The technology for health plans to process claims online in real time has been available for several years (Medical Economics, "Claims in, approval out—in seconds," July 9, 2001). But until recently, there hasn't been any compelling reason for plans to invest in that when they could hold onto physicians' money instead. Now, however, the advent of health savings accounts and the growth of patient cost-sharing have prompted several plans to take a second look at real-time claims adjudication. The idea is to tell patients what they owe at the point of care, so that their payments can be deducted automatically from their health savings accounts or flexible spending accounts.