Back to customer servicesHospitals, clinics, and departments

A batch of billing queries arrives, but clinical, coverage and legal teams are addressing different issues.

Each question needs a response on the necessity of a test, medicine or consumable and its payment conditions.

How does this scope address your concerns?

You worry that a long medical explanation will miss the actual query or lack the rules applicable at the time.

When this scope fits

One care topic with a defined question list, lawfully available materials and an internal reviewer.

When the scope needs adjusting

Guaranteed reversal of deductions, fabricated records or treating general clinical benefit as proof of payment eligibility.

REAL SOURCES · ILLUSTRATIVE REQUEST · DOWNLOADABLE SAMPLE

Ten payment queries tied to records and applicable rules

Download sample packZIP

Payment-response evidence matrix

01Clinical context then

Locate original notes, orders and reports

02Medical necessity

Link contemporaneous standards and patient context

03Payment conditions

Check national/provincial/pooling-area items, standards and dates

Jurisdiction: mainland China. No real records or payment determination. Article 11 of the 2026 rules is the reference.

Check	Finding / sample content	Use
Query 07	Necessity does not establish payment eligibility	Locate clinical and payment bases separately
Original records	Missing originals remain flagged	Request missing originals; never reconstruct fiction
Professional review	Disputed points remain pending	Deliver response after one review round

SOURCES USED IN THIS EXAMPLE

国家医保局 · 基金使用监督管理条例实施细则，2026

Prepared 5 Oct 2026 · Selected references, not an exhaustive systematic search

Scope & acceptance

Work covered by the quote

Illustrative scope: 1 care topic, 10 review questions, up to 100 pages of available material and 1 professional review, checking local rules applicable at the time.

Pilot reference: CNY 10,000–50,000/batch. Fictional CNY 12,000 budget: 2,000 for classification and indexing, 6,000 for evidence and rules, and 4,000 for review and explanation; 6,000 at start and 6,000 at delivery. No percentage of recovered money is charged.

Acceptance criteria

Each agreed query is addressed with source locations. Medical records are not fabricated retrospectively.

Checking the evidence

Volumes come from the current proposed pilot scope. The budget and scenario are illustrative, not a completed client project or real transaction. A formal quote follows confirmation of scope, data permissions and personnel.
Inputs to confirm: original query IDs and dates, original record versions, local rules at the time and service agreements. Retrospectively invented records are not used.

Workflow and inputs

From inputs to delivery

Explore the workflow and deliverable structure. This preview does not run searches, read real records or produce medical findings.

01 / WORKFLOW PREVIEW

Define the task

Provide de-identified query IDs, dates and region, separating clinical from payment questions.

Methods, sources and professional responsibilities

THE BASIS FOR THIS SCOPE

Why this approach? Inspect the basis.

Institutional decisions require effect evidence, resources, implementation conditions and local applicability.

OFFICIAL GUIDANCE

WHO Guidelines

World Health Organization

Inspect public-health and clinical guidance

Find WHO guidelines and review the recommendation questions, evidence base and intended settings.

Scope & access conditions

Global guidance is not evidence of local implementation outcomes. Check population, resources, policy and timing.

Open official source

PUBLIC DATABASE

Cochrane

Read systematic reviews and plain-language summaries

Explore a question’s research synthesis and the confidence researchers have in the findings.

Scope & access conditions

Plain-language summaries are public; full-review access varies. Applicability still depends on the population and question.

Open official source

METHOD REFERENCE

GRADE · Cochrane Handbook

Cochrane · Chapter 14

Show effect size and confidence separately

Present important outcomes, relative and absolute effects, available data and certainty, with reasons for downgrading.

Scope & access conditions

GRADE evaluates a body of evidence for a particular outcome. Database inclusion or one study does not automatically establish high certainty.

Open official source

These references support problem definition and evidence appraisal. Your conclusions still require project-specific sources and professional review.

The value of this commissionEOS maps contemporaneous local rules and records question by question, separating medical explanation from procedural advice.

Batch evidence support for audit questionsCompare alternatives and value

Does the audit concern clinical need, payment conditions or missing records?

What to assess	symplr / Hayes	Evidence OS · Commissioned scope
Service focus	Hayes supports coverage, utilisation-management and appeal evidence.	EOS maps contemporaneous local rules and records question by question, separating medical explanation from procedural advice.
When to choose	Hayes is particularly relevant for US payer evidence libraries and ratings.	Example: one topic, ten audit questions, up to 100 record pages and one professional review.

What the fee pays for: Planning reference: CNY 10,000–50,000 per batch, based on questions and records rather than recovered sums.
Value beyond this task: Reuse numbered indexes and verified sources in similar later reviews.
How to assess value: Track response coverage, additional-check hours and rework; reversal of deductions is not guaranteed value.

Verify jurisdiction, rule dates, original records and medical/legal responsibility.

CHECK THE OFFICIAL SERVICE SCOPEsymplr / Hayes · Evidence Analysis for payers

Reuse and updates after delivery

A dated regional source index supports a reuse assessment for later batches, with duplicate source-checking work identified before charging.

Agree reuse rights, retention and export periods, and future update fees when scoping.

Questions before commissioning

Can we identify questions that are not primarily medical?

The classification separates medical necessity, payment conditions and record completeness. Procedures and responsibility remain for the organization and relevant professionals.

Are lawyers or formal dispute proceedings included?

No. A formal dispute requires a separate scope, with legal and third-party costs listed separately.

Can I buy this online now?

Email us your scoping request at no charge. We’ll reply as soon as possible to confirm scope and prepare a quote. Services, professionals, contracts and payment are confirmed separately. This form does not accept medical-record attachments or sensitive images.

Define the delivery for your actual question.

Add your goal, available inputs and timing. Agree scope, review responsibilities and a quote before commissioning.

Request scope & quote

Explore other situations

Hospitals, clinics, and departments

Your department wants to change a care process, but is unsure whether the evidence is sufficient.

A current-process versus evidence table, relevant patient groups and proposed pilot measures to help the department decide what to do next.

CNY 30,000–80,000 per projectSee the deliverable

Hospitals, clinics, and departments

Your team searches the literature again at every meeting, without retaining the previous evidence base.

A versioned shared question collection, monthly change briefs and a professional-support time log showing what changed and what did not.

CNY 60,000–180,000 per department per yearSee the deliverable