An audit request from the Medical Service often reaches a hospital months after discharge, with a tight deadline and spread across several systems. The software gathers the relevant parts of the chart from the documents you provide, drafts a substantiated and legally precise reply, and links every statement to its underlying record. The answer to the payer is still authored by the hospital.
Why case dialogues are now becoming the bottleneck
Since 2026, jurisprudence draws a sharper distinction between primary and secondary misallocation. Both must be addressed separately in the reply to the Medical Service, each substantiated by its own evidence. Six to twelve weeks after discharge the chart is closed; what was not documented can hardly be added in a defensible way. Within that window, existing documentation must be argued medically and prepared with legal precision for the payer.
The GKV Contribution Rate Stabilization Act adopted by the Federal Cabinet on 29 April 2026 targets approximately €16.3 billion of relief to the statutory health insurance system for 2027, a significant share of it from the inpatient sector. The operational consequence is foreseeable: audit density will rise. How precisely a hospital answers a case dialogue therefore becomes a revenue question.
The chart of the case in question is dropped into the system — admission record, progress documentation, findings, discharge letter, where applicable nursing documentation and therapy protocols. Documents that today live in different applications now sit bundled inside one case.
02
Draft the reply
From the chart provided and the request issued by the Medical Service or payer, the system extracts the billing-relevant facts. Within a minute a draft reply is ready — substantiated, drafted with legal precision, and with each statement linked to its underlying original record. Where the evidence is thin, the system flags this and indicates which additional records would support the point. Content is not invented; passages that require supplementation remain visible as such.
03
Approve and send
Medical controlling or the medical leadership reviews the draft, changes what needs changing, approves, and sends. Processing status, deadlines, and accountability are visible to executive leadership in a dashboard.
In the hospitals we work with, a single case worker — without medical accreditation — processes around 120 case dialogues in half a working day. The same work would have previously taken 30 hours or more.
Also available as outsourced handling
Not every hospital can absorb a software rollout in the short term. For the decisive quarters before Q1 2027 we therefore also offer case dialogue handling as classical outsourcing: our specialists handle the work on the hospital's behalf, under the hospital's responsibility and according to the hospital's specifications.
Requests are returned within 24 hours with a substantiated, legally reviewed draft reply.
The final answer to the Medical Service or the payer is signed by the hospital.
Data processing exclusively within the EU, with a data processing agreement and a complete data protection package.
Scalable from individual peak-load weeks to full takeover of the incoming case dialogue volume.
Outsourcing is designed as a transitional arrangement, not a permanent function. Hospitals that later switch to software-based self-operation retain the chart, case history, and reply library.
What this means economically
15 min → 1 min
Processing time per case dialogue
Reduction of pure processing time per case dialogue from approximately 15 minutes to roughly one. The freed-up time flows into the cases where medical and legal argumentation actually matters.
120 cases / 0.5 day
Throughput per case worker
120 cases per half working day — conventionally more than 30 hours of work. The bottleneck shifts from sorting work to medical-controlling approval.
€1,469
Per avoided reduction
Protection of revenue that is already earned. With an average invoice reduction of €1,469 per challenged case and challenge rates around 50 percent, the quality of every single reply has a direct impact on the annual result.
Live dashboard
Visibility for the executive board
Processing status, deadlines, average success rate of replies, and revenue effect are available in real time.
What the software explicitly does not do
The system makes no reimbursement decisions, formulates no diagnoses, and does not recommend treatment. From the available chart it generates a draft reply for medical and legal review. Professional responsibility for the answer to the Medical Service or the payer remains with the hospital that sends it.
The system does not invent content. Every statement in the draft is linked to its original source; whatever cannot be substantiated is flagged as a gap, not silently added — even when it would rhetorically strengthen the argument.
Legal framework and data processing
Processing entirely within the European Union (Frankfurt data centre).
Templates for the data processing agreement and DPIA are delivered with the product.
A works council information package per § 87 BetrVG is available for co-determination.
Supported procedures: § 275c SGB V (Medical Service audit procedure), PrüfvV, § 301 SGB V (GKV and DRV data exchange), Hybrid-DRG billing.
Preparation for the EU AI Act (applicable from August 2026); AI literacy training for clinical staff is included.
Frequently asked questions
What does aiomics case dialogue handling do?
As soon as a request from the Medical Service or a health insurer arrives, the software collects the relevant parts of the chart — admission record, progress documentation, findings, discharge letter — and drafts a substantiated and legally precise reply. Every statement in the reply is linked to its source in the chart. Medical controlling or the medical leadership reviews the suggestion and authorises the response.
How quickly can a case dialogue be processed with aiomics?
In our customer hospitals, pure processing time per case has dropped from typically 15 minutes to roughly one minute. The relevant chart is dropped into the system; the system extracts the billing-relevant facts and produces a draft that is substantiated and legally sound. The final answer to the payer is sent by the hospital.
How many cases can a single case worker handle?
Users without medical accreditation process around 120 case dialogues per half a working day with aiomics. The same work would conventionally have taken 30 hours or more. Professional responsibility for the reply remains with the hospital's medical controlling team or medical leadership.
Do you also offer case dialogue handling as a service?
Yes. For hospitals that cannot absorb a software rollout in the short term, our specialists handle the cases on the hospital's behalf, under its responsibility and according to its specifications. Incoming requests are returned within 24 hours with a substantiated, legally reviewed draft; the hospital reviews and sends. This classical outsourcing arrangement is designed as a transitional solution for the decisive quarters.
Is the software a medical device?
No. Case dialogue handling is administrative documentation and writing assistance. It does not produce medical diagnoses, treatment recommendations, or reimbursement decisions. It structures the existing chart and proposes a reply; the final answer to the Medical Service or the payer is the hospital's responsibility.
Which reimbursement paths are supported?
Case dialogues with the Medical Service per § 275c SGB V in the GKV sphere, rehabilitation queries per § 301 para. 4 SGB V in data exchange with the statutory insurers and the German Pension Insurance, and replies in the context of Hybrid-DRG billing.
What does the separation between primary and secondary misallocation mean for the reply?
Current jurisprudence requires that primary and secondary misallocation be treated as separate audit subjects and addressed individually. The software structures the reply accordingly and sorts the evidence in the chart along both aspects so that the answer to the Medical Service holds up legally.
Where is the data processed?
Entirely within the European Union, in a Frankfurt data centre. Data processing agreement, GDPR-compliant data protection management, and works council information are delivered with the product.
Can reply templates be adapted to our hospital?
Yes. Hospitals can create as many of their own presets as they wish — for example for particular case constellations, recurring challenge patterns, or argumentative preferences of individual payers. On request we run the initial calibration jointly with your medical controlling team.
Can the logic be tailored to individual OPS codes?
Yes. The reply logic can be tied to individual OPS codes with their respective documentation and structural requirements — for early rehabilitation complex treatments as well as for OPS codes with structural minimum-requirement criteria. Presets are updated after the annual OPS revision; the hospital decides from which admission date a new version applies.
Are German Pension Insurance requirements treated separately?
Yes. For rehabilitation in the DRV sphere, requirements per § 301 para. 4 SGB V in XML data exchange are honoured, including the SWE checklist and the three audit stages of the substantive dataset audit performed by the German Pension Insurance. Rehab-specific presets for AHB and phase-transition constellations can be created.
Can we check beforehand how defensible our existing documentation is?
Yes. On an anonymised sample from live operations, the system reviews admission and progress documentation for the gaps where an MD audit typically begins. You receive a sober report: which case constellations carry the highest risk of primary or secondary misallocation today, where chains of evidence are thin, and where reductions are likely. A dress rehearsal for the actual audit — independent of whether the software is introduced afterwards or not.
Does the system invent arguments when the chart is thin?
No. Whatever appears in the draft is substantiated by the chart provided and linked to its original record. What cannot be substantiated is flagged as a gap — even if it would rhetorically strengthen the argument. This separation is the basis of the software's regulatory positioning.
In 30 minutes we work through an anonymised case dialogue from your hospital together — from the incoming request to the approval-ready draft. You will then see where the biggest bottlenecks in your current process lie.
