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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 Healthicity?

Healthicity delivers an integrated compliance and auditing platform designed to simplify regulatory responsibilities across healthcare organizations of all sizes. Its approach combines workflow automation, document management, education delivery, incident tracking, and real-time reporting into a centralized, cloud-based system. Compliance Manager allows administrators to train staff, store policies, conduct risk assessments, investigate incidents, and track attestations in one secure location. The auditing solution streamlines audit creation, document review, corrective action planning, and performance monitoring, eliminating the need for manual spreadsheets or disconnected tools. Users appreciate the software’s clean interface, customizable setup, and ability to support multi-location operations with consistent oversight. The platform improves transparency by making audits, investigations, and compliance activities traceable and reportable at any time. Healthicity’s customer support team is highly regarded for its responsiveness and expertise, ensuring organizations get the guidance they need. Testimonials highlight significant time savings, stronger reporting capabilities, and smoother collaboration across departments. By consolidating formerly scattered workflows, Healthicity helps healthcare teams operate with greater clarity and preparedness. Ultimately, the platform empowers organizations to maintain compliance, manage risk, and deliver high-quality patient care with confidence.

Media

Media

Integrations Supported

Compliance Manager by Healthicity
Healthicity Audit Manager

Integrations Supported

Compliance Manager by Healthicity
Healthicity Audit Manager

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

Healthicity

Date Founded

2015

Company Location

United States

Company Website

www.healthicity.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

Categories and Features

Audit

Alerts / Notifications
Audit Planning
Compliance Management
Dashboard
Exceptions Management
Forms Management
Issue Management
Mobile Access
Multi-Year Planning
Risk Assessment
Workflow Management

HIPAA Compliance

Access Control / Permissions
Audit Management
Compliance Reporting
Data Security
Documentation Management
For Healthcare
Incident Management
Policy Training
Remediation Management
Risk Management
Vendor Management

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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