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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 Clarus RCM?

Transform your revenue cycle with Clarus RCM, a frontrunner in risk adjustment coding solutions that encompass both retrospective and prospective HCC coding, commercial risk adjustment coding, HEDIS abstraction, RADV audits, chart reviews, data validation, and comprehensive revenue cycle management services. Our certified coders guarantee an accuracy rate exceeding 95%, coupled with swift turnaround times. Utilizing a state-of-the-art technology suite, Clarus RCM Inc provides meticulous revenue cycle management (RCM) services. By integrating RCM with healthcare consulting, we enable hospitals and physicians to optimize their existing revenue streams, uncover new payment opportunities, and improve RCM efficiencies. In addition to holding an ISO/IEC 27001:2013 certification, we strictly comply with HIPAA regulations and ISMS standards. Our operations have been rigorously evaluated by UL-DQS, an American accreditation organization, affirming our commitment to delivering exceptional healthcare services with a focus on quality and security. This unwavering commitment to excellence not only supports our clients’ needs but also contributes positively to the broader healthcare ecosystem, fostering improvements across the industry.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

API Availability

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
Web-Based Support

Training Options

Documentation Hub

Training Options

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

Clarus

Date Founded

2014

Company Location

United States

Company Website

www.clarusrcm.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
Practice Management
Quotes/Estimates

Medical Coding

Not specified

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