Case Study: ProMed Health Care Administrators improves claims processing and reduces overpayments with PCG Software’s Virtual Examiner

ProMed Health Care Administrators (ProMedHCA) - Customer Case Study

ProMed Health Care Administrators (ProMed HCA), a California-based managed care administrator serving independent practice associations and medical groups, needed a better way to defend claim denials and provide physicians with clear, objective justification. To strengthen its claims administration process, ProMed HCA looked for a claims code auditing solution and selected PCG Software’s Virtual Examiner.

With PCG Software’s Virtual Examiner, ProMed HCA gained a single source for reimbursement rates, coding rules, fraud monitoring, billing pattern analysis, and insurance regulations. The system improved claims processing, helped the company communicate more clearly with physicians, and supported contract negotiations by showing compensation as a percentage of Medicare rates. ProMed HCA also reported saving money and reducing overpayments on fee-for-service claims, with CFO Baram Bahremand noting that the software had a substantial positive operational impact beyond direct savings.

ProMed Health Care Administrators (ProMedHCA)

Baram Bahremand

Chief Financial Officer