that aims to standardize, stage, and verify the accuracy of data flowing in and out of the database. This strategic initiative not only provides more cost-effective and flexible integration alternatives but also enhances the precision of business intelligence reporting. In addition, the reporting platform is crafted with the user's perspective in focus, featuring over 100 ready-made reports, customizable dashboards through a simple drag-and-drop interface, a specialized reporting database, and additional functionalities, all aimed at simplifying data access and analysis. As a result, these capabilities collectively allow users to make timely and informed decisions with greater ease and efficiency. Ultimately, the combination of these advanced features ensures that users are well-equipped to leverage the system to its fullest potential.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

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

PCIS

Date Founded

2001

Company Location

United States

Company Website

www.pcisvision.com/solutions/claimsvision/

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

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

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