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 helps
Where a payer offers real-time answers, Ventus uses them; where it does not, Ventus gets the answer from the payer portal or by phone. Benefits and claim status come back normalized across 300+ payers and are written back into the practice management system.
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