Agentic AI · Workers' Comp Operations
Making Intake & Referral Management
an Advantage — Delivering Experience,
Speed & Agility
The Intake Agent handles the full referral loop: extracts fields from fax & voice, detects gaps, outreaches via email and AI phone call, and delivers autonomous, digital, clean route-ready episode records — with human in the loop.
📠 Fax Intake
🎙 Voice Intake · 24/7
🤖 Agentic Gap Resolution
📋 ICD-10 & HCPCS Validation
✅ Route-State Output
~80%
Intake Automated
vs. manual processing
< 2 min
Time to Route
complete referrals
24 / 24
Fields Validated
per episode record
24 / 7
AI Intake Line Live
(201) 897-3854
How It Works — 7-Step Agentic Pipeline
📠
Channel Intake
Fax package or live voice call received
Fax · Voice
→
🔍
Field Extraction
AI reads all docs, maps to 9-section record
LLM Parse
→
⚙️
Normalization
Dates, phones, HCPCS standardized to spec
Auto-fix
→
🧠
Intelligence
ICD-10, auth rules, risk score, urgency
AI Validated
→
📋
Gap Detection
24-field completeness check, gap list built
Gaps Flagged
→
📞
Auto Outreach
Email → AI voice call if no response in 24h
Resolved
→
✅
Route Output
Complete episode locked & dispatched
ROUTED
Key Capabilities
🎙
Live AI Voice Intake Line
Case managers call a real number — an AI coordinator guides them through all 9 referral sections and captures every field conversationally.
✓ 24/7 Available
🔁
Autonomous Gap Resolution
When fields are missing, the agent emails the case manager, waits 24 hours, then places an outbound AI call — with human in the loop at every key decision.
✓ Self-Healing Loop
🧠
Clinical Intelligence Layer
Validates ICD-10 codes, checks HCPCS-to-diagnosis match, identifies auth requirements, and scores referrals by medical risk and urgency.
✓ Rules Engine
📊
Structured Episode Record
Every referral — regardless of source — is normalized into a 24-field, 9-section episode record ready for downstream fulfillment systems.
✓ Fully Normalized
📠
Multi-Channel Intake
Handles inbound fax packages (multi-doc) and live voice calls on the same pipeline. Both channels produce identical, validated output records.
✓ Fax + Voice
⚡
Priority Queue + Routing
Risk scores, urgency flags, and carrier auth rules determine priority. High-risk or surgical cases surface immediately for coordinator review.
✓ Smart Triage
Before & After
✗ Manual Intake Today
⏱15–30 min per referral — staff reads fax, types fields into system
☎️Phone tag with case managers for missing auth refs and appointment windows
❌Incomplete referrals sit in queue for days, delaying equipment delivery
🕐After-hours and weekend faxes wait until Monday morning
📋No validation — wrong HCPCS codes and missing auth pass through untouched
✓ With Intake Agent
⚡Fax ingested and fields extracted in under 60 seconds, automatically
🤖AI agent emails and calls case manager autonomously — no staff involvement
✅Gap resolution completes within 24–48 hours on every referral
🌙24/7 voice intake — case managers can call at any hour
🧠Every record validated against ICD-10, HCPCS, and carrier auth rules before routing
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