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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 PBM Express?

At the core of PBM Express is the adjudication program, which meticulously edits claims to guarantee accurate processing results, regardless of the intricacy of the plan design. The parameter drive program offers a highly flexible framework that allows for tailored customization based on client needs. Laker's innovative software solution provides clients with outstanding performance and industry-leading uptime. As a leader in technology, Laker continually enhances its systems to meet the changing needs of its clients. Clients of Laker enjoy access to the quickest, most adaptable, and most robust system available on the market. In addition, Laker works hand-in-hand with its clients to develop, test, and launch new products, helping them improve their competitive positioning and capture new business opportunities. As client claim volumes rise, Laker adapts alongside them, highlighting the shared advantage of promptly implementing effective software adjustments to facilitate this expansion. This dedication to collaboration and innovation ensures that Laker remains an instrumental ally in driving its customers' achievements, fostering a partnership that thrives on mutual success and growth over time.

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

Web-Based Support

Training Options

Documentation Hub

Training Options

Documentation Hub
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

Laker Software

Date Founded

2000

Company Location

United States

Company Website

www.lakersoftware.com/services

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

Claims Processing

Not specified

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