Virtual Examiner

Virtual Examiner

PCG Software
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About

Efficient checks, integrated expertise and a high degree of automation reduce the transaction costs of vouchers to a minimum. Sumex Core is the basis for automated electronic invoice verification. It contains the business components and workflows, which can be assembled and parameterized in a modular way. Current and correct tariff and reference data are central to efficient invoice verification. Sumex reference data is compiled from publicly available sources, processed in a timely manner and made available on the Sumex tariff server. The data is additionally presented in an information system and can be consulted directly by the experts in the context of the current billing. DRG Expert supports the controlling of billing for services in acute care, created according to SwissDRG regulations. DRG Expert presents case data in the context of regulations, contains statistical key figures and offers what-if analyses.

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.

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

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

Audience

Companies searching for a flexible workflow solution for automated processing of claims documents

Audience

Healthcare organizations that want to enhance their current claims adjudication system

Support

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

Support

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

API

Offers API Not Supported

API

Offers API Not Supported

Screenshots and Videos

Screenshots and Videos

Pricing

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

Pricing

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

Reviews/Ratings

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

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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

Training

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

Training

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

Company Information

Sumex
Founded: 2019
www.sumex.ch/en/Sumex-Suite

Company Information

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

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Categories

Claims Processing Supported
E-Invoicing Supported

Categories

Claims Processing Supported
Medical Billing Supported
Medical Coding Supported

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

Integrations

Siddhartha Supported

Integrations

Siddhartha Not Supported
Claim Sumex and update features and information
Claim Sumex and update features and information
Claim Virtual Examiner and update features and information
Claim Virtual Examiner and update features and information