I-CAPS
I-CAPS, an Intelligent Claims Administration System, addresses all functional areas in the health claims payment environment. It uses a single architecture that covers the needs of payers, including billing, enrollment, claims, claims management, contracting and pricing. Our Intelligent Claims Administration System, I-CAPS, and our Coding Compliance Software (Advanced Value Scale -AVS), support knowledge-based decision making to help our clients reduce costs. With (Advanced Network Administrator -ANA), it is easier to ensure the integrity of Provider data. Our (RB-UCR), which is the first industry-first Resource-Based Usual Customary and Responsible fee schedule based upon RBRVS/NCCI, is also easier. Cost Containment Audit and Recovery Services, (CCARS), can be used to perform a non-invasive audit of claims effectiveness.
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Virtual Examiner
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.
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mobile claims
Virtual diagramming, voice annotation and photo documentation are all available in your palm. It is quick and easy to capture claim information onsite, eliminating the need for followup visits. This also gives policyholders a great opportunity to be involved in the settlement process. In just a few steps, adjusters can estimate, document, and close a claim. This allows for a quicker, more efficient, and more accurate claim settlement. Mobile Claims makes it possible to settle claims onsite with onsite estimates. Our algorithms, which are logic-based questionnaires that generate loss-specific estimates in fraction of the time it takes to build standard estimates, can be applied to create custom estimates in a fraction the time. It is easy to integrate, train and use. The cost of changing is virtually eliminated, which has huge benefits for carriers, adjusters and contractors as well as policyholders. Fully equipped with aerial imagery/measurement and 3D virtual diagramming, geospatial visualizations, video collaboration, contents, and so on.
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omni:us
Integration into existing claims systems is seamless. Automate processes and reduce costs It is no longer a choice between improving customer experience and saving money. Data driven insights enable you to make better decisions. Automate manual processes Empower your claims personnel. Invest in the happiness of your customers. Integrate incoming claims seamlessly with your insurance core system. Automate claim processing to reduce inefficiencies and increase customer satisfaction.
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