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Volume 9, Issue 1 1st Quarter 2016RealTime Claims Adjudication System No Longer Available after May 1, 2016, Medical Mutual real-time claims adjudication (RTA) system is shutting down at 12:01 a.m.

How to fill out real-time claims adjudication system

How to fill out real-time claims adjudication system:

1. Understand the purpose: Familiarize yourself with the purpose and objectives of a real-time claims adjudication system. This system is designed to streamline the claims processing and payment process by automating the verification and adjudication of claims in real-time.
2. Gather necessary information: Collect all the relevant information required for the claims adjudication process. This may include patient information, provider details, insurance coverage details, medical records, and any supporting documentation.
3. Access the system: Log in to the real-time claims adjudication system using your authorized credentials. Ensure that you have proper access rights to perform the adjudication process.
4. Enter claim details: Enter all the necessary claim details accurately into the system. This may include the nature of the claim, diagnosis codes, procedure codes, billed amounts, and any other required information.
5. Verify claim information: Review the entered information to ensure accuracy and completeness. Cross-check the details against any supporting documentation to avoid any potential errors or discrepancies.
6. Check eligibility and coverage: Utilize the system's features to verify patient eligibility and insurance coverage. This step ensures that the claim is valid and eligible for adjudication.
7. Adjudicate the claim: Submit the claim for adjudication using the system's built-in tools. The system will utilize pre-defined rules and algorithms to assess the claim's validity, appropriateness, and whether it meets the set criteria for payment.
8. Review and approve: Review the adjudication results provided by the system. Check for any errors, discrepancies, or rejections. If necessary, make adjustments or corrections before approving the claim.
9. Generate payment or denial: Once the claim is approved, the system will automatically generate payment instructions or generate a denial notification if the claim doesn't meet the criteria for payment.
10. Documentation and reporting: Make sure to properly document the adjudication process and keep records for future reference. Additionally, utilize the system's reporting features to generate comprehensive reports on claims processed, payments made, denials, and any other relevant metrics.

Who needs real-time claims adjudication system:

1. Healthcare providers: Real-time claims adjudication systems are essential for healthcare providers, including hospitals, clinics, and individual practitioners. These systems help streamline the claims process, reduce administrative burdens, and ensure timely payments.
2. Health insurance companies: Insurance companies benefit from real-time claims adjudication systems by automating the verification and adjudication process. This leads to faster and more accurate claims processing, minimizing fraudulent claims and improving customer satisfaction.
3. Patients: Real-time claims adjudication systems indirectly benefit patients by expediting the claims processing, reducing the time between treatment and reimbursement. This increases transparency and efficiency, resulting in a smoother healthcare experience for patients.

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What is real-time claims adjudication system?

Real-time claims adjudication system is a process where insurance claims are processed, reviewed, and approved or denied electronically in real-time.

Who is required to file real-time claims adjudication system?

Healthcare providers and insurance companies are required to file real-time claims adjudication system.

How to fill out real-time claims adjudication system?

Real-time claims adjudication system is typically filled out through a secure online portal provided by the insurance company.

What is the purpose of real-time claims adjudication system?

The purpose of real-time claims adjudication system is to speed up the process of claims processing, reduce errors, and improve efficiency.

What information must be reported on real-time claims adjudication system?

Information such as patient details, treatment provided, diagnosis, and charges must be reported on the real-time claims adjudication system.