Adjudicator

Adjudicator

Cervey
Virtual Examiner

Virtual Examiner

PCG Software
Adjudicator Virtual Examiner

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Adjudicator:

About

Adjudicator is a plan management and prescription claims adjudication platform for pharmacy benefit managers, health plans, hospitals and health systems, pharmacy programs, managed care organizations, manufacturers, and retail pharmacies. It supports configurable plan designs and benefit structures, multi-tenant environments, pharmacy network configurations, and management of drugs, formularies, and maximum allowable cost (MAC) pricing. Its member portal provides real-time benefit-status and pending-claim tracking, secure document uploads, and notifications. A prior authorization dashboard provides access to claims data and secure communications. An API framework supports data exchange with internal processes and external business partners. Adjudicator helps organizations manage pharmacy benefits and prescription claims.
Virtual Examiner:

About

Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.
Adjudicator:

Platforms Supported

Windows Not Supported
Mac Not Supported
Linux Not Supported
Cloud Supported
On-Premises Not Supported
iPhone Not Supported
iPad Not Supported
Android Not Supported
Chromebook Not Supported
Virtual Examiner:

Platforms Supported

Windows Not Supported
Mac Not Supported
Linux Not Supported
Cloud Supported
On-Premises Not Supported
iPhone Not Supported
iPad Not Supported
Android Not Supported
Chromebook Not Supported
Adjudicator:

Audience

Prescription Benefit Managers (PBMs), Third-Party Administrators (TPAs), Self-Funded Employers, Health Plans, Hospitals & Health Systems, Pharmaceutical Manufacturers, Cash & Discount Card Sponsors, Retail Chain Pharmacies
Virtual Examiner:

Audience

Healthcare organizations that want to enhance their current claims adjudication system
Adjudicator:

Support

Phone Support Supported
24/7 Live Support Supported
Online Not Supported
Virtual Examiner:

Support

Phone Support Supported
24/7 Live Support Not Supported
Online Supported
Adjudicator:

API

Offers API Supported
Virtual Examiner:

API

Offers API Not Supported
Adjudicator:

Screenshots and Videos

Virtual Examiner:

Screenshots and Videos

Adjudicator:

Pricing

No information available.
Free Version Not Supported
Free Trial Not Supported
Virtual Examiner:

Pricing

No information available.
Free Version Not Supported
Free Trial Not Supported
Adjudicator:

Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

Review this Software
Virtual Examiner:

Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

Review this Software
Adjudicator:

Training

Documentation Supported
Webinars Supported
Live Online Supported
In Person Supported
Virtual Examiner:

Training

Documentation Supported
Webinars Not Supported
Live Online Not Supported
In Person Not Supported
Adjudicator:

Company Information

Cervey
Founded: 1978
United States
cervey.com
Virtual Examiner:

Company Information

PCG Software
Founded: 1984
United States
pcgsoftware.com/product-offerings/virtual-examiner/
Adjudicator:

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Adjudicator:

Categories

Virtual Examiner:

Categories

Claims Processing Supported
Medical Billing Supported
Medical Coding Supported
Virtual Examiner:

Claims Processing Features

Adjustor Management Supported
Case Management Supported
Claim Resolution Tracking Supported
Co-Pay & Deductible Tracking Supported
Compliance Management Supported
Customer Management Supported
Electronic Claims Supported
Forms Management Supported
Paper-Based Claims Supported
Payor Management Supported
Policy Administration Supported

Medical Billing Features

Claims Processing Supported
Claims Scrubbing Supported
Code & Charge Entry Supported
Compliance Tracking Supported
Customizable Dashboard Supported
Dunning Management Supported
Invoice History Supported
Patient Eligibility Checks Supported
Practice Management Supported
Quotes/Estimates Supported
Remittance Advice Supported
Adjudicator:

Integrations

No info available.
Virtual Examiner:

Integrations

No info available.
Adjudicator:
Claim Adjudicator and update features and information
Claim Adjudicator and update features and information
Virtual Examiner:
Claim Virtual Examiner and update features and information
Claim Virtual Examiner and update features and information