AI Payment Integrity Software

Coding Complexity is Exploding

• 70,000 ICD-10, 10,000+ CPT, 7,000+ HCPCS level II codes
• 1,500 new DXs and Procedures (2022-2026)
• 1,200 New Coding Rules and Regulations (2022-2026)
• Impossible for any person to remain up to date

Audit Risk has Increased 9x

• 2022: Only 5% of Medicare Advantage (MA) Plans audited
• 2026: 100% of MA Plans are now audited
• OIG Fines are now $10,000 or more per violation
• OIG Convictions 2022-2026 rose from 661 to 1,185

Staffing Shortages & Growing Costs

• 66% of Claims and Compliance report staffing shortages
• Claims volume continues to increase 4-5% annually
• High Dollar claims are rising 29% year over year
• Hiring alone is no longer a scalable solution

Manual vs AI Claims Review

Your team wasn't hired to manually research thousands of claim line items every day. They were hired to make complex payment decisions, investigate high-risk claims, validate clinical necessity, and resolve contract disputes.

Every night, Virtual Examiner® audits every claim line item against three years of billed patient history (episode of care), the latest coding rules, payer policies, and contract requirements—automatically quarantining only the claims that require your team's attention.

Instead of expanding headcount to keep pace with growing claims volume, your experts begin each day with only the claims that require human judgment—improving payment accuracy, strengthening compliance, increasing recoveries, and reducing the time spent researching routine claims.

Smarter Medical Coding Starts Here

Built on the same AI coding intelligence behind Virtual Examiner®, iVECoder® gives providers, billing teams, students, and educators instant access to one of the world's most comprehensive medical coding and reimbursement knowledge bases. Updated quarterly with the latest coding and reimbursement changes, iVECoder helps reduce denials, improve coding accuracy, prepare for CPC® and CCS® certification, and build confidence—all within one easy-to-use platform.

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