Nivano Physicians Choose PCG Software's Virtual Examiner to increase cost containment and claims efficiency

PCG Software Gains New High Valued IPA Client

On November 6, 2018, Nivano Physicians who serve providers in the Greater Sacramento area and has Medicare, Medicare Advantage, Medi-Medi, and Medi-Cal patient populations elected to implement implement PCG Software's Virtual Examiner (VE). VE works in parallel to MedVision's QuickCAP to streamline processes, increase cost containment, increase HEDIS, and identify and rectify fraud and waste.

Nivano Physician's Immediate Impacts.

“Our team at Nivano Physicians has wholeheartedly embraced the Virtual Examiner® system. We are finding VE’s ease of integration to our core platform and ability to swiftly apply millions of edit rules in adjudication, identifying issues prior to check-runs truly has helped minimize and practically eliminate problems of overpayment today,” said Sarath Artham, CEO and Chief Technological Officer, of Nivano Physicians. “The healthcare industry continues to experience the loss of billions of premium dollars to fraudulent, abusive, and wasteful billing practices. Virtual Examiner® helps healthcare organizations like Nivano enhance their claims adjudication system by targeting providers who exhibit improper or erroneous coding patterns to contain, recover and conserve premium dollars,” said Michael Lubao, CEO of PCG Software. By implementing, integrating, and automating these cost containment solutions, PCG and MedVision are able to work together to contain cost and streamline the internal claims process for customers like Nivano.”

Impact on Nivano's Physicians

Virtual Examiner’s® integration with MedVision’s QuickCAPTM solution enhances the relationships between Nivano and its provider network by educating individual providers on proper billing practices and improving physician office staff’s understanding of coding and claims payment guidelines. Each time an inconsistency is detected in a claim, Virtual Examiner® Prepares a remittance report, explaining why the claim is reduced or denied. In the process, providers often become aware of state and federal rules governing claims submissions for the first time.

How MedVision views Virtual Examiner

“With the continued change in reimbursement options and the complexity of rules across all lines of business, it behooves any payer organization to include PCG’s process and expertise. We see this as a significant value-add to QuickCAP’s overall administrative abilities in streamlining and improvement of claims payment environments.” - Albert Sosa, CEO for MedVision.

Conclusion

If your MSO, IPA, or TPA is utilizing MedVision's QuickCAP system for claims adjudications, get a FREE demo and audit to see how Virtual Examiner perfectly compliments QuickCAP. We'll show you how together these two softwares can reduce fraud and waste, increase cost containment and help your providers and your organization increase its HEDIS scores as well.