The Ultimate Clean Claim: Real-Time Claim Adjudication (RTCA)
athenahealth partners with payers to help physicians resolve claims immediately.
Athenahealth is participating in a pilot project with Humana and BCBS of Florida to enable physicians to submit a claim at the time of service, receive a fully adjudicated claim response from the payer and collect the appropriate payment before the patient leaves the office. In order to take advantage of real-time adjudication (RTCA), athena clients will need to adopt the best practice of performing charge entry at the time of check-out. After the claim is created and passes the Rules scrubs, it will electronically travel to the payer and adjudication will be received back in a matter of seconds. The advantages are clear - knowing that a claim is successfully adjudicated AND being prepared to collect the patient's responsibility (or set up a payment plan) before they leave the office!
RTCA works especially well for doctors seeing patients with high patient responsibility plans, either deductibles or coinsurance. Collecting patient payments at the time of service saves the physician office from the hassle of phone calls and letters to collect balances and it reduces the practice's bad debt rate.
athenahealth's strategic plan includes expanding on the Florida pilot with the ultimate goal of offering RTCA to athenahealth clients nationwide.