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features
design
support

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Description

Alaffia utilizes an advanced AI-driven system to identify and address fraud, waste, and abuse within complex healthcare claims, aiming to avert and recuperate overpayments for both payers and employers. By spotting and rectifying inaccuracies in misbilled claims prior to any incorrect payments being processed, Alaffia not only helps recover funds but also aids in minimizing future financial losses. With the potential for overpayments on erroneous claims to amount to hundreds of dollars annually for each employee, collaborating with Alaffia can lead to significant cost savings. The Alaffia system works to identify and amend incorrectly billed claims, thereby reducing the chances of overpayments occurring. Our integration with your health plan or TPA is designed to be seamless, ensuring that there is no interruption in service for your members. We operate on a contingency basis, meaning you incur costs only when we successfully generate savings for you. Additionally, we take measures to guarantee that providers do not bill your employees for services that were never actually rendered, thus safeguarding your financial interests. Through our innovative approach, we strive to enhance the overall integrity of healthcare 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 No 

API Access

Has API No 

Screenshots View All

Screenshots View All

Integrations

No details available.

Integrations

No details available.

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) Yes 
In Person Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) No 
In Person No 

Vendor Details

Company Name

Alaffia Health

Country

United States

Website

alaffiahealth.com

Vendor Details

Company Name

PCG Software

Founded

1984

Country

United States

Website

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

Product Features

Claims Processing

Adjustor Management Yes 
Case Management Yes 
Claim Resolution Tracking Yes 
Co-Pay & Deductible Tracking Yes 
Compliance Management Yes 
Customer Management Yes 
Electronic Claims Yes 
Forms Management Yes 
Paper-Based Claims Yes 
Payor Management Yes 
Policy Administration Yes 

Medical Billing

Claims Processing Yes 
Claims Scrubbing Yes 
Code & Charge Entry Yes 
Compliance Tracking Yes 
Customizable Dashboard Yes 
Dunning Management Yes 
Invoice History Yes 
Patient Eligibility Checks Yes 
Practice Management Yes 
Quotes/Estimates Yes 
Remittance Advice Yes 

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