WorkflowsPayer enquiries and preliminary proceedings
Answer payer enquiries with evidence from the case record.
aiomics connects existing record passages with the specific enquiry and prepares a response draft with source references. Revenue-management and medical teams review the reasoning. Your hospital retains its approval and submission process.
Address the specific review question using the documented record
A payer case dialogue requires the enquiry, documented course and supporting passages together. aiomics assembles these records for response preparation. Later additions to the treatment record remain subject to documentation duties; changes must remain traceable.
Hospital billing reviews have their own procedural rules and document-submission requirements. Response preparation in aiomics supports work with the evidence. Your hospital checks deadlines, permitted procedural steps and the required transmission channel.
Provide the enquiry and related records, such as admission notes, progress records, findings and the discharge letter. Documents are assembled with the case and become sources for response preparation.
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Prepare a draft reply
The supplied chart and query are used to prepare a draft reply. It brings together documented facts and supporting passages and flags gaps. The medical controlling team checks whether the sources support each statement and the query has been answered. Medical and, where needed, legal review take place before approval.
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Approve and send
Medical controlling and the responsible physicians review the draft and its sources. The hospital arranges any required legal review. Approval and sending follow the hospital’s agreed procedure.
Assess value through a complete case: assemble records, prepare the draft, check sources, complete and approve it. Include cases requiring substantial additional work.
Also available as outsourced handling
We also offer preparation of payer replies as a commissioned service. Scope, turnaround and review responsibilities are agreed with your hospital.
You receive a draft with documented facts and source references. Professional and any required legal review take place before approval under the agreed process.
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.
A later transition to handling cases with the software in-house is planned together during implementation.
Measure preparation, review and outcome separately
Preparation
Work to produce a draft
Record the time spent reviewing records and preparing the response, together with record size and enquiry type.
Review
Corrections and additions
Measure professional review, including cases requiring further medical or legal work.
Progress
Outcome by procedural stage
Record the payer’s response separately from task time. Case circumstances, available evidence and procedural stage affect the outcome.
Overview
Coordinate outstanding cases
The shared case view shows processing status. Automatic statutory deadline calculations and further analysis are planned.
Review and responsibility
The software helps assemble the record and formulate a reply. The hospital’s responsible professionals assess treatment needs, reimbursement, and legal sufficiency. Each draft reply requires review and approval before sending.
An AI draft with source references can still contain errors or unsupported statements. Review each statement together with the passage cited. The hospital must resolve missing information and contradictions before sending the reply.
Legal framework and data processing
Technical and contractual documentation identifies processing locations, subprocessors and access arrangements.
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.
Response preparation uses documented facts. The hospital checks deadlines, procedural steps and transmission; further automation is planned.
Implementation covers appropriate review of AI drafts and responsibilities during use.
Frequently asked questions
What does aiomics case dialogue handling do?
The software organises the supplied chart material around the query from the Medical Service or insurer and prepares a draft reply with source references. Medical controlling and clinical leadership review the information and reasoning. The hospital approves and sends the response.
How quickly can a case dialogue be processed with aiomics?
Time depends on record size, the enquiry and required additions. A meaningful assessment measures preparation, professional review and submission separately against the existing process.
How many cases can a single case worker handle?
Assess capacity using comparable cases during your trial, including source review, corrections and cases needing further professional input. Your hospital determines how work is divided between administrative, revenue-management and medical staff.
Do you also offer case dialogue handling as a service?
Yes. We also offer preparation of payer replies as a commissioned service. Scope, turnaround and professional and any required legal review are agreed with the hospital. The hospital approves and sends the final response.
Which tasks does the software perform in payer case dialogues?
It supports administrative documentation and writing: bringing existing passages together, organising documented facts, and drafting a reply. Professional and legal assessments and final approval remain with the hospital. Documentation of the regulatory assessment is available on request.
Which reimbursement paths are supported?
Response preparation follows the specific enquiry and supplied records. Statutory-insurance case dialogues, German pension-insurance reports and private reimbursement enquiries involve different requirements and procedures. Your hospital checks the context; the software prepares documented information and a draft.
Can aiomics help prepare preliminary payer proceedings?
Existing record passages can be organised around a payer enquiry and brought together in a draft. The hospital checks the reasoning, applicable deadlines and permitted procedural step. The responsible professionals handle legal assessment, approval and sending.
Where is the data processed?
Processing locations and participating service providers are described in the technical and contractual documentation, supporting your hospital’s data-protection review.
Can reply templates be adapted to our hospital?
Use your own templates for recurring documentation tasks and the required response structure. Draft content uses the supplied evidence. Revenue-management and medical staff review which statements address the specific enquiry.
Can the logic be tailored to individual OPS codes?
Specific checks of German procedure-code documentation and structural requirements are planned. Today, aiomics supports assembling existing information and supporting passages. Your professionals check the applicable code version and minimum requirements.
Are German Pension Insurance requirements treated separately?
Templates can reflect the structure of the intended rehabilitation report. aiomics prepares information from selected sources and highlights omissions. The hospital checks current Deutsche Rentenversicherung requirements and mandatory data transmission.
Can we check beforehand how defensible our existing documentation is?
Yes. Using an anonymised sample of cases, we review admission and progress documentation for missing evidence, contradictory statements, and gaps in traceability. The report helps your medical controlling team review both the documentation and the processes used to create it.
Does the system invent arguments when the chart is thin?
AI can generate unsupported statements. The supplied chart therefore forms the basis of the draft, with source references and gap flags to support review. The hospital checks each argument against the original records and corrects the draft before approval.
We work through an anonymized example together: identify the enquiry, check supporting passages and edit a response draft. Your team sees preparation and the subsequent review steps.