Where is an adjudication rule applied in the Resolute workflow?

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Adjudication decisions in the Resolute workflow are driven by the rules that define how a claim is evaluated and paid. The adjudication rule is the exact mechanism used to apply policy logic during the claim’s adjudication step, determining eligibility, coverage, and payment calculations based on patient and payer rules. This rule is applied when the claim enters adjudication, guiding the automated decisions that decide what the payer will reimburse. The other aspects—rate type, security role assignment, and revenue code mapping—serve different purposes: rate type classifies pricing for services, security role assignment controls who can perform actions in the system, and revenue code mapping handles the coding of charges for billing. None of these govern the decision logic of adjudication itself, which is why the adjudication rule is the correct focus.