✅ Health Plans, MSOs, PACE
✅ Cost Containment
✅ Fraud, Waste, Abuse
✅ 72+ million edits
✅ 99% see ROI in 90 days
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#1 AI Medical Coding Software for Payer Organizations
Reducing Healthcare Costs and Targeting FWA
If you pay out claims without Virtual Examiner®, you are losing money and risking CMS audits and possible de-delegation. For over 30 years, we've helped 170+ payer organizations, ranging from those with 1 to 200 lines of business and 10,000 to over 5 million lives, manage the numerous new and existing requirements imposed by CMS, AMA, and Medicaid, with partial to full risk. It's too much for one person to know, so we created the world's #1 AI medical coding and compliance database with all the answers and suggested edits you need. Never pay out an incorrect claim again and improve your encounter data.
72M
72 million edits spanning from 1996 to present day with quarterly updates to our AI coding auditing engine.
ROI
99% of our clients have seen an ROI from VE or VE+VEWS within 90 days of implementation and training.
FREE
PCG offers free 3-year claims audits for payer organizations, and FREE iVECoder trials for payers and providers.
95%
We've had 95% client retention for the past 13 years and we're not slowing down. Are we your next success story?
Payer Claims Auditing Solutions
Control your costs, increase compliance, and empower your claims and compliance teams
Payers, MSOs, PACE, and TPAs
The world's only full episode of care claims auditing solution for payer organizations. Enable your team to walk into work and identify every problematic claim line item, including what's wrong with it and suggestions on how and why to deny or reduce the claim, in line with CCI and Medicaid guidelines.
Payer Automations & Integrations
Once you're live with VE, VEWS can help with integrated automating within your authorizations and claims software applications, making real-time approvals, denials, and addressing problematic provider requests a breeze. Learn more about VEWS by clicking the button below.
High Desert Medical
Virtual Examiner and Virtual AuthTech have been game changers, enabling us to save taxpayer dollars while remaining compliant with an ever-changing payer requirements landscape. Highly recommend!
Medpoint Management
The integration of Virtual Examiner, Virtual AuthTech, and real-time claims auditing within VEWS has empowered us to customize our business lines, auditing processes, and compliance measures in ways we once only imagined.
InnovAge
As a PACE program, cost containment and compliance is so important. Every dollar paid is a taxpayer dollar. We take every claim seriously, but VE and VA allow us to ensure that our providers are paid every cent as well.
Provider Claims Auditing Solutions
Decrease denials and increase compliance with our AI medical coding scrubber
Clinics and Providers
If your medical group or clinic is consistently getting denials, our team will help you utilize iVECoder to find out why, to correct your improper billing techniques using our software, and then how to use iVECoder to negotiate better reimbursement rates on your most commonly billed codes. What are you waiting for?
RCM & Billing Companies
Billing software companies and clearinghouses in need of a code scrubber before payer claims submission, look no further. VEWS has 72 million plus edits and when integrated properly it can reduce denials, and help educate billing personnel with payer-level knowledge reasoning. It's the entire coding package in one!
Mirra Health
The usage of iVECoder has enabled us to properly audit providers' billing patterns, enabling faster payment and compliance that we could never have accomplished without it.
Kona Consulting
As a compliance, RCM, and provider based MSO focusing on pre-claim submission, I've never seen a claims scrubber like iVECoder, and their VE claim auditing for payers, is on a different level.
Claims Auditing for Consultants & Software
Help your provider and payer clients reduce costs and increase compliance
Healthcare Consultants
Our AI claims and coding software solutions can save your payer organization clients millions in cost containment and help them avoid FWA audits that could crumble their business. Additionally, we offer your clients free claims audits and strategies, all in an effort to help reduce costs and risk.
Clearninghouses & Billing Software
Billing software companies and clearinghouses in need of a code scrubber before payer claims submission, look no further. VEWS has 72 million plus edits and when integrated properly it can reduce denials, and help educate billing personnel with payer-level knowledge reasoning. It's the entire coding package in one!
Pinnacle Brokers
I've partnered with PCG for over 12 years, and they've saved my payer clients millions in claims auditing and countless taxpayer dollars with their FWA strategies.
QuickCap
Virtual Examiner has helped our MSOs and PACE programs seamlessly take control of their compliance in remarkable parallel to our software systems.
Key Software
PCG's AI claims auditing system has enabled our prospective clients to save millions, thus allocating additional funding for our AI agents and solutions. Great partnership!
The PCG Library of Guides and Updates
Research CPT Codes
Using our Code Scrubber, we've written world-class explanations on CPT code usage, rules, and scenarios. Search now
FWA Updates
We chronicle every week about FWA findings, investigations, provide guides on how to prepare and more
AI Innovation Updates
We report to you on the latest developments on AI and automation for faster decision making and profitability.
Operational Guides
Easy-to-follow busines development, marketing, planning, strategy, and financial guides for growth.
Healthcare Conferences
Explore our reviews of current and past conferences, where PCG will be speaking, and so much more!
All Articles
Or do it the old-fashioned way and search our entire library of helpful articles, guides, and reviews.
