San Diego’s Community Health Group Deploys PCG Software’s
Virtual Examiner®
Automated Software
Virtual Examiner pinpoints billing errors and unfair billing practices, enabling
Community Health Group to educate providers and eliminate long-term billing errors
MALIBU, Calif. — September 08, 2009 — PCG Software, a leading provider of software solutions designed to ensure proper and accurate payment of medical claims for healthcare payer and provider organizations, today announced that Community Health Group (San Diego) has deployed PCG’s Virtual Examiner fraud and abuse prevention software.
According to Joseph Garcia, Community Health Group’s chief operating officer, the organization had been searching for more than five years for an automated auditing tool to enhance the claims adjudication process: “We wanted to enhance our regulatory compliance efforts to detect billing errors and/or unfair billing practices in the most efficient manner. For years, we’ve been looking for an automated system that was robust enough for our needs and we found it in PCG’s Virtual Examiner.”
Community Health Group also uses data generated by Virtual Examiner in its provider-relations efforts. Because Virtual Examiner pinpoints the exact reasons a claim is improper, the payer shows providers the rule, rate or applicable regulation that caused the claim to be adjusted or denied. As a result, providers across the board have corrected many long-term errors in their billing processes.
“Virtual Examiner helps us fulfill our essential regulatory responsibilities along with managing healthcare efficiently and effectively,” Garcia asserts. “For health plans like ours, Virtual Examiner is a low-risk proposition. The savings are there, and the system pays for itself very quickly. Even more importantly, we can partner with our providers to ensure proper coding and payment in the most effective manner.”
Virtual Examiner is a cost-containment solution that evaluates claims for proper billing and identifies claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery possibilities.
About Community Health Group
Community Health Group is San Diego’s largest and oldest local non-profit health plan. We have been committed to exemplary customer service and quality health care for 27 years. As members of the community, our 140 staff members understand the needs of San Diego residents, which means we are multilingual, multicultural and ready to serve you. We offer three health coverage programs: Medi-Cal, Healthy Families, and Medicare Advantage Special Needs Plan. Community Health Group also provides benefits administration and claims processing services to Employer Groups through Community Administrators, a third party administrator.
About PCG Software
Established in 1984, PCG Software is a leading provider of innovative software solutions designed to slow the escalating costs of healthcare. The company works with healthcare payer organizations to increase profitability and maximize financial recoveries, while assisting their provider partners to improve the accuracy of billing processes.
The company’s flagship software solution enhances claims adjudication systems with more than 30 million edits per claim and uses investigative profiling reports to graphically indicate patterns of fraud and abuse. Through more accurate and efficient claims adjudication, this fraud and abuse prevention software acts as an automated cost containment system for national and regional health insurance plans, independent practice associations and third party administrators. More information about PCG Software can be found on the World Wide Web at www.pcgsoftware.com. Press contact information:
Dave Anderson, Dodge Communications, (770) 998-0500 ext. 229
danderson@dodgecommunications.com
Michael Lubao, PCG Software, (877) 789-1291 ext.202
mlubao@pcgsoftware.com
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