Synthetic data prototype — no PHI. Numbers, names, and IDs are fabricated for design review only.

Patient 360

Longitudinal Episode View

Search a synthetic patient or episode to inspect discharge → TCM → PCM → billing → outcomes end-to-end.

Robert Davis

PT-000004 · USC-900004 · EPI-2026-0004

PCM ActiveMedium riskCommercialStones

Specialist Post-SurgicalPost-Surgical SPOCDischarge ListAI 46%Urology Post-Surgical RecoveryLongitudinalTCMDMEPost-Acute

NBA: Verify DME delivery + patient education

Reason codes: POLYPHARMACY, HIGH_LOS

Outreach

PCM Min.

Paid $

$174

Age / Sex

71 · M

ZIP

90046

Language

English

Payer

Anthem Blue Cross

Procedure

Stone Removal

Surgeon

Dr. Rebecca Lim

Surgery Site

USC Pasadena Surgery Center

Surgery Date

Feb 13, 2026

Discharge

Feb 13, 2026

LOS

Status

PCM Active

Consent

On file

Episode Timeline

22 events

Program Assignment · DME · Eligible

2026-01-28 00:00

Not accepted (Pass payer check)

Order Set · Post-Urology Discharge Bundle · Activated

2026-01-28 00:00

4 orders

Intake Trigger · Discharge List · USC Discharge Planner

2026-01-28 15:30

Routed at 2026-01-28 00:00

Program Assignment · Post-Acute · Eligible

2026-01-29 00:00

Accepted (assigned by AI Engine)

Program Assignment · TCM · Pending Verification

2026-01-30 00:00

Not accepted (Pending payer check)

Order Set · DME Recovery Bundle · Activated

2026-01-31 00:00

4 orders

DME Order · Acme Care Equipment · 1 item(s) · Shipped

2026-02-12 00:00

E0143 Folding walker

Surgery · Stone Removal

2026-02-13

Dr. Rebecca Lim

Discharge · LOS 0d

2026-02-13

Outreach · Attempt 1 · TCM Accepted

2026-02-13 12:30

Sofia Diaz

Outreach · Attempt 2 · Left Voicemail

2026-02-17 10:00

Liam Chen

Outreach · Attempt 3 · TCM Accepted

2026-02-17 11:30

Jamal Carter

TCM Encounter · Telehealth · CPT 99495

2026-02-25

Note sent to USC

Billing · TCM Encounter · CPT 99495 · Paid

2026-02-25

$174 / $174

Exception · Referral Leakage Risk · High · Open

2026-03-02 10:00

Liam Chen

PCM Enrollment · Enrolled · consent pending

2026-03-03

Steerage · Follow-up → USC

2026-03-07

USC Pasadena Surgery Center

Satisfaction · Post-TCM · 3.9/5

2026-03-12

PCM Activity · Phone Call · 18m

2026-03-12 10:50

Brandon Lee

Satisfaction · PCM Monthly · 4.6/5

2026-03-22

Nurse was responsive and reassuring.

PCM Activity · Specialist Coordination · 17m

2026-04-03 13:00

Carmen Ortiz

PCM Activity · Med Reconciliation · 7m

2026-04-03 15:30

Brandon Lee

Outreach Attempts

ID	Attempt	Datetime	Outcome	Staff	Min
OUT-0007	#1	2026-02-13 12:30	TCM Accepted	Sofia Diaz	17
OUT-0008	#2	2026-02-17 10:00	Left Voicemail	Liam Chen	4
OUT-0009	#3	2026-02-17 11:30	TCM Accepted	Jamal Carter	8

TCM Encounters

ID	Encounter	Type	CPT	Doc Complete	Note → USC	Staff
TCM-0004	2026-02-25	Telehealth	99495	Yes	Yes	Sofia Diaz

2 satisfaction survey(s) on file — see timeline.

Actionable Chat

Synthetic

I can answer questions about this patient's EPIC workflow, intake trigger, pathway, programs, order set, tasks, and billing evidence. Try one of the suggested prompts below.

Next Best Actions

Rule-based recommendations derived from the patient's current state.

Resolve exception: Referral Leakage Risk
Critical
Open 32d, assigned to Liam Chen
Owner: MA
Capture PCM consent
Medium
Enrollment exists without signed consent on file
Owner: Ops Coordinator
Log additional PCM time this month
Medium
Current month at 24m; need 6m more to bill 99426
Owner: RN

Open Exceptions

Referral Leakage Risk
32d open · Open
High