Revenue-cycle teams spend much of their time assembling evidence that already exists. An insurer asks the hospital to justify a procedure or support the length of stay; someone has to find the diagnosis, the first observations, the procedure notes, the abnormal results and the bill, and turn them into a letter. When that takes days, claims age and cash waits.
Draft from the record, not from memory
A well-designed assistant drafts the formal reply strictly from the treating doctor's record for that encounter: diagnosis, first observations, procedures with dates and operator, abnormal labs, imaging impressions, medication and the bill breakdown. Finance reviews the letter, edits it if needed and sends it; the response is stored on the claim and audited1. The same approach works for pre-authorisation requests for insured inpatients.
From denial to managed work
A claims workqueue and its actions
| Claim state | Agent prepares | Person decides |
|---|---|---|
| Denied | Denial reason, missing evidence, draft justification | Resubmit or appeal |
| Query from insurer or TPA | Reply drafted from the encounter record | Edit and send |
| Pre-authorisation needed | Request drafted from the admission record | Approve and submit |
| Stuck or ageing | Follow-up note with claim history | Follow up |
| Service not billed | Leakage flag with the delivered service | Mark recovered or dismiss |
Note: Based on the Revenue 360 workbench in the Hospital 360 demo, which runs on synthetic data.
Source: SCIKIQ, “Hospital 360 — SCIKIQ Healthcare-in-a-Box demo” (2026)
Measure insurers, not only claims
Denials are not evenly spread. An insurer scorecard — denial rate, days to settle, money stuck beyond 45 days and the top denial reason per insurer — shows where to fix documentation templates, where to renegotiate and where to escalate1.
Every query an insurer sends is a question the clinical record has usually already answered. The work is getting the answer out, accurately and quickly. (SCIKIQ view)