Virtual ExaminerPCG 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.
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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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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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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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Audience
Companies searching for a flexible workflow solution for automated processing of claims documents
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Audience
Healthcare organizations that want to enhance their current claims adjudication system
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Support
Phone Support
Supported
24/7 Live Support
Not Supported
Online
Supported
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Support
Phone Support
Supported
24/7 Live Support
Not Supported
Online
Supported
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API
Offers API
Not Supported
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API
Offers API
Not Supported
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Screenshots and Videos |
Screenshots and Videos |
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Pricing
No information available.
Free Version
Not Supported
Free Trial
Not Supported
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Pricing
No information available.
Free Version
Not Supported
Free Trial
Not Supported
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Reviews/
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Reviews/
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Training
Documentation
Not Supported
Webinars
Not Supported
Live Online
Not Supported
In Person
Not Supported
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Training
Documentation
Supported
Webinars
Not Supported
Live Online
Not Supported
In Person
Not Supported
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Company InformationSumex
Founded: 2019
www.sumex.ch/en/Sumex-Suite
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Company InformationPCG Software
Founded: 1984
United States
pcgsoftware.com/product-offerings/virtual-examiner/
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Categories |
Categories |
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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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Integrations
Siddhartha
Not Supported
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