AI Solutions for Payer Consultants

VE Supplies Maximum Stop Loss

VE saves clients 5-15% overpayments

Virtual Examiner focuses exclusively on the money-saving errors your clients miss every day. Instead of looking at budgets or operations, VE audits every claim against three full years of billing history to uncover duplicates, unbundled services, missing or incorrect modifiers, and other overpayment risks hidden inside daily claims.

Each night, VE identifies overspend, incorrect reductions, and high-risk patterns that directly impact stop-loss exposure. These claims are routed into Virtual Reporter for correction the very next morning. Your clients recover dollars, reduce high-cost liability, strengthen stop-loss protection—and you become the consultant who brought a reliable, ongoing savings engine to every engagement.

Reducing Risk and Liability

VE's AI Engine helps reduce 5-15% Non-compliance

Not every issue is about saving money up front—some errors can cost your clients hundreds of thousands or even millions in fines, penalties, or de-delegation if left uncorrected. VE’s AI engine identifies claims that should be paid but are coded, billed, or documented incorrectly, thereby threatening compliance across Medicare, Medicaid, Medi-Medi, and commercial lines of business.

Instead of selective auditing or retroactive cleanup, VE flags potential compliance failures in real time: improper modifiers, coverage violations, terminated codes, POS inaccuracies, and clinical inconsistencies. Your clients avoid CMS findings, state sanctions, provider disputes, and major regulatory exposure—while you deliver stronger compliance outcomes without adding more work to your plate.

Smarter Hiring Through AI

VR Benefits Claims Staffing

Virtual Reporter becomes the extra auditing workforce your clients never had. It reviews every claim against three years of history, flags errors by category, and organizes them into targeted work queues—eliminating hours of manual claim-by-claim review. Teams no longer waste time searching for issues; VR hands them a prioritized list of high-value corrections, allowing smaller teams to accomplish the work of a full audit department with greater accuracy and consistency.

FWA Module Benefits Compliance Staffing

The FWA module automates what normally requires high-level analysts: identifying outliers, patterns, and high-risk behaviors across thousands of claims. It pinpoints providers, codes, or categories that require attention, letting compliance teams focus on action—not discovery. Instead of adding investigators or auditors, organizations rely on VE’s intelligence to drive targeted reviews, corrective action, and long-term compliance strategies without expanding staff.

VA Benefits SIU and Provider Relations

Virtual AuthTech gives Medical Management and Provider Relations the real-time adjudication clarity they’ve always needed but could never staff for. It instantly evaluates codes, medical necessity, POS, modifiers, and clinical appropriateness—helping teams avoid approving unnecessary care, over-priced services, or incorrectly coded authorizations. It also supports provider contracting by showing fair CMS-based pricing and payment expectations. With VA doing the heavy analysis, teams operate faster, reduce backlogs, and avoid hiring additional reviewers.