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TOTAL REFERRALS
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Click ▶ Demo on James Holloway to walk through the full intake pipeline. Click View on any referral to see its episode record and place an outbound call. Live inbound line: (201) 897-3854.
🔀 Select Intake Channel
Fax / Document
PDF, image scan, or text referral with attached clinical notes
Inbound Voice Call
Case manager calls in — AI conducts live intake interview
📂 Referral Package — Document Checklist
WC-2026-084431_ReferralForm.pdf
Fax — Image PDF
✓ Received
View ›
WC-2026-084431_ClinicalNotes.pdf
Physician Notes
✓ Received
View ›
WC-2026-084431_RxPrescription.jpg
Scanned Image
✓ Received
View ›
Authorization Document
Auth / Insurance
⚠ Missing
View ›
Step 1 — Channel Intake
Extracting fields from referral package
🔍 Extraction Results — All Documents
§1 · Worker Details
worker.name
James Holloway
Referral Formworker.dob
1978-03-14
Referral Formworker.address
4821 Elmwood Dr, Anaheim CA 92801
Referral Formworker.language / interpreter
Not found
Missing§2 · Insurance Details
insurance.carrier
Coastal Insurance Group
Referral Forminsurance.claim_number
WC-2026-084431
Referral Forminsurance.auth_reference
Not found
Missing§3 · Adjuster Details
adjuster.name
Maria Santos
Referral Formadjuster.phone / email
714-555-0192 · m.santos@coastalins.com
Referral Formadjuster.case_manager_name
Linda Torres
Fax Coveradjuster.case_manager_email
l.torres@coastalins.com
Fax Cover§4 · Provider Details
provider.name
Kevin Marsh, MD
Clinical Notesprovider.npi
1234567890
Clinical Notesprovider.practice
Pacific Orthopedic Associates
Clinical Notes§5 · Diagnosis Details
diagnosis.icd10_codes
S83.209A
Clinical Notesdiagnosis.description
Post-ACL reconstruction, right knee
Clinical Notesdiagnosis.body_part
Right knee
Clinical Notesdiagnosis.surgical_history
ACL reconstruction 2026-03-28
Clinical Notes§6 · Services Requested
services.item_description
Rollator Walker — 4-wheel
Referral Formservices.hcpcs_code
E0143
Referral Formservices.clinical_justification
Bariatric rating required (285 lbs). Post-ACL instability.
Clinical Notes§7 · Prescription Details
prescription.item
Rollator Walker, 4-Wheel
Rx Prescriptionprescription.specifications
— not specified
Rx Prescriptionprescription.signed_by
Kevin Marsh, MD
Rx Prescriptionprescription.signed_date
2026-04-25
Rx Prescriptionprescription.no_substitution
true
Rx Prescription§8 · Provider Notes
provider_notes.clinical_narrative
Patient 4 wks post-op ACL repair. Limited weight-bearing. ROM 0–65°.
Clinical Notesprovider_notes.functional_status
Ambulatory with assistance, fall risk
Clinical Notesprovider_notes.treatment_plan
PT 3x/week. Reassess at 6-week follow-up.
Clinical Notesprovider_notes.follow_up_date
2026-05-28
Clinical Notes§9 · Appointment Window
scheduling.appointment_window
Not found
Missingscheduling.transportation
Not found
MissingStep 2 — Normalization
Raw extracted data mapped to standard Episode Record format
📋 Episode Record — Normalized
worker.name
James Holloway
worker.dob
1978-03-14
worker.address
4821 Elmwood Drive, Anaheim, CA 92801
worker.language
null
worker.interpreter
null
insurance.carrier
Coastal Insurance Group
insurance.claim_number
WC-2026-084431
insurance.auth_reference
null
adjuster.name
Maria Santos
adjuster.phone
+17145550192
adjuster.email
m.santos@coastalins.com
adjuster.case_manager_name
Linda Torres
adjuster.case_manager_email
l.torres@coastalins.com
provider.name
Kevin Marsh
provider.npi
1234567890
provider.practice
Pacific Orthopedic Associates
provider.phone
+17145552200
diagnosis.icd10_codes
S83.209A
diagnosis.description
Post-ACL reconstruction, right knee
diagnosis.body_part
Right knee
diagnosis.surgical_history
ACL reconstruction 2026-03-28
services.item_description
Rollator Walker — 4-wheel
services.hcpcs_code
E0143
services.quantity
1
services.duration
90 days
services.clinical_justification
Bariatric rating req. (285 lbs). Post-ACL instability.
prescription.item
Rollator Walker, 4-Wheel
prescription.specifications
not specified
prescription.signed_by
Kevin Marsh, MD
prescription.signed_date
2026-04-25
prescription.no_substitution
true
provider_notes.clinical_narrative
4 wks post-op ACL repair. Limited weight-bearing. ROM 0–65°.
provider_notes.functional_status
Ambulatory with assistance, fall risk
provider_notes.treatment_plan
PT 3x/week. Reassess 6-week follow-up.
provider_notes.follow_up_date
2026-05-28
scheduling.appointment_window
null
scheduling.transportation
null
episode.channel
fax
episode.status
incomplete
Step 3 — Intelligence Layer
Validate, score, fix codes, check duplicates, and determine authorization before outreach
🔁 Duplicate Detection
No duplicate episode found. Checked against claim number WC-2026-084431 and patient James Holloway / 1978-03-14 — no existing open or routed episode matches.
✅ Compliance Validation
✅
ICD-10 S83.209A — Active code, valid format, matches injury description
✅
HCPCS E0143 — Active code, valid format, matches rollator walker description
✅
HCPCS ↔ Diagnosis match — E0143 (rollator walker) is appropriate for S83.209A (knee injury, post-surgical)
✅
Prescription date 2026-04-25 — Valid, within 12 months
✅
NPI 1234567890 — Valid 10-digit format
⚠️
Code auto-corrected: HCPCS input was
e0143 (lowercase) → normalized to E0143🔧 Service Clarification
✅
Item confirmed: Rollator Walker (4-wheel) is appropriate for post-ACL surgical recovery with fall risk. HCPCS E0143 matches diagnosis.
⚠️
Spec mismatch flagged: Prescription does not specify frame size or weight capacity. Clinical notes indicate patient weight is 285 lbs — standard rollator is contraindicated. Bariatric specification (400 lb capacity) is required. prescription.specifications is null → added to gap list. Case manager confirmation required before vendor dispatch.
🔑 Authorization Determination
🔑
Prior authorization REQUIRED — Coastal Insurance Group requires prior auth for HCPCS E0143 (rollator walker). insurance.auth_reference is null → added as priority gap. Routing is blocked until resolved.
📊 Risk & Urgency Score
4
CLINICAL RISK
Post-surgical, fall risk
3
URGENCY
Appt within 1 week
7
PRIORITY SCORE
MEDIUM
Summary: Post-surgical ACL recovery with fall risk (risk: 4). Appointment window not yet confirmed but referral is within standard scheduling window (urgency: 3). Prior authorization required and missing — this is the primary blocker. Code E0143 validated and corrected to uppercase. No duplicate found. Episode is ready for completeness check and CM outreach to resolve 5 missing fields.
Step 3 — Completeness Check
Episode Record compared against required fields
4 required fields are null. Package incomplete — proceeding to digital outreach.
✅ Present (20 / 25 required fields)
✓ §1 worker.name
✓ §1 worker.dob
✓ §1 worker.address
✓ §2 insurance.carrier
✓ §2 insurance.claim_number
✓ §3 adjuster.name + email
✓ §3 case_manager.name + email
✓ §4 provider.name + npi
✓ §5 diagnosis.icd10_codes
✓ §5 diagnosis.description
✓ §6 services.item + hcpcs
✓ §6 services.clinical_justification
✓ §7 prescription.item
✓ §7 prescription.signed_by + date
✓ §8 provider_notes.clinical_narrative
🔴 Gap List — 5 Fields Required from Case Manager
- 🔑 §2 insurance.auth_reference — Authorization reference number
- 🌐 §1 worker.language / worker.interpreter — Primary language
- 📅 §9 scheduling.appointment_window — Preferred date + time range
- 🚗 §9 scheduling.transportation — Transportation confirmation
- ⚖️ §6 item.specification — Equipment spec not confirmed for patient context (weight 285 lbs — bariatric required)
Step 4 — Digital Outreach
Agent emails case manager requesting only the 5 missing fields
📧 Outreach Email — Sent
To:Linda Torres <l.torres@coastalins.com>
Subj:Action Required — Missing Info · Referral [WC-2026-084431]
Sent:2026-05-01 09:02 · via email
Hi Linda,
Thank you for the referral for James Holloway (DOB: 1978-03-14, Claim: WC-2026-084431).
To complete coordination, we still need:
🔑 Authorization reference number
📅 Appointment window — preferred date and time range
🚗 Transportation — will the patient need a ride arranged?
🌐 Language / interpreter — patient's primary language?
⚖️ Equipment specification — confirm bariatric spec for patient weight (285 lbs)
Please reply within 24 business hours. If we don't hear back, our coordination agent will follow up by phone.
Thank you,
Intake Coordination Agent
No response received after 24 business hours. Escalating to outbound voice call.
Step 5 — Voice Outreach
No email response — agent places outbound AI call to case manager
Calling Linda Torres at +1 (714) 555-0198 · Outreach attempt #2
📞 Outbound Call — Transcript
Call complete
01:48
AGENTHi, this is the Intake Coordination Agent calling for Linda Torres. I'm following up on the referral for James Holloway, claim WC-2026-084431. We sent an email yesterday but haven't heard back. Do you have a moment?
CMYes, sorry about that — I've been swamped. Go ahead.
AGENTNo problem at all. We just need five things. First — do you have the authorization reference number for this claim?
CMYes it's AUTH-2026-CIG-7741.
AGENTGot it — AUTH-2026-CIG-7741. Next, what's the preferred appointment window for the equipment delivery?
CMCan you do May 5th, between 10 and noon?
AGENTPerfect — May 5th, 10 AM to 12 PM. Will the patient need transportation arranged?
CMNo, he'll drive himself.
AGENTConfirmed — patient self-transports. What's the patient's primary language and does he need an interpreter?
CMEnglish, no interpreter needed.
AGENTGot it. Last one — the prescription lists a rollator walker but doesn't specify bariatric. Our records show patient weight at 285 lbs, which requires a bariatric frame. Can you confirm bariatric specification is correct?
CMYes, bariatric — 4-wheel, 400 lb capacity. Sorry that wasn't on the form.
AGENTConfirmed — bariatric rollator, 4-wheel, 400 lb capacity. To recap: auth AUTH-2026-CIG-7741, May 5th 10–noon, self-transport, English no interpreter, bariatric spec confirmed. All correct?
CMYes that's right.
AGENTThank you Linda. Your referral is now complete. We'll coordinate the delivery and follow up with a confirmation. Have a great day!
All 5 missing fields captured from call. Episode Record updated. Running completeness check.
Try it live — place a real outbound call
Vapi AI calls (407) 625-9532 and asks for the 5 missing fields on Holloway's referral
Step 6 — Route State Output
Episode complete. Normalized record locked and dispatched.
All required fields confirmed across both channels. Saved to output/dme-intake-WC-2026-084431-20260501.md
Referral — Route State
Episode: EP-20260501-WC2026084431 · Completed: 2026-05-01 11:52
ROUTED
§1 · Worker
worker.name
James Holloway
worker.dob
1978-03-14
worker.address
4821 Elmwood Drive, Anaheim, CA 92801
worker.language / interpreter
English / false ✦ via call
§2 · Insurance
insurance.carrier
Coastal Insurance Group
insurance.claim_number
WC-2026-084431
insurance.auth_reference
AUTH-2026-CIG-7741 ✦ via call
§3 · Adjuster
adjuster.name
Maria Santos
adjuster.phone / email
+17145550192 · m.santos@coastalins.com
case_manager
Linda Torres · l.torres@coastalins.com
§4 · Provider
provider.name / npi
Kevin Marsh, MD / 1234567890
provider.practice
Pacific Orthopedic Associates
§5 · Diagnosis
diagnosis.icd10_codes
S83.209A
diagnosis.description
Post-ACL reconstruction, right knee
diagnosis.body_part
Right knee
diagnosis.surgical_history
ACL reconstruction 2026-03-28
§6 · Services Requested
services.item_description
Rollator Walker — 4-wheel, bariatric
services.hcpcs_code
E0143
services.quantity / duration
1 / 90 days
services.clinical_justification
Bariatric rating req. Post-ACL instability.
§7 · Prescription
prescription.item
Rollator Walker, 4-Wheel, Bariatric
prescription.specifications
285 lb capacity, 4-wheel
prescription.signed_by / date
Kevin Marsh, MD / 2026-04-25
prescription.no_substitution
true
§8 · Provider Notes
provider_notes.clinical_narrative
4 wks post-op ACL. Limited weight-bearing. ROM 0–65°.
provider_notes.functional_status
Ambulatory with assistance, fall risk
provider_notes.treatment_plan
PT 3x/week. Reassess 6-week follow-up.
provider_notes.follow_up_date
2026-05-28
§9 · Scheduling
scheduling.appointment_window
2026-05-05 · 10:00–12:00 ✦ via call
scheduling.transportation
self ✦ via call
Intake Metadata
episode.channel
fax
outreach.last_channel
voice
outreach.attempts
2