VA Live
VA Live automates your authorization workflow in real time. It evaluates each request against your rules and instantly approves, denies, or routes cases for review. The result: faster decisions, lower administrative costs, and consistent, defensible outcomes across your organization.
Authorization Review & Automation
VA Live does Auth Code research for you
VA Live enhances the Virtual Examiner® Suite with real-time authorization decision support, enabling plans, MSOs, and PACE organizations to validate requests as they come in. Instead of post-decision audits or manual reviews, VA Live uses CMS rules, AMA guidance, medical necessity logic, payer policies, and historical VE data for immediate assessments. This results in quicker, more consistent decisions, fewer denials, and clear justifications for every approval, pend, or denial—integrated within your existing authorization platform.
AI-Assisted Authorization Decisions
What is required to get Auths automated?
Successful authorization automation starts with preparation, not technology. Before VA Live can drive real-time decisions, payers must define how authorizations are reviewed, which rules apply by line of business, and where automation is appropriate versus clinical judgment.
VA Live does not replace utilization management policy—it operationalizes it.
Mapping Your Authorization Codes & Rules
To automate authorizations, your team must first map procedure codes, diagnosis requirements, provider types, places of service, and plan-specific coverage rules. VA Live relies on this configuration to understand which services require prior auth, which conditions must be met, and which requests are eligible for straight-through processing. This upfront mapping ensures that Medicare, Medicaid, and commercial policies are applied correctly and consistently across all authorization requests.
Defining the Rules of Automation Stop and Start
Not every authorization should be automated. VA Live requires clear thresholds for when requests are approved, denied, pended, or escalated to clinical staff. Plans define what qualifies as routine versus complex, what triggers medical director review, and which scenarios must remain manual. VA Live enforces these guardrails in real time—preventing inappropriate auto-decisions while removing low-risk requests from clinical queues.
VA Live Logic is the backbone for Suggested Decisions
Once rules and workflows are defined, VA Live applies real-time validation to every authorization request. Incomplete submissions, non-covered services, policy conflicts, and medical necessity gaps are flagged immediately with clear reasoning and recommended actions. Requests that meet all requirements move forward without delay, while exceptions are routed appropriately—creating faster decisions, fewer appeals, and a defensible audit trail for every determination.
Getting VA Live Operational
PCG has Authorization Automation Partners
True authorization automation requires more than technology—it requires correct clinical logic, regulatory alignment, and disciplined execution. VA Live provides the real-time, defensible authorization determinations, while automation partners operationalize those determinations inside your existing authorization and utilization management systems. These partners bring deep medical management, utilization review, and compliance expertise, translating VEWS outputs—approval, denial, pend, or escalation—into automated actions that execute consistently within your workflows.
Rule ownership remains with the client. Payers define which services require authorization, applicable clinical thresholds, exception handling, and when human review is required. VA Live enforces those rules uniformly in real time, and automation partners configure system behaviors to execute them—ensuring every automated authorization decision is compliant, auditable, and defensible while preserving full payer control over policy design and risk tolerance.
Client Results & FREE Audits
VA Live is an Add-on to VE
Before launching VA Live, we provide a free full 3-year claims audit to show what VE would have found and what VEWS will automate going forward. This analysis uncovers missed denials, reductions, improper payments, and high-risk patterns your team could not have caught manually. These findings become your roadmap: how VEWS will automate claims, streamline authorizations, and prevent future overspend the moment your system goes live.
What do we need to start a FREE audit
You’ll sign a Mutual NDA and BAA, then securely send three years of claims data. We analyze the data for 3–5 weeks and return a full findings presentation including dollar savings, compliance exposure, duplicate trends, and ROI projections. This audit is completely free and requires no commitment.
How our clients getting a 90-Day positive ROI?
Most organizations see ROI in under 90 days because VE immediately identifies duplicate payments, incorrect codes, global conflicts, and unbundled procedures. These savings occur before your team even finishes implementation. VE’s combination of automation and accuracy is the reason payers see measurable results faster than any other claims auditing software.
How does implementation and training work?
Installation is completed in 1–2 weeks on your secure intranet. We then conduct a 5-day onsite training with your Claims, SIU, and Medical Management teams. Week One you are fully operational, auditing live claims, and generating immediate savings. No lengthy onboarding, no outsourcing, no delays.
Get Real-Time Authorizations Editing live in 1-2 months
VE Clients Only
Only VE Clients are eligible for real-time Claims automation. VE has to be installed on a dedicated server for VEWS to run properly. Click here for VE Demo.
VEWS Proposal
PCG will evaluate the project based on your current authorization software, rules, and team members, then submit a 1-time installation, initialization, testing, and monthly licensing proposal. Once signed, we're off to the races!
Implementation and Go-Live
Full integration, testing, and go-live can take from 3-6 weeks, depending upon your claims software and the availability of your internal IT team and third-party vendors as needed. Following Go-Live, we will perform 8 hours of training to your Auth and IT teams.
