Duplicate query detected. {insurer.name} has asked for these documents before — generate the dispute letter citing IRDAI guidelines on redundant queries.
EHRPre-filled from {claim.doctor}'s clinical note in clinical-service. Edit as needed.
)}
Generate with AI
)}
{generating && (
Drafting in IRDAI-compliant clinical language…
)}
{draft && (
Draft generated. Edit below, print, get doctor's signature, then upload signed copy as a query attachment.
)}
);
}
function craftJustificationLetter(claim, query, insurer, indication, clinical) {
const today = new Date().toLocaleDateString('en-IN', { day:'2-digit', month:'long', year:'numeric' });
return `${PCQT_d.tenant.name}
${PCQT_d.tenant.addressLine}
ROHINI: ${PCQT_d.tenant.rohini} · Reg: ${PCQT_d.tenant.regNumber}
Date: ${today}
To,
The Medical Officer
${insurer.name}
Subject: Justification for ${indication.toLowerCase()} — Claim ${claim.id} — Patient ${claim.patient.name} (${claim.patient.uhid})
Reference: Your query dated ${PCQT_d.dayOnly(query.raisedAt)}
Dear Sir/Madam,
This is with reference to the above-mentioned cashless claim. We respectfully submit the following clinical justification:
CLINICAL CONTEXT
Patient ${claim.patient.name}, ${claim.patient.age}/${claim.patient.gender}, was admitted on ${PCQT_d.dayOnly(claim.admittedAt)} under the care of ${claim.doctor} (Reg ${claim.doctorReg}). The primary diagnosis is ${claim.icd} — ${claim.icdLabel}.
Symptom onset: ${claim.symptomOnset}.
CLINICAL JUSTIFICATION
${clinical}
Based on the above, the chosen course of treatment was medically necessary and the level of care provided is appropriate, justified, and aligned with IRDAI standard treatment guidelines.
We respectfully request expeditious approval of the pre-authorization in line with the IRDAI Health Insurance Regulations, 2016, § 13(4) on response timelines.
For any further clarification, please feel free to reach us on the hospital insurance desk.
Thank you.
Yours sincerely,
______________________________
${claim.doctor}
Reg. No: ${claim.doctorReg}
${claim.ward.split('·')[0].trim()} Department
${PCQT_d.tenant.name}
[Hospital Seal]`;
}
function SidebarQueryGuide({ insurer }) {
return (
About queries
TPA queries are written in cryptic shorthand. PulseChart's AI translates them into a plain action checklist with the documents you need.
{insurer.name} typically responds in {insurer.slaPreauthMin} min. Anything longer is escalatable.
);
}
Object.assign(window, { QueriesTab });
// HMS-available document types: in integrated mode these can be auto-attached
// from the corresponding HMS microservice without manual upload.
window.HMS_AVAILABLE_DOCS = [
'CONSULTATION_PAPER', // clinical-service · SOAP notes
'DIAGNOSTIC_REPORT', // radiology-service
'LAB_REPORT', // lab-service
'DISCHARGE_SUMMARY', // clinical-service
'HOSPITAL_BILL', // billing-service
'PAYMENT_RECEIPT', // billing-service
'PHARMACY_BILL', // pharmacy-service
'OT_NOTES', // clinical-service
'IMPLANT_INVOICE', // pharmacy-service
];
window.HMS_SERVICE_FOR = {
CONSULTATION_PAPER: 'clinical-service',
DIAGNOSTIC_REPORT: 'radiology-service',
LAB_REPORT: 'lab-service',
DISCHARGE_SUMMARY: 'clinical-service',
HOSPITAL_BILL: 'billing-service',
PAYMENT_RECEIPT: 'billing-service',
PHARMACY_BILL: 'pharmacy-service',
OT_NOTES: 'clinical-service',
IMPLANT_INVOICE: 'pharmacy-service',
};
function ehrClinicalPrefill(claim) {
// Builds a believable EHR-derived clinical fact paragraph based on the claim's
// ICD-10 and admission context. In production this would pull the doctor's
// SOAP note from clinical-service.
const prefills = {
'I21.0': `Patient presented with crushing chest pain x 4 hours, diaphoretic. ECG showed ST elevation V2-V5 (anterior STEMI). Troponin-I 14 ng/mL (peak). Echocardiogram revealed anterior wall akinesia with EF 38%. Required ICU monitoring for arrhythmia surveillance and IABP standby. Known HTN x 8 years on amlodipine 5mg.`,
'I21.9': `Substernal chest pain x 6 hours with diaphoresis. ECG inferior wall changes. Troponin elevated. Required ICU for hemodynamic monitoring and cardiology consult.`,
'O82': `G3P2L2 · 38 weeks gestation · previous LSCS · elective repeat caesarean planned. No labour. Vitals stable. Indication: previous classical incision precluding TOLAC. Baby live and well at birth, APGAR 9/9.`,
'S72.0': `Mechanical fall at home 2 days prior. X-ray showed comminuted intertrochanteric fracture R neck of femur, Garden IV. Patient cannot weight-bear. Indication for hip hemiarthroplasty: age 71, displaced fracture, expected delayed union with internal fixation.`,
'K35.80':`RLQ abdominal pain x 18 hours. WBC 14,500. CT abdomen showed dilated, inflamed appendix with peri-appendiceal fat stranding. No perforation. Indication for laparoscopic appendectomy: imaging-confirmed acute appendicitis with rising inflammatory markers.`,
'J18.9': `Fever x 5 days, productive cough, breathlessness x 2 days. Known T2DM. CXR shows right lower lobe consolidation. SpO2 92% on room air. ABG showed pH 7.34. Indication for ICU admission: respiratory distress in an immunocompromised diabetic; requires NIV protocol unavailable on general ward.`,
'I63.9': `Sudden onset right arm weakness and dysarthria, witnessed onset 3 hours prior. NIHSS 8. CT head ruled out haemorrhage. MR brain showed acute left MCA territory infarct. Required ICU monitoring for thrombolysis protocol.`,
}[claim.icd] || `Patient admitted under ${claim.doctor} on ${claim.symptomOnset}. Course detailed in clinical-service SOAP note. Procedure / admission medically necessary based on documented clinical findings.`;
return prefills;
}