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Description
ClaimScore stands out as the sole independent software solution focused on tackling the growing issue of claim fraud within class action settlements. Each claim is meticulously assessed on an individual basis through our unique AI, ML, and Cloud Architecture in real-time, with results displayed instantly on an interactive dashboard. Initially, every claim starts with a ClaimScore of 1,000, which diminishes whenever it does not meet a specific criterion. These criteria are assigned either fixed or variable weights based on their relationship to fraudulent and legitimate claims. To enhance transparency, every claim is accompanied by deduction codes that correspond to the failed criteria, ensuring that all involved parties, including the administrator and the court, are fully informed of the precise reasons behind any claim rejection. This meticulous approach not only fosters trust among stakeholders but also reinforces the integrity of the claims process.
Description
Virtual Examiner®, PCG Software’s flagship product, monitors an organization's internal claims process to track provider data for fraudulent or abusive billing patterns and maximizes financial recovery. The Virtual Examiner®, a PCG Software product, allows healthcare organizations to improve their claims adjudication system by allowing for more than 31,000,000 edits per claim. The software monitors an organization's internal claim process to identify and reduce payments for incorrect or erroneous code to save premium dollars. Virtual Examiner®, is more than a claims management solution that focuses 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.
API Access
Has API
API Access
Has API
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
ClaimScore
Founded
2022
Country
United States
Website
www.claimscore.ai
Vendor Details
Company Name
PCG Software
Founded
1984
Country
United States
Website
pcgsoftware.com/product-offerings/virtual-examiner/
Product Features
Insurance Claims Management
CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting
Product Features
Claims Processing
Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration
Medical Billing
Claims Processing
Claims Scrubbing
Code & Charge Entry
Compliance Tracking
Customizable Dashboard
Dunning Management
Invoice History
Patient Eligibility Checks
Practice Management
Quotes/Estimates
Remittance Advice