A concept for Equipia
Equipia finds the gap. Agents close it.
Equipia already reads the chart and knows exactly what's missing. The days and staff hours go into what happens next: writing the request, following up, matching the reply, writing the appeal. Agents take that part over, and your team approves anything clinical.
Concept prepared by Ian Harman. Patients, practices and queue counts are synthetic. Dollar figures are estimates you can change.
What it's worth
An estimate for a mid-size bracing supplier
Every input is a starting guess. Change any of them to your own numbers and the totals update.
How the estimate works
- 0 orders a month hit a documentation gap. Staff time on them drops from 0 hours to 0, because a person only reviews and approves the agent's request.
- Fewer gap orders are abandoned because no follow-up is forgotten: 0 more completed orders a month at the average payment.
- 0 claims a month are denied. Agents draft the appeals, so more get filed; at the win rate, 0 more are paid.
- Not counted: audit packet prep, prior auth status checks, fewer rep calls to the office, patient cost texts.
Same order, two ways
One knee brace order
The referral is missing one thing Medicare requires: an exam finding of knee instability. Equipia catches it in seconds either way. What changes is what happens next. Illustrative, not measured.
Equipia today
9 days · 5 touches- Mon 9:03Rules engine flags the missing exam finding.
- Mon–TueOrder waits in the queue behind new referrals.
- Tue 11:30Intake writes a request and faxes the doctor's office.15 min
- Wed–ThuNo reply. Nobody follows up; intake is on new referrals.
- Fri 3:00Rep calls asking where the order is. Intake calls the office: the fax never reached the right person. Resends it.20 min
- Next TueAddendum lands in the shared fax inbox and sits overnight.
- Next WedIntake attaches it to the order and re-runs the check. Ready to dispense.20 min
Equipia with agents
25 hours · 1 touch- Mon 9:03Rules engine flags the missing exam finding.
- Mon 9:04Agent drafts a request naming exactly what's missing and checks it against the payer rules.
- Mon 9:11Intake approves it from the Agent Desk. Agent faxes it.2 min
- Mon 2:40No reply, so the agent calls the office the same day and confirms the right person has it.
- Tue 10:15Addendum arrives. Agent matches it to the order within a minute.
- Tue 10:16Rules engine re-runs: all criteria met. Ready to dispense. Rep and patient notified.
What your team would see
Three screens
Agents live inside Equipia. Staff work one queue, every order shows what the agent did, and reps get answers from their phone.
1 · Agent Desk
One queue for everything agents are working on. They stop only where a person should decide.
Agent Desk
Synthetic demo data
Needs your approval
Visit note doesn't document knee instability on exam (LCD L33318). Agent drafted a specific addendum request to Dr. A. Patel's office.
Written order is missing the practitioner's NPI. Agent prepared a corrected-order request through the practice's portal.
Denied as not medically necessary. Agent drafted a redetermination citing the LCD criteria the chart meets, with notes, order and delivery proof attached.
Agent assembled the packet from the order: written order, visit notes, delivery ticket and patient signature. Nothing missing.
Guardrails
Agents act inside Equipia, never around it.
- Every outbound request is checked against the payer rules first.
- Clinical requests and appeals wait for a person. Follow-ups and status checks don't.
- Every step is logged on the order, so the audit trail writes itself.
- Patient data stays in Equipia.
| Patient | Item | What the agent is doing | Waiting on | Next step |
|---|---|---|---|---|
| T. Brooks | L1833 | Requested signed order by fax | Lakeside Ortho | Call the office tomorrow, 9:00 |
| A. Nguyen | L3916 | Submitted prior authorization on payer portal | Payer | Check status every 4 hours |
| D. Price | L0650 | Reply received, re-running payer rules | Nothing | Mark ready to dispense |
| S. Patel | L1851 | Texted patient their cost and a payment link | Patient | Schedule delivery once paid |
| L. Moore | L4361 | Resupply eligibility check | Nothing | Open new order on the eligible date |
2 · One order, one closed loop
Every order shows what the rules engine found, what the agent did about it, and who approved what.
J. Doe · Knee orthosis
Ready to dispenseOpened with 1 documentation gap. Closed by the agent in 25 hours, with one human approval.
Order
- Item
- L1833
- Payer
- Medicare Part B
- Policy
- LCD L33318
- Referred by
- Dr. A. Patel
- Source
- Fax
Rules engine checklist
- MetWritten order complete
- MetPractitioner visit note on file
- MetKnee instability on exam Was missing; closed by agent
- NextSigned proof of delivery triggers the claim
What happened
- Mon 9:02Referral arrived by fax. Equipia extracted the order, insurance card and visit note.Equipia today
- Mon 9:03Rules engine flagged 1 gap: knee instability not recorded on exam, which L33318 requires.Equipia today · usually lands on a person here
- Mon 9:04Agent drafted a request for exactly what's missing and checked it against payer rules.Agent
- Mon 9:11Intake approved it. Agent faxed Dr. Patel's office.Person
- Mon 2:40No reply, so the agent called, confirmed receipt, and set a follow-up for the morning.Agent
- Tue 10:15Addendum arrived. Agent matched it and extracted the exam findings.Agent
- Tue 10:16All criteria met. Ready to dispense; rep and patient notified.Equipia + agent
The request the agent sent
Thank you for referring this patient. Before we can dispense, Medicare needs the visit record to show knee instability found on exam.
Could you send an addendum to the 10/22 note describing the instability you observed and how it was tested? Nothing else is needed.
3 · Rep assistant
Reps ask, the agent answers
Reps get order status and the exact ask for the doctor's office from their phone, without calling intake.
- Knows every order the rep owns and what it's waiting on.
- Gives the rep the one-line ask to hand the office in person.
- Texts them the moment an order is ready to dispense.
Ask about your ordersProposed next step
Prove it on one workflow
Start with the missing-documentation chase. Measure it before and after, so the number in the calculator becomes a number you can show customers and investors.
- Step 1BaselineMeasure days from gap flagged to gap closed, and staff touches per order, on today's process.
- Step 2Run the agentAgents chase missing documentation on live orders. Your team approves every outbound request.
- Step 3CompareSame two measures, side by side. Decide what to extend next: denials, prior auth, or audits.