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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 Shift Subrogation?

Shift Subrogation is an innovative software-as-a-service (SaaS) platform powered by artificial intelligence that independently identifies, assesses, and highlights potential subrogation recovery opportunities for insurance companies, particularly within the Property & Casualty (P&C) industry. By merging structured data such as policy details and claims with unstructured text, including loss descriptions and comments from adjusters, the system utilizes generative AI along with a range of analytical models to determine liability, apply relevant state laws and negligence principles, and examine exposures while factoring in statute limitations and jurisdictional regulations, as well as referencing external sources like product recalls. It generates alerts that come with scores and detailed explanations for each recovery opportunity, enabling claims handlers to grasp not only which cases are worth pursuing but also the rationale behind each suggestion. The platform also features continuous monitoring of claims, adapting alerts as new information emerges or as assessments of recoverability evolve over time. This ongoing vigilance helps insurance firms stay informed and take proactive steps in their recovery strategies, ultimately enhancing their operational efficiency in managing subrogation claims. Consequently, the integration of advanced technology ensures that these companies are equipped with the insights needed to maximize their recovery potential effectively.

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

Shift Technology

Date Founded

2013

Company Location

France

Company Website

www.shift-technology.com/products/subrogation

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

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