Virtual Examiner
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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Healthicity Audit Manager
For medical auditing, Audit Manager streamlines the way you manage audits by merging audit workflow, management, education, and reporting into one easy-to-use, web-based solution.
Audit Manager brings simplicity by helping you:
Identify Revenue
Evaluate financial impact. Minimize denials and identify up to 10%, per provider, in missed revenue with extensive reporting and analytics tools.
Increase Efficiency
Improve your auditing efficiency by up to 40%. Reduce the amount of time you spend completing audits with our user-friendly interface.
Improve Accuracy
Customize your audit templates. Include your own standards, MAC carrier guidelines, and claim scrubber tech for ideal results.
Audit Manager features:
Built-in Tableau integration for in-depth analytics and reporting.
Flexible Audit Management: View the status, and each associated status, of every audit, by any auditor.
E/M Calculator
Automatically calculate E/M codes with a built-in calculator.
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HCC Coding Engine
Aptarro’s HCC Coding Engine is an AI‑powered solution that integrates seamlessly with electronic medical records and practice management systems to scan every patient encounter in real time, automatically identifying and closing coding gaps to ensure all Hierarchical Condition Category (HCC) diagnoses are accurately captured for optimal risk adjustment and revenue. By applying industry‑proven rules and machine learning models, it prioritizes high‑value encounters for coder review, boosts productivity up to 300% per coder without adding provider workload, and reduces denials through real‑time validation and compliance updates. With exception‑based workflows, clear dashboards for RAF score trends, built‑in audit trails and logging, and fast implementation within existing workflows, organizations see immediate ROI in their first billing cycle and unlock millions in missed revenue while maintaining clinical focus and documentation integrity.
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Encipher Health
Encipher Health is a comprehensive AI-powered healthcare technology platform that automates medical coding, risk adjustment, and revenue-cycle processes across specialties. Using Neuro-Symbolic AI, OCR, ML, and knowledge-graph logic, it converts unstructured clinical documentation into accurate, audit-ready codes (CPT, ICD-10, HCC, HCPCS) while enforcing payer, CMS and compliance rules. Its products — including GI coding automation, radiology coding (Conrad AI), anesthesia coding (Sedate AI), HCC/risk adjustment (Cogent AI / RiskGen‑Core / RAF Totalizer), E/M coding, home-health coding, ICD-10-AM support, AR follow-up and denial resolution — streamline workflows, reduce manual effort, minimize denial risk, and accelerate reimbursements. Real-time and retrospective workflows, seamless EHR integration, MEAT-criteria validation, modifier logic, and compliance guardrails ensure high accuracy, regulatory alignment and audit readiness.
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