By Sagar Shankaran, Founder of CallSphere
Eligibility, compliance and cadence checks on every $84 resupply order now cost a fraction of a cent. Worked numbers on a 6,000-order-a-month DME program.
Key takeaways
Eighty-four dollars. That is roughly what a routine CPAP resupply order bills out at when the cushion, the filters and the tubing all fall due in the same ninety-day cycle. Now look at your denial report for last quarter and find how many of those $84 orders came back — plan termed, compliance documentation not on file, quantity over the allowed cadence, patient in a covered Part A stay. You shipped the product, paid the freight, and got nothing.
You have never audited those orders before they ship. Nobody does. Auditing a resupply order costs a person four to six minutes, and four to six minutes against $84 of billed revenue with a thin margin on the product is not an argument anybody wins. So the resupply program runs on volume and eats the denials as a cost of doing business, while the pre-billing review that your reimbursement manager built gets applied to the power mobility files and the ventilators, where the dollars justify it.
Be clear about this: skipping the check was the right call under the old arithmetic. A resupply coordinator making $22 an hour loaded costs about $1.83 for five minutes. On an $84 order at a 7% denial rate, the expected loss per order is about $5.88, and you would only catch part of it. Once you add the fact that most of the checks come back clean and the coordinator is doing nothing productive on those, the case falls apart. Anyone who told you in 2024 to inspect every resupply order was telling you to spend a dollar to find eighty cents.
So you did what the industry does. Quarterly eligibility sweeps instead of per-order checks. A compliance report pulled from ResMed AirView or Philips Care Orchestrator once a month instead of at order time. A resupply cadence enforced by the calendar rule in Brightree or Bonafide rather than against the specific plan's actual limits, which differ between straight Medicare, a Medicare Advantage plan and your state Medicaid.
Running frontier AI got roughly ten times cheaper from 2025 into 2026. Capable models now cost around two dollars for a million words' worth of work, and running smaller models on your own hardware costs roughly ninety percent less than cloud for high-volume repetitive jobs. That is the entire development. There is nothing clever in it.
But it moves the decision. A per-order documentation and eligibility check that cost you a resupply coordinator's five minutes in 2025 now costs a fraction of a cent in 2026, which means the checks you reserved for the ventilator files can run on every single $84 cushion order. The check did not get smarter. It got cheap enough to run everywhere, which for a resupply program shipping thousands of orders a month is a bigger change than any accuracy improvement would have been.
Hear it before you finish reading
Talk to a live CallSphere AI voice agent for healthcare in your browser — 60 seconds, no signup.
flowchart TD
A["Order builds in the 90-day resupply queue"] --> B["Coverage still active on this plan today?"]
A --> C["PAP compliance download on file and current?"]
A --> D["Quantity within this payer's allowed cadence?"]
B --> E{"All three clear?"}
C --> E
D --> E
E -->|Yes| F["Releases to the warehouse pick list"]
E -->|No| G["Held with the exact missing item named"]
G --> H["Resupply coordinator works a 40-line list, not 6,000 orders"]
The useful checks in a resupply program are not exotic. They are the ones your best billing specialist would run if she had unlimited time, and there are about six of them.
The output is not a report. It is a hold. Clean orders release straight to the pick list; the ones that fail land on a short exception list that names the specific missing item, so your resupply coordinator spends her morning on forty real problems instead of spot-checking six thousand orders she cannot possibly review.
Illustrative numbers for a mid-sized resupply program. Substitute your own volume and your own denial rate off last quarter's report.
| Resupply orders shipped per month | 6,000 |
| Average billed per order | $84 |
| Denial or rejection rate on resupply | 7% |
| Denied orders per month | 420 |
| Share preventable before shipping (eligibility, compliance, cadence, order on file) | about half, or 210 |
| Billed revenue at stake on those | about $17,640 per month |
| Product and freight wasted on orders that should never have shipped, at $31 each | about $6,510 per month |
| Cost to run all six checks on all 6,000 orders at 2026 prices | about $20 per month |
| Coordinator time on the exception list, 40 holds per day at 4 minutes | about 2.7 hours per day |
The line that matters is the twenty dollars. Not because twenty dollars is impressive, but because it is small enough that the decision is no longer about the running cost at all — it is about whether the checks are wired correctly into your system and whether somebody works the exception list every morning. That is a management problem, which is a much better problem to have than an economics problem.
One caution on the savings figure. Preventing a denial is not the same as collecting the money; some of those 210 orders should genuinely not ship, and that revenue simply does not exist. The honest way to state the benefit is that you stop paying product and freight on orders that were never going to pay, and you stop spending billing time on appeals that were never winnable. Both are real. Neither is $17,640 landing in the bank.
A check that runs everywhere also fails everywhere, quietly, if it is wrong. Three specific hazards in this trade.
First, eligibility responses lie by omission. A real-time response can say active coverage and still not tell you the patient has a secondary that is now primary, or that a Medicare Advantage plan requires prior authorization through Evolent for exactly these codes. Treat a clear eligibility check as one input, not as a decision.
Still reading? Stop comparing — try CallSphere live.
See the healthcare AI agent handle a real call — complete, industry-specific, and live in your browser. No signup.
Second, do not let an automatic hold quietly stop a patient's oxygen or their ventilator circuit. There is a difference between a $60 mask cushion and a supply a patient depends on to breathe. Set the rule so that respiratory and life-supporting items never auto-hold; they flag to a respiratory therapist and ship while the documentation gets chased.
Third, the compliance question is clinical territory. Whether a patient's usage pattern supports continued need — and what to do about a patient whose usage is dropping — belongs to your RT and the ordering physician, not to a rule that reads a number off a download. Use the check to surface the patients whose usage fell off. Do not use it to make the coverage argument for you.
Maybe not on resupply. But the same near-zero cost per check applies to things you also skip for cost reasons: verifying the delivery address on every order, screening every ordering physician against exclusion lists, or checking every capped rental approaching month eleven. Pick whichever of those you currently sample rather than check, and start there.
January is exactly when the per-order check pays for itself. Plan changes land on the first, patients move between Medicare and Medicare Advantage without telling you, and a quarterly eligibility sweep run in December is already stale by 3 January. A check that runs on the order itself catches those on the day they matter instead of in April when the denials arrive.
Not at 6,000 orders a month. Running on your own machines makes sense when volume is very high and the job is repetitive, and it is a real option now that it costs roughly ninety percent less than cloud for that kind of work. But at your volume the cloud cost is already a rounding error, and the setup effort is better spent on wiring the checks into Brightree properly.
Give it to one named person — usually the resupply coordinator, with the reimbursement manager reviewing the categories weekly. An exception list nobody owns turns into a queue of 4,000 held orders inside a month, at which point somebody switches the whole thing off and you are back where you started.
Pull last quarter's resupply denial report and sort it by reason code. Count how many of the top three reasons could have been caught before the box left the warehouse. That number, multiplied by your average billed amount, is the honest size of this opportunity for your company — and it takes an afternoon to produce.
Then look at what the exception list does to your phone. Every held order eventually becomes a patient call asking where their supplies are, and those calls arrive in a lump. CallSphere builds AI voice and chat agents that answer those calls and your web chat around the clock, tell the patient the actual status of their order and take the details you need, so cleaning up the back end does not simply move the pressure onto the front desk.
Written by
Sagar Shankaran· Founder, CallSphere
LinkedInSagar Shankaran is the founder of CallSphere, where he builds production AI voice and chat agents deployed across healthcare, hospitality, real estate, and home services. He writes about agentic AI, LLM engineering, and shipping voice agents that handle real calls in production.
See how AI voice agents work for your industry. Live demo available -- no signup required.
Remittances posted, denials drafted, tomorrow's 24 patients checked for benefits before 8am. What an optometry practice's morning queue looks like in 2026.
Sports physical therapy and student health clinics in Pullman, Washington lose patients to missed calls every semester surge. How to answer every single one.
Bilingual family medicine clinics in Yakima, Washington field English and Spanish calls from harvest crews at all hours. An AI receptionist answers them all.
Optometry practices in Newport, Oregon serve retirees, tourists, and the fishing fleet. An AI answering service books exams and triages urgent eye calls 24/7.
Dermatology clinics in Medford, Oregon see call surges from summer sun through wildfire smoke season. How an AI receptionist answers every patient call.
PCS season floods Great Falls, Montana pediatric practices with calls. How an AI receptionist answers 24/7, books visits, and captures TRICARE details.
© 2026 CallSphere Inc. All rights reserved.
Made within San Francisco
Watch how CallSphere handles real customer calls, schedules appointments, and processes payments — live.
Try Live DemoBook a DemoCalculate Your ROI