Health System AI Payment Integrity
Payment Integrity Ecosystem for At-Risk Health Systems
Connect authorization review, real-time claims editing, nightly claims auditing, reimbursement validation, and provider billing oversight through one integrated Virtual Examiner® ecosystem.
Unify Payer and Provider-Side Payment Integrity
Virtual Examiner® supports risk-bearing health systems that operate clinics, manage authorizations, adjudicate claims, and retain financial responsibility for care. VA Live™ applies VE coding and reimbursement logic during authorization workflows. VEWS™ returns real-time claim-level findings inside the billing or claims platform. Virtual Examiner® and Virtual Reporter® then audit current and historical claims for payment accuracy, reimbursement variances, provider trends, contract conflicts, and FWA indicators.
Real-time authorization coding and reimbursement review
Real-time claims determinations inside existing billing or claims platforms
Nightly claims auditing with historical lookback
Provider and specialty billing trend analysis
Contract and reimbursement variance identification
Custom rules, exclusions, edits, and workflow configurations
Human-controlled denials, reductions, pends, and escalations
Disclaimer: PCG identifies coding, reimbursement, claims, and provider-billing findings for client review. Final authorization, adjudication, payment, recovery, compliance, and investigative decisions remain controlled by your organization.
5 Requirements for an Integrated Payment Integrity Ecosystem
Unified EMR
All clinics use one primary EMR and billing environment for consistent data flow.
Shared Coding Logic
Every clinic applies the same VE coding, reimbursement, and payer rules.
Real-Time Auths
VA Live™ returns coding and reimbursement findings during authorization review.
Real-Time Claims
VEWS™ returns configurable claim findings inside the billing or claims platform.
Enterprise Oversight
Virtual Reporter® centralizes provider, specialty, clinic, and financial trend reporting.
Accelerating Enterprise Decision-Making
One Coding and Compliance Throughout Your System
Large health systems often operate across multiple clinics, specialties, coding teams, and operational departments. Even within one EMR, inconsistent rule interpretation can create authorization delays, claim errors, reimbursement variance, provider frustration, and avoidable financial risk.
Virtual Examiner® provides a shared coding, reimbursement, and payer-rules foundation across authorization review, claims editing, nightly auditing, contract validation, and provider reporting. Your teams work from the same underlying logic while retaining control over every final operational and payment decision.
Why Disconnected Rules Create Risk →
When clinics, coding teams, authorization departments, and claims operations rely on different manuals, local interpretations, and update schedules, the same service can be reviewed differently across the organization. A shared VE knowledgebase reduces variation and creates a more consistent standard for coding, reimbursement, and payment review.
Where VE Intelligence Is Applied →
The same VE logic can support real-time authorization review through VA Live™, real-time claims editing through VEWS™, nightly historical claims auditing, provider and specialty trend analysis, contract validation, and client-configured edits. Each workflow uses the same core coding and reimbursement intelligence.
What Changes for Your Health System →
Teams spend less time researching codes and reconciling conflicting interpretations. Leadership gains centralized visibility across clinics and specialties, while operational teams receive more consistent findings, clearer rationale, faster review, and better documentation for correction, recovery, escalation, or workflow refinement.
Every Auth, Every Claim, is Audited for Maximized Compliance
Let's Get Started
Whether you already use Virtual Examiner® or are exploring PCG for the first time, we’ll help you identify the most practical path to VA Live.
Contact Us
Please try again later.
