Case Study: St. Joseph’s Medical Resources reduces claims processing costs with PCG Software’s Virtual Examiner

St. Joseph’s Medical Resources - Customer Case Study

St. Joseph’s Medical Resources, a healthcare organization that manages Independent Physician Associations and billing for physician practices, was struggling to review claims for more than 80,000 patients using an outdated manual process. The claims team needed a more consistent and customizable way to handle highly technical claims across different reimbursement practices, and turned to PCG Software and its Virtual Examiner® solution.

PCG Software implemented Virtual Examiner® to automatically adjudicate claims each evening and provide claims managers with reports they could use to review denials, explanations of benefits, and questionable claims. The result was a more efficient, standardized claims review process and considerable cost savings from catching erroneous claims that may have been missed manually, helping St. Joseph’s Medical Resources improve profitability.