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ease
features
design
support

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Description

Streamlined verification processes, combined with specialized knowledge and a high level of automation, significantly minimize voucher transaction costs. At the heart of this system lies Sumex Core, which serves as the foundation for automated electronic invoice validation. This platform encompasses business components and workflows that can be configured and customized in a modular fashion to suit various needs. For effective invoice validation, having up-to-date and accurate tariff and reference data is crucial. Sumex gathers this reference data from publicly accessible resources, processes it promptly, and makes it available via the Sumex tariff server. Furthermore, this information is displayed in an accessible information system, allowing experts to reference it during the billing process. DRG Expert enhances the oversight of billing for acute care services, adhering to SwissDRG guidelines. It not only presents case data in line with regulations but also includes essential statistical indicators and enables what-if scenarios for better decision-making. This comprehensive approach ensures that all stakeholders have the necessary tools to maintain accuracy and efficiency in billing practices.

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

Screenshots View All

Screenshots View All

Integrations

Siddhartha

Integrations

Siddhartha

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

Sumex

Founded

2019

Website

www.sumex.ch/en/Sumex-Suite

Vendor Details

Company Name

PCG Software

Founded

1984

Country

United States

Website

pcgsoftware.com/product-offerings/virtual-examiner/

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

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

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