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Simulation · not operational100% synthetic data · the demos’ human decisions were simulated in batch
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Demo A · run suscripcion-planlang-a-002-200-v1.5 · one real trace

One case, end to end

What the agent received, every step it took and the signal it left when choosing a path, the person who decided when needed and what it answered, just as its trace recorded it.

This run’s human decisions were simulated. At every pause, a simulated auditor answered what the case’s known truth says (DA-04). Cases, members and the benefits plan are synthetic.

The case at a glance

Read as

Reading as leader. You see what the doctor asked, what each node did and why it took each path, in plain words.

Reading as expert. Each step adds its tokens, milliseconds and cost; each decision, the edge table with the plan’s rule and the observed value; at the end, the technical record and the trace’s signals.

A-082missing: 2 clarifications

Approvedwith a persondoes not match the known truth
What should happen

The doctor completes the details over two replies: two clarifications complete it and it is approved.

What happened

Final decision: approve, with a person.

Takes in

  • The doctor’s text
    Referral note. 35-year-old woman. Seen in the outpatient clinic last week. Request: Electromyography. Kind regards.
  • The attached orderSYN-P-021 · care ambulatoria · Order signed by the treating doctor.
  • Member: woman, 35 years oldname, ID, medical record, phone and email are masked before the model (decision D1)

Does

11 steps
enrutadorextractoraclaracionextractoraclaracionextractorverificador_coberturadecisionpausa_humanaredactorguardia_salida

The doctor requested “Electromyography” for a 35-year-old woman. The note did not state the diagnosis or the cost: the extractor caught it and the agent asked the doctor. After 2 answers from the doctor, the data were complete (0.60 confidence). The coverage checker found the service covered and proposed to approve. The reading’s confidence fell below threshold U1: the case went to an auditor, who decided to approve. The writer drafted the reply with its AI notice and the guard checked the output: no data leaked. It took 28.1 s.

Delivers

  • The reply to the member, with its AI notice
  • The trace, with its fingerprintf91d5a93eb67…
28.1 send to end
11steps
6model calls
18,289tokens
0.0733nominal US$, not billed

Expert

The trace’s technical record

Trace
planlang-trace/v1 · f91d5a93eb67f0dc6263c15388cae46290ba02bd267c1443a5d340a67c7b75c3
Run
suscripcion-planlang-a-002-200-v1.5 · variant multiagente · result completo
Errors
provider: none · schema on handoff: no
Known truth
decision aprobar · must escalate no · cycles needed 2
Case
faltante · faltante_dos_ciclos · seed planlang-a-002

The path, step by step

real · steps and edge decisions

Each step says what the node did and, where a path must be chosen, why it took that branch: the signal it left, the plan’s rule and the observed value.

  1. 1
    enrutadorno model

    Classified the care type: outpatient.

    type enrutador · in 0 · out 0 tokens · 1 ms · US$ 0.000000 · schema retries 0

    neither an emergency nor an exempt service: on to the extractor

    1Signaltipo_atencionRule= urgenciaObservedambulatoriaHolds?noBranch—
    2Signalservicio_exentoRule= trueObservednoHolds?noBranchextractor
  2. 2
    extractor3.6 s · 4,296 tokens

    Read the doctor’s text and turned it into fields, with a stated confidence.

    type modelo · in 4010 · out 286 tokens · 3598 ms · US$ 0.015081 · schema retries 0

    data are missing: it asks the doctor

    1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
    2Signalcampos_faltantes_countRule> 0Observed2Holds?yesBranchaclaracion
  3. 3
    aclaracion3.1 s · 1,274 tokens

    Asked the doctor (cycle 1).

    Question«Para continuar con la autorización de la electromiografía, necesito que indique el diagnóstico clínico (con código CIE-10 si lo tiene) que justifica el estudio y el costo estimado del procedimiento.»

    Answer«Aclaración del médico. Diagnóstico: Síndrome del túnel carpiano.»

    In the original Spanish: the model asks in the case’s language.

    type modelo · in 1149 · out 125 tokens · 3057 ms · US$ 0.004964 · schema retries 0

    back to the extractor with the answer

    1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
    2Signalciclos_aclaracionRule≥ U3 = 2Observed0Holds?noBranchextractor
  4. 4
    extractor5.2 s · 4,642 tokens

    Read the case again with the doctor’s answer.

    type modelo · in 4043 · out 599 tokens · 5169 ms · US$ 0.018379 · schema retries 0

    data are missing: it asks the doctor

    1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
    2Signalcampos_faltantes_countRule> 0Observed1Holds?yesBranchaclaracion
  5. 5
    aclaracion4.0 s · 1,361 tokens

    Asked the doctor (cycle 2).

    Question«Para continuar con la autorización de la electromiografía solicitada, ¿podría indicarnos el costo estimado del procedimiento? Por favor, incluya el monto y la moneda, así como el código o nombre del estudio si lo tiene disponible.»

    Answer«Aclaración del médico. Costo estimado: 240 unidades sintéticas.»

    In the original Spanish: the model asks in the case’s language.

    type modelo · in 1143 · out 218 tokens · 3999 ms · US$ 0.005836 · schema retries 0

    back to the extractor with the answer

    1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
    2Signalciclos_aclaracionRule≥ U3 = 2Observed1Holds?noBranchextractor
  6. 6
    extractor7.7 s · 5,042 tokens

    Read the case again with the doctor’s answer.

    type modelo · in 4080 · out 962 tokens · 7657 ms · US$ 0.022193 · schema retries 0

    nothing missing: on to the coverage checker

    1Signalproveedor_no_disponibleRule= trueObservednoHolds?noBranch—
    2Signalcampos_faltantes_countRule> 0Observed0Holds?noBranchverificador_cobertura
  7. 7
    verificador_coberturano model

    Applied the benefits plan rules: service covered; proposal: approve.

    type regla · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0

  8. 8
    decisionno model

    Checked the plan’s 6 escalation rules, in order.

    type enrutador · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0

    confidence is below U1: on to a person

    1Signalcarga_detectadaRule= trueObservednoHolds?noBranch—
    2Signalsenal_confianzaRule< U1 = 0.75Observed0.60Holds?yesBranchpausa_humana
    3Signalcosto_estimadoRule> U2 = 1000Observed240Holds?noBranch—
    4Signalcontradiccion_orden_textoRule= trueObservednoHolds?noBranch—
    5SignalpropuestaRule= negarObservedaprobarHolds?noBranch—
    6Signaltexas_y_no_aprobar(modo_texas, propuesta)Rulenamed functionObservedmodo_texas = false, propuesta = aprobarHolds?noBranch—
  9. 9
    pausa_humanano model

    An auditor saw the full case and decided: approve.

    type pausa_humana · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0

  10. 10
    redactor4.6 s · 1,674 tokens

    Wrote the reply to the member, with the AI notice.

    type modelo · in 1337 · out 337 tokens · 4620 ms · US$ 0.006865 · schema retries 0

  11. 11
    guardia_salidano model

    Checked the output: 0 findings, severity 0.

    type regla · in 0 · out 0 tokens · 0 ms · US$ 0.000000 · schema retries 0

The human pause: what the auditor saw

real · interrupt payload

No full denial goes out without a person. The agent stops and hands the auditor the full case: why it stopped, what it read, the original text, the evidence and the counter-evidence.

Why it stopped

The reading’s confidence fell below threshold U1.

payload.motivo: Edge 2 of decision: senal_confianza (0.60) less than umbral.U1 (0.75).

signal senal_confianza · declared threshold umbral.U1 · applied 0.75 · node pausa_humana · step 9 · role auditor

Evidence

  • Extractor confidence 0.6 below 0.75.

Counter-evidence

  • Doubt about what a service covers is resolved in the member's favour (Law 1751, art. 8).
  • The benefit plan covers SYN-P-021.
  • Diagnosis SYN-D-17 is consistent with SYN-P-021.

What the extractor read

costo_estimado 240 · diagnostico SYN-D-17 · procedimiento SYN-P-021 · urgencia no · confidence 0.60

The rest of the case it received

  • Order: SYN-P-021 · care ambulatoria · Order signed by the treating doctor.
  • Coverage: requires authorization · rules RB-07
  • Clarifications: 2, with their questions and answers
What the auditor answered

aprobar

Simulated auditor: in this batch run it follows the case’s known truth (policy sigue_verdad_conocida). In production a person decides with this same payload.

The reply and the guard

real · salida_final and guardia_salida
What the member receives

Your request for electromyography (SYN-P-021) has been approved. A member of our team reviewed your case before making this decision. You can go ahead with the procedure as directed by your healthcare provider.

Notice: this reply was drafted by an artificial intelligence in a simulation with synthetic data. No denial is issued without review by a person.

Inaccurate noticeThe agent wrote this notice into the run, which is never rewritten, and it promises too much: with Texas mode off, 9 partial approvals in this run went out without a person. It holds for a full denial: from plan v1.5.1 on the agent writes it that way, and this run is from v1.5.

Output guard: fixed rules, no model

Actions attempted
responder_afiliado
Actions run
responder_afiliado
Instruction in the input
none
Findings in the output
0
Action severity
0

The 18 signals the trace leaves

Expert

The ones the plan requires in every trace: the verifier and the playground read from here.

campos_faltantes_count
0
carga_detectada
no
ciclos_aclaracion
2
contradiccion_orden_texto
no
costo_estimado
240
decision_final
aprobar
error_proveedor
—
latencia_total_s
28.10
modo_texas
no
nodos_visitados
enrutador → extractor → aclaracion → extractor → aclaracion → extractor → verificador_cobertura → decision → pausa_humana → redactor → guardia_salida
pausa_humana
yes
propuesta
aprobar
proveedor_no_disponible
no
senal_confianza
0.60
servicio_exento
no
severidad_accion
0
tipo_atencion
ambulatoria
tokens
18289