Real-time Claims Adjudication

Real-time claims adjudication: the process by which medical billing claims are submitted to a payer for processing whereby the claims are adjudicated automatically and payment/denial information is sent back to the submitter in real-time. The process allows the medical practice to submit a patient’s claim to the payer and determine the patient responsibility while the patient is still in the office.

MTBC, the Unique Healthcare IT Company®,  has recently announced that it is offering automated real-time claims adjudication. RTA allows a practice to immediately determine the actual payment of the claim–eliminating lengthy delays between submission and payment.

RTA allows a practice to bypass the standard billing process by submitting claims directly to the insurance company’s claim adjudication systems. Administrative staff within the doctor’s office are able to use the RTA system to enter the procedure and diagnosis codes used by the healthcare provider as well as the patient co-payment and immediately receive notification of the claim payment.

The typical in-office billing process requires 20-60 days for claim adjudication.

The typical in-office medical billing process–a maze of complexity and delays

This hallmarks of the typical medical billing process are: cumbersome software, exceedingly slow processing times, excessive data entry, and delayed payments. Real-time claims adjudication with MTBC eliminates these headaches by allowing a provider to immediately determine the patient responsibility.

MTBC’s RTA process provides claim responses in 3-7 seconds.

Currently this service is only available with UnitedHealthcare, however MTBC is in testing with Humana and Blue Cross Blue Shield of Florida. As more insurance companies come online with this technology, MTBC’s medical billing service will allow its clients to submit claims directly from its EMR software or from its web-based billing platform.

As other companies begin testing this technology and deploying it through EMR and PM software, physicians and their staff will reap the benefits of peace-of-mind and increased cash flow. At this time, MTBC appears to be the only company in the industry offering this service to its premium billing clients without any additional fees or expenses.

Key RTA Facts:

  • Immediately send claim information and receive detailed payment information and patient responsibility
  • Excellent tool for doctors who treat patients with high responsibility plans, deductibles, coinsurance, and co-pays
  • Reduces patient accounts receivable
  • Eliminates patient billing and patient telephone calls regarding bills submitted through RTA
  • Reduce claim payment time