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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 EncoderPro.com?

EncoderPro Spotlight, created by OptumCoding, serves as an indispensable online medical coding reference tool designed to support those working in ambulatory coding, billing, and reimbursement by ensuring they have timely and accurate access to a variety of coding systems, including CPT, HCPCS Level II, ICD-10-CM/PCS, and ICD-9-CM, along with essential regulatory insights; this innovative software is equipped with powerful search and reference capabilities that compile a wide array of procedure, service, supply, and diagnosis codes, complemented by detailed descriptions and cross-coding information, enabling users to quickly locate the correct codes and reduce the likelihood of submission errors. Beyond basic code listings, the platform also supplies specialized content and tools that deepen users' comprehension of compliance matters, covering areas such as National Correct Coding Initiative (NCCI) edits, Hierarchical Condition Categories (HCCs), and guidelines on coverage determinations, while also incorporating automated review functions for proper unbundling and modifier usage, along with a thorough historical content database essential for adjudication. As a result, EncoderPro Spotlight not only aids coding professionals in their quest for precision and efficiency but also empowers them to navigate the intricate world of medical coding with greater confidence. Ultimately, the tool stands out as a vital asset for anyone striving to excel in the ever-evolving field of medical coding and billing.

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

Optum

Company Location

United States

Company Website

www.optumcoding.com/online-coding/encoderpro-spotlight/

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

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