What is Real-Time Adjudication?
Definition
Real-Time Adjudication is the immediate processing of a submitted claim by a payer, returning an adjudication response—allowed amount, patient responsibility, and edits—while the patient is still in the office. Supported by a subset of medical and dental payers, it is distinct from eligibility checks and can return determinations in seconds to minutes. For example, a dental claim may come back instantly with copay, frequency limitations applied, and the final patient balance.
Why It Matters
When available, real-time adjudication enables point-of-service collections and reduces downstream rework, lifting POS collections by 20–40% and trimming A/R days by 5–10 for supported payers. For a DSO with $2M in monthly charges, a 20% POS lift can bring $400,000 forward within the month, improving cash flow and lowering bad-debt exposure.
How Ventus AI Helps
Ventus agents initiate eligibility verification and payer-specific real-time adjudication or estimation flows directly in portals and clearinghouses via browser-native automation, then write back allowed amounts and patient responsibility to the PMS/EHR—no APIs required. For payers without true RTA, agents loop claim-status checks 24/7 to return near-real-time determinations within hours and queue exceptions, with deployment in under 7 days. This standardizes front-desk collections and speeds revenue recognition across locations.
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