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Agent Architecture & Ecosystem
Workers' Compensation · Operations · Agentic AI
Client Deployment Framework
Build Principles — How Agents Are Deployed in Your Environment
Every agent is built to be owned, audited, and operated by the client — not a black box
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Modular
Each agent is a standalone, independently deployable module with defined inputs, outputs, and handoffs. Swap, extend, or replace any module without touching the rest.
One agent per business function
Standardized input/output contracts
Configurable rules per carrier or state
Add agents incrementally — no big bang
Plug into existing workflows via API or file
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Auditable
Every decision the agent makes is logged, explainable, and traceable. You can see exactly what the agent read, what it extracted, and why it acted — at every step.
Full decision log per episode
Source attribution — which doc, which field
Human override at every stage
Immutable audit trail for regulators
Confidence scores on extracted fields
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Deployable in Your Environment
Agents run in your cloud, using your credentials, your LLM contract, and your data stores. No shared infrastructure. PHI never leaves your environment.
Deploys to AWS, Azure, or GCP
Uses your OpenAI / Azure OpenAI contract
Integrates with your claims system via API
HIPAA-compliant data residency
Client owns all code, data, and models
Full Agent Ecosystem — End-to-End WC Operations
10 agents covering the complete referral-to-payment lifecycle · Built incrementally · Human in the loop throughout
Intake & Authorization
Intake Agent
Processes fax & voice referrals, extracts all fields, resolves gaps via email & AI call, routes complete episode
Fax + Voice
Gap Resolution
24/7 Live Line
Authorization Agent
Submits prior auth requests, tracks approval status, escalates denials, and updates episode record automatically
Auth Submission
Status Tracking
Denial Mgmt
Compliance Agent
Checks state-specific WC rules, carrier requirements, and documentation completeness before any episode proceeds
State Rules
Carrier Logic
Doc Check
Scheduling & Fulfillment
Scheduling Agent
Books delivery or fitting appointments, sends confirmations, manages reschedules, coordinates interpreter and transport needs
Auto-Book
Reminders
Transport Coord
Fulfillment Agent
Dispatches order to preferred vendor, tracks delivery status, confirms receipt with patient, closes fulfillment loop
Vendor Dispatch
Delivery Track
Receipt Confirm
Patient Communication Agent
Sends appointment reminders, delivery ETAs, and equipment instructions in the patient's language via SMS or voice call
Multilingual
SMS + Voice
Instructions
Billing & Intelligence
Billing Agent
Generates claims from episode records, submits to carrier, processes ERAs, flags denials, and manages resubmission workflow
Claim Submit
ERA Process
Denial Mgmt
Triage & Priority Agent
Scores every referral by medical urgency, re-injury risk, and carrier SLA — surfaces critical cases to coordinators immediately
Risk Scoring
SLA Watch
Escalation
Analytics & Audit Agent
Monitors cycle times, error rates, and exception patterns across all agents — produces reports for ops leaders and regulators
Cycle Time
Audit Logs
KPI Reports
Referral-to-Payment Flow — All Agents in Sequence
Human in the loop at every flagged exception — agents handle the straight-through path autonomously
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Gap Resolve
Email + Call
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Schedule
Appt + transport
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Fulfill
Dispatch + deliver
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Patient Comm
Confirm + instruct
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Built & live today
Next phase
Roadmap
100%
Client-Owned & Deployable