Case Study: Tuality Health Alliance automates claims adjudication and reduces costs with PCG Software’s Virtual Examiner

Tuality Health Alliance Uses Virtual Examiner® to Automate the Claims Adjudication Process and Strengthen its Provider Relationships

Tuality Health Alliance, a physician-hospital community organization serving patients, physicians and care providers, was looking for ways to automate manual claims processes, improve cost control, and keep up with evolving CMS and billing requirements. With a small administrative staff and a growing need to reduce fraud, abuse, and waste, the organization turned to PCG Software and its Virtual Examiner® platform.

PCG Software implemented Virtual Examiner® along with complementary tools including Virtual Reporter™, Virtual AuthTech®, and Sym-Key® Virtual Auto-Post™ to automate claims adjudication, auditing, reporting, and posting. The solution helped Tuality identify rejected or underpaid claims, uncover nearly 10% in annual savings opportunities from a review of 2012 claims, improve encounter-data quality, and strengthen provider relationships by educating offices on billing practices and coding guidelines.

Tuality Health Alliance

Chris Senz

Chief Operating Officer