AdjudicatorCervey
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Virtual ExaminerPCG Software
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Related Products
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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.
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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.
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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
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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
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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
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Virtual Examiner:
Audience
Healthcare organizations that want to enhance their current claims adjudication system
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Adjudicator:
Support
Phone Support
Supported
24/7 Live Support
Supported
Online
Not Supported
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Virtual Examiner:
Support
Phone Support
Supported
24/7 Live Support
Not Supported
Online
Supported
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Adjudicator:
API
Offers API
Supported
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Virtual Examiner:
API
Offers API
Not Supported
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Adjudicator:
Screenshots and Videos |
Virtual Examiner:
Screenshots and Videos |
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Adjudicator:
Pricing
No information available.
Free Version
Not Supported
Free Trial
Not Supported
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Virtual Examiner:
Pricing
No information available.
Free Version
Not Supported
Free Trial
Not Supported
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Adjudicator:
Reviews/
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Virtual Examiner:
Reviews/
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Adjudicator:
Training
Documentation
Supported
Webinars
Supported
Live Online
Supported
In Person
Supported
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Virtual Examiner:
Training
Documentation
Supported
Webinars
Not Supported
Live Online
Not Supported
In Person
Not Supported
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Adjudicator:
Company InformationCervey
Founded: 1978
United States
cervey.com
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Virtual Examiner:
Company InformationPCG Software
Founded: 1984
United States
pcgsoftware.com/product-offerings/virtual-examiner/
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Adjudicator:
Alternatives |
Virtual Examiner:
Alternatives |
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Adjudicator:
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Virtual Examiner:
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Virtual Examiner:
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Virtual Examiner: | |||||
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Virtual Examiner:
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Adjudicator:
Categories |
Virtual Examiner:
Categories |
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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
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Adjudicator:
Integrations
No info available.
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Virtual Examiner:
Integrations
No info available.
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Adjudicator:
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Virtual Examiner:
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