Case Study: South Florida Community Care Network streamlines claims auditing with PCG Software's Virtual Examiner

South Florida Community Care Network (SFCCN) - Customer Case Study

South Florida Community Care Network (SFCCN), one of Florida’s largest healthcare systems, was struggling to keep up with constant changes in coding, coverage, and payer guidelines. Its nine-person claims department was handling code auditing for nearly 35,000 covered lives through a paper-based process, which made quality control, claims history reviews, and identification of duplicate or ineligible claims difficult and time-consuming. PCG Software helped address these challenges with its Virtual Examiner® solution.

PCG Software implemented Virtual Examiner® to automate claims auditing and detect improper claims, coding errors, and duplicate payments. The system integrated smoothly with SFCCN’s existing processes and vendor contracts, eliminating manual data reentry and freeing up claims specialists to focus on higher-value work. It also helped monitor billing patterns, support Medicare compliance, and improve recovery efforts, with the broader goal of reducing erroneous payments and conserving premium dollars.

South Florida Community Care Network (SFCCN)

Tracy Harswick

Vice President, IT Systems and Payment Operations