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.
Learn more
EncoderPro.com
EncoderPro Spotlight by OptumCoding is a web-based medical coding reference application designed to help ambulatory coding, billing, and reimbursement professionals manage critical coding tasks with accurate, real-time access to CPT, HCPCS Level II, ICD-10-CM/PCS, and ICD-9-CM code sets and associated regulatory guidance; the software includes powerful search and reference capabilities that combine thousands of procedure, service, supply, and diagnosis codes with descriptive and cross-coding information so users can find the right codes quickly and reduce errors in claim submission. It provides proprietary content and tools that go beyond basic code lists to include deeper insights into regulatory compliance topics such as National Correct Coding Initiative (NCCI) edits, Hierarchical Condition Categories (HCCs), and coverage determination policies, automated edit review options for proper unbundling and modifier use, and a historical content database for adjudication reference.
Learn more
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.
Learn more
iMedX
iMedX, Inc. provides clinical documentation and revenue-cycle solutions designed to help healthcare providers focus on patient care rather than administrative burdens. The platform supports AI medical coding, standard medical coding, clinical documentation, abstraction of core measures, and revenue-cycle-management workflows. Their AI medical coding offering, part of the ‘RCM Companion Suite’, uses advanced machine-learning to improve accuracy, reduce denials, and accelerate payments by automating case-routing, pre‐populating codes, guiding coders in real time, and surfacing documentation gaps before claims leave the organization. Users gain features such as intelligent case routing to the right coder, autonomous resolution of routine cases, in-moment assistance through an AI assistant, and embedded audit tools that identify missed reimbursement, documentation errors, and compliance risks.
Learn more
