This template is part of the claim denial routing guide. Fill it in after your first call with the sponsor and write only what someone at the company has confirmed.
How to write each line
Five writing rules keep the page short and safe to forward:
- One or two lines per field. If a field needs a paragraph, the detail belongs in SourceX's later review.
- Types, not names. Write "billing system" or the product category, never a login, a client or a patient.
- Read numbers, do not estimate them. A count comes from a report someone at the company ran, stated loosely ("several thousand a month").
- Write "unknown" when nobody knows, and add who could check. A named gap helps; a guess misleads.
- Let the sponsor read it first. The brief goes to the decision-maker from inside the company, so the sponsor must be comfortable sending it unchanged.
The nine-field template
| Field | What to write | Format | Leave out |
|---|---|---|---|
| 1. Company | Provider or billing company, full-time headcount at peak, country | One line, approximate headcount | Client names |
| 2. Business task | The workflow in one sentence | Verb first: "Sending each denial to..." | Any specific claim |
| 3. Record classes | Kinds of records, each named separately | Comma list of three to five types | Samples or screenshots |
| 4. Systems | Where each class sits, by type or product name | One system per class | Logins, exports |
| 5. History | Years held, per system when they differ | "About N years" | Retention advice |
| 6. Volume | Items per month, from a report | A loose order of magnitude | Dollar amounts at stake |
| 7. Access event | A documented date that changes access, with its source | Date and document | Pressure or estimates |
| 8. Open question | The single gap that most limits the history | One question ending in a question mark | Speculation about files |
| 9. Authority | Sponsor, decision-maker, adviser | Three roles, no personal names needed | Opinions on the deal |
A completed brief (Illustrative)
The values below describe a fictional 350-person medical billing company in the U.S. They are Illustrative: not a real company, case or deal, and no figure is a forecast.
- Company: medical billing company serving physician groups, about 350 full-time staff at peak, United States.
- Business task: sending each payer denial to the coding, authorization, eligibility or credentialing team that can fix its cause, and tracking the fix to payment.
- Record classes: line-level denial reasons as received; routing rules with change history and reasons; resolved cases with resolution codes; a cause-to-team map for reason codes; queue work instructions.
- Systems: billing system that receives 835 remittances; denial case manager being replaced this year; team-lead spreadsheets for payer-specific exceptions.
- History: about seven years of resolved cases; rule change log kept for three years; spreadsheets for four.
- Volume: several thousand denied lines a month, from the billing system's denial report, read by the VP of billing operations.
- Access event: the old case manager becomes read-only when the new tool goes live and is retired six months later, per the vendor contract.
- Open question: when one denial had several causes, does the resolved case show each cause's route and fix, and will rule versions survive the switch?
- Authority: VP of billing operations as sponsor; CEO as decision-maker; compliance officer reviewing client agreements and HIPAA obligations.
Notice what is absent: no client names, no payer names, no counts per client, no revenue figures. Because this is a billing company, most claim-level history belongs to client providers. HHS's summary of the Privacy Rule notes that a provider remains covered whether it sends claims itself or through a billing service, so the provider's agreement with the billing company sets what the company may do with that history. The rule sets, cause-to-team map and work instructions are the company's own, which is worth an optional tenth line.
Field notes specific to denial routing
Record classes (field 3). Name each class separately, because each sits in a different place and has a different rights answer. Denial reasons arrive as X12 Claim Adjustment Reason Codes; routing rules translate them into team assignments; resolved cases record the fix. "Denial data" alone tells SourceX nothing about which of these the company kept.
Access event (field 7). Only a documented event counts: a vendor contract end date, a project cutover, a retention schedule. Do not create urgency.
Open question (field 8). The hardest case is one denial with several causes, such as a two-line claim where one line lacks authorization and the other has a billing error. The exception examples page walks through one.
Authority (field 9). Sponsor and decision-maker are rarely the same person; the who-can-say-yes decision tree helps fill this line.
Checks before the brief is forwarded
- Metadata only. Every line describes records; none contains one.
- Company qualification. The introduced company needs 50+ full-time employees at peak (contractors excluded), documented operating history, rights to license and an authorized contact. Companies in the U.S., Canada and the EU qualify, as do companies in the UK, Australia, New Zealand, India, Singapore, South Africa, Latin America, the UAE and Saudi Arabia when at least 90% of the data is in English.
- Sponsor approval. The sponsor has read it and will forward it.
- Partner paperwork. You have signed the Channel Partner Agreement; the first valid introduction within the 90-day window is credited when the company submits a verified application.
- Unknowns stated. Buyer interest, the rights result, the de-identification required and any offer stay unknown until SourceX reviews the opportunity.
SourceX licenses approved business data directly from companies for AI training and evaluation and manages the agreement, rights review, data preparation, delivery and payout. The client opportunity brief generator can format the nine lines, and the warm introduction brief helps frame the first conversation. For the wider sector, see healthcare operations and how to sell a medical billing company.
Next step
Refer a company. Earn up to $100,000. Default reward: 25% of Actual Supplier Payout, capped at $100,000 cumulatively per referred company. Eligibility and payment conditions apply, and a signed Schedule A or addendum can differ. A lead, meeting or signature alone does not trigger payment.
When all nine fields are filled and the revenue cycle head is ready to forward the brief, register as a partner, confirm the company on who qualifies and read the program terms before you submit the introduction.