5 Ways Real-Time Medical Claims Adjudication Speeds Up The Reimbursement Process


The rising healthcare costs have added to the provider’s concerns of correctly assessing the patients’ payments, coinsurance, deductibles, and non-covered services for accurate filing of claims. Over the years, Real-Time Medical Claims Adjudication (RTA) has emerged as an apt answer to this concern. Providers can now bill for the services right at the point of service even before the patient leaves the office. This not just reduces the chance of denials but also cuts down on the administrative burden and paperwork, leading to cost reduction and quick turnaround times. RTA eliminates the need for providers to follow up and resolve their claims, allowing them to focus on their core services.

Here are the top 5 ways through which real-time adjudication accelerates collections for providers

Higher Approval Rate

The nature of healthcare makes it imperative for care providers to assess the patient’s responsibility at the time of providing the service. This is where RTA comes handy. RTA claims are given priority during the payer’s adjudication, thus, shortening the reimbursement time. Records suggest that about 85% of the transactions can be effectively adjudicated in the real-time, which reassures providers that they would get paid for their services to the patient.

Provider and Patient Satisfaction

For the provider, RTA simplifies the process of assessing the patient’s share of the healthcare service payment as they can receive all relevant data just by providing the claim or identification number. They can readily take a printed copy of the patient’s EOB statement and address the queries that the patient may raise, which helps in patient satisfaction

Faster Payments

With real-time medical claims adjudication, the provider receives the member’s share of the healthcare expenses before they leave the provider’s office while the remaining part from the payer in the span of a few days. Thus, the risk of bad debts that may crop up due to the patient’s liabilities gets reduced. The quick turnaround in reimbursement implies fewer follow-ups and makes it a delightful experience for both the provider and the patient.

Reduced Risks

As the RTA module uses specialized software to determine the probability of claims before a patient is administered the treatment, the risk of erroneous assessments drops. The RTA module is highly effective in identifying abnormal consumption patterns, thus cutting down on the chances of frauds and misuses.

Lower Operating Costs

Without an RTA module in place, care facilities have to invest in human resources and administrative works which depletes the bottom line. Providers can now employ fewer individuals to address the claims and benefits inquiries and other such non-value-adding tasks. Instead, they can now ramp up their billing process while maintaining a claims accuracy rate to improve cash flow and operations.

By leveraging real-time medical claims adjudication services, stakeholders can redesign the way they manage healthcare claims and make the process more transparent and efficient. The financial and administrative implications make RTA a prudent choice for providers to get paid for their services and ensure continued operations.