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Ten years ago, the healthcare industry had successfully completed Y2K and was very close to completing the initial phases of the HIPAA transactional implementation. These were significant milestones for the “administrative” side of healthcare (as opposed to the “clinical” side). Since then, developing real-time adjudication (RTA) for healthcare claims has been one of the top administrative priorities for the industry. From a high-level standpoint, RTA makes sense. However, the healthcare transaction process has nuances both from a technology and business perspective, which present significant challenges to the development and adoption of RTA.