AI Medical Coding Software

Bridging Minds with AI

Empower your claims and authorizations team members with Advanced AI coding solutions to save money, time, and increase compliance.

Solving Medical Coding Errors for 30 years

If you’re paying or processing claims without Virtual Examiner®, you’re likely losing time, money, and visibility. For over 30 years, PCG has supported payer-at-risk and capitated healthcare organizations (HCOs) with 5,000 to 5,000,000+ members, properly auditing claims against a patient's entire billed history to maximize compliance and cost savings.


No team can keep up with it all manually, which is why we built one of the most comprehensive coding and compliance databases available—continuously updated with current rules and logic from the AMA, CMS, and Medicaid —so your team can make accurate, defensible decisions.

Audits on the Rise!

Audit activity is ramping up across Medicare and Medicaid, and it’s not slowing down. In the last 24 months alone, Medicare Advantage audits have expanded from roughly 60 plans a year to over 500—putting nearly every payer under the microscope.


Most organizations don’t realize where their exposure actually sits until they look back at all of their claims and audit against 3 years of patient billed history per patient (episode of care).


That’s why payers come to PCG for a free 3-year audit—to understand their risk, identify missed savings, and see what Virtual Examiner® would catch. Here’s what we found across our last 20 audits.

8-18% Error Rates

  • 10% Missed Denials →

    While CMS allows roughly a 7.66% improper payment rate (CERT), payers are missing an additional 10–18% of mandated denials—not due to negligence, but because it’s nearly impossible to catch everything manually.

  • 8-12% Modifier Error →

    We also found 8-12% of claims impacted by modifier errors, including misuse of -25, -59, -26/-TC, and -76/-77. Required reimbursement adjustments were often not applied, and even conservative correction scenarios can translate into tens of thousands—if not millions—in annual overpayments.

  • 22% Pended for Contractual Review →

    22%+ of claims were questionably coded, exposing inconsistencies with CMS and Medicaid requirements. These findings often led organizations to reevaluate contract compliance with providers—ensuring reimbursement logic protects the provider, the patient, and the health plan.

AI solutions for Payers

Savings, Compliance, FWA

Virtual Examiner

The world's most advanced and comprehensive medical coding and claims logic database in the world. While you sleep, our AI audits claims going back three years and then suggests denials, reductions, and pends. It's the foundation for savings, compliance, and building automations.

Authorization Automation

VE Upgrade: VA Live

Once you adopt VE into your claims and compliance workflow, you can leverage VE's coding logic to review and audit authorizations in real-time. Save countless hours of coding review of authorizations and avoid the old adage, "you auth it, you pay it."

Five black stars.

High Desert Medical

Virtual Examiner has greatly improved our cost containment and compliance, while Virtual AuthTech has helped our authorizations department.

Five black stars in a horizontal row, indicating a high rating.

Medpoint Management

We started with VE and VA, then worked with PCG to automate our authorizations and claims. Our efficiency greatly improved.

Five black stars in a row.

InnovAge

We believe ourselves the best PACE program in America, and when it comes to cost containment and compliance we chose the best, PCG.

AI solutions for RCM

Reducing Denial Rates & Faster Provider Approval & Payments

AI Medical Code Scrubber

Pre-Audit for Less Denials

The biggest coding database, updated quarterly, allowing you to quickly run mock authorizations, mock claims, research codes, and even use our pricing module.

Real-time AI Code Scrubber

Real-time Integration

Get real-time claims auditing pre-submission when we integrate the world's largest coding database directly into your billing software, clearinghouse, or EMR/EHR.

Accepting New Partnerships

Claims Software Reseller

Help Payer Clients and Yourself with a code engine

Your clients want speed, security, and cost containment so they can grow faster, you should be offering our AI Medical Coding solutions. They grow, you grow, we grow.

Five black stars arranged horizontally.

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.

Five black stars in a row.

QuickCap

Virtual Examiner has helped our MSOs and PACE programs seamlessly take control of their compliance in remarkable parallel to our software systems.

Five black stars in a row.

HCIM

We've enjoyed our partnership with PCG for 15+ years, where they provide the coding rules and knowledge, and we work with payers to automate claims and authorization tasks.

Five black stars.

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!

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