AI Payment Integrity Intelligence

Reduce Improper Payments and Audit Risk

Empower your claims, compliance, SIU, and provider relations teams with the most advanced AI medical coding and rule intelligence.

Healthcare's payment integrity changes are outpacing human capital and capabilities...

Fraud is growing

Fraudulent billing, upcoding, duplicate claims, and abusive billing patterns can go undetected for months or years. Every improper payment that slips through increases financial exposure and puts additional pressure on your SIU and compliance teams.

  • FWA Stats

    • $2 Billion recovered in 2025
    • 1,185 convictions in 2025
    • Estimated $400 billion in FWA per year

Less Experts in the Field

Healthcare organizations face increasing pressure to recruit and retain experienced medical coders, claims examiners, auditors, and compliance professionals. As claims complexity increases, relying on additional headcount alone becomes an expensive and increasingly difficult strategy.

  • Workforce Stats

    • 66% of payers report staffing shortages
    • 8% entry-level workforce growth by 20235
    • 14,000+ vacant payer roles
    • "The Experts" are retiring or leaving the field

Endless Codes

Thousands of medical codes, modifiers, and billing combinations create opportunities for costly errors. Your claims professionals cannot realistically research every line item against years of claims history while keeping up with daily processing demands.

  • Code Stats

    • 2.6 M Medicare NCCI code-pair edits
    • Account for modifiers
    • Account for Medical Necessity
    • Account for varying DOS

Constant Rule Changes

CMS, AMA, Medicaid, and payer-specific requirements continually evolve. Keeping your claims systems, internal policies, and employees aligned creates a constant risk of outdated edits, inconsistent decisions, and improper reimbursements.

  • Rule Stats & News

    • NCCI edits are updated quarterly
    • NCCI can be retroactive
    • Can be mutli-stage NCCI releases

Audits on the Rise

Government oversight, payment reviews, and compliance audits demand accurate decisions backed by defensible documentation. Missing billing discrepancies today can mean recoveries, corrective action, and expensive investigations tomorrow.

  • Latest Audit Stats

    • Estimated $374 billion in Medicaid improper payments (2025)
    • Estimated $28.8 billion in Medicare FFS improper payments (2025)

Empowering Your Workforce with VE

Virtual Examiner® (VE) helps health plans, MSOs, and claims organizations overcome growing payment integrity challenges without continually expanding their workforce. By automating medical coding and billing rule analysis, identifying potential improper payments, and reviewing historical claims, VE empowers claims, compliance, and SIU professionals to focus on complex cases that require human expertise. The result is stronger payment integrity, greater operational efficiency, and the ability to manage increasing claims complexity without proportional increases in staffing.

The AI Platform Behind Payment Integrity

Virtual Examiner®

Healthcare AI with an ROI

Unlike most healthcare software, Virtual Examiner® (VE) delivers a measurable return on investment every day.  Every denial or reduction accepted by your claims or compliance team becomes documented savings that can be tracked, measured, and reported—giving executives clear visibility into financial impact while improving payment accuracy, strengthening compliance, and reducing improper payments. Those measurable results have helped us earn a 97% client retention rate over the past 30 years.

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.

We Help Clinics and Coding Student too!

Pass those Courses and Reduce Denials

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.

PCG's Trusted Partners

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 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.

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!

Five black stars.

Moss and Adams

Over 20 years, our mutual clients have benefitted from their coding database and rules, with our recovery efforts. It's made for an amazing partnership.

Five black stars.

AMI

Our TPA outsourced abilities coupled with PCG's coding and rules logic have helped us reach new compliance and coding results.

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