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Nivano Physicians Selects PCG's Flagship Software to Monitor and Enhance the Internal Claims Process
[November 06, 2018]

Nivano Physicians Selects PCG's Flagship Software to Monitor and Enhance the Internal Claims Process


Integration between Virtual Examiner® and existing QuickCAP™ solution from MedVision will allow for cost containment and streamlined processes

LAS VEGAS, Nov. 06, 2018 (GLOBE NEWSWIRE) -- PCG Software (PCG), a leading provider of software solutions designed to slow the escalating costs of healthcare, today announced Nivano Physicians has selected PCG’s flagship claims auditing software, Virtual Examiner® (VE), to help the California-based independent physician association (IPA) enhance their current claims adjudication system. Virtual Examiner® seamlessly integrates with QuickCAP™ 7.0, Nivano’s existing health benefits solution created by software developer MedVision.

“Our team at Nivano Physicians has wholeheartedly embraced the Virtual Examiner system. We are finding VE’s ease of integration to our core platform and ability to swiftly apply millions of edit rules in adjudication, identifying issues prior to check-runs truly has helped minimize and practically eliminate problems of overpayment today,” said Sarath Artham, CEO and Chief Technological Officer, Nivano Physicians.

“The healthcare industry continues to experience the loss of billions of premium dollars to fraudulent, abusive and wasteful billing practices. Virtual Examiner® helps healthcare organizations like Nivano enhance their claims adjudication system by targeting providers who exhibit improper or erroneous coding patterns to contain, recover and conserve premium dollars,” said Michael Lubao, CEO of PCG Software. “By implementing, integrating and automating these cost containment solutions, PCG and MedVision are able t work together to contain cost and streamline the internal claims process for customers like Nivano.”



Virtual Examiner’s® integration with MedVision’s QuickCAP™ solution enhances the relationships between Nivano and its provider network by educating individual providers on proper billing practices and improving physician office staff’s understanding of coding and claims payment guidelines. Each time an inconsistency is detected in a claim, Virtual Examiner® prepares a remittance report, explaining why the claim is reduced or denied. In the process, providers often become aware of state and federal rules governing claims submissions for the first time.

“With the continued change in reimbursement options and the complexity of rules across all lines of business, it behooves any payer organization to include PCG’s process and expertise. We see this as a significant value-add to QuickCAP ‘s overall administrative abilities in streamlining and improvement of claims payment environments,” said Albert Sosa, CEO, MedVision.


The ease of implementation between Virtual Examiner® and existing QuickCAP™ also allows for Nivano to quickly integrate from legacy systems, a crucial component as organizations navigate and industry that continues to embrace quickly evolving technologies.

For more information on PCG Software’s Virtual Examiner®, visit http://pcgsoftware.com/product-offerings/virtual-examiner/

About PCG Software
Established in 1984, PCG Software is a leading provider of innovative software solutions designed to slow the escalating costs of healthcare. The company works with healthcare payer organizations to increase profitability and maximize financial recoveries, while assisting their provider partners to improve the accuracy of billing processes.

The company’s flagship software solution, Virtual Examiner®, enhances claims adjudication systems with more than 30 million edits per claim and uses investigative profiling reports to graphically indicate patterns of fraud and abuse. Through more accurate and efficient claims adjudication, this fraud and abuse prevention software acts as an automated cost containment system for national and regional health insurance plans, independent practice associations and third-party administrators. For more information, visit www.pcgsoftware.com, or follow us on Twitter.

About Nivano Physicians
Nivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties.  Nivano Physicians is a strong and committed advocate for the Medi-Cal community—ensuring that managed health care is actually ‘manageable.’ The association educates and advises clients and physician participants and oversees their managed health care needs.

About MedVision Solutions
MedVision, Inc. is an innovative software solutions provider to the healthcare industry of intuitive and integrated products to help organizations operate efficiently and provide them with a competitive advantage. MedVision’s flagship product, QuickCAP v7.0, is a complete health benefits software solution that leverages advanced technology to automate workflow, enable superior analytics, integrate business processes and improve patient outcomes, while reducing operating costs.

Press contact information:
Dave Anderson
Anderson Interactive
252-715-4767
dave@andersoni.com

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