Case study: Simplifying the claims process for LTSS providers
The project
Many of the providers supporting LTSS are non-medical, such as a construction company that might build a wheelchair ramp or an installation company that might install a special alert system. Referred to as “atypical providers,” they can range in size and many times have no experience with medical coding or jargon. The claims form project was part of a group of projects to make working with this payer easier for the atypical provider..
The Problem
Because many LTSS providers are “atypical” aka non-medical:
- They could not use the standard claim form as they were unfamiliar with many of the required fields.
- As a work around, they’d submit invoices via mail, email or fax which often contained wrong or missing information.
This resulted in:
- Payer employees having to input data manually to process claims.
- Payer employees would have to contact providers when mistakes were made.
- Provider payments would often be significantly delayed, due to missing information.
Our objective
To create a streamlined form that:
- Makes form completion fast and easy.
- Uses information the provider knows and has in their possession.
- Eliminates the ability to leave out information.
- Eliminates delays in payment.
- Eliminates manual entry of data by the payer.
My role
- UX design
- User research
Collaborators
- Business stakeholders
- System Analyst
- Solutions Architect
- Service Developer
- UX Design Team Members
The solution
- Reduced from 43 manual entries
- Clear form requirements eliminate the risk of missing information
- Previously, rejections were often due to manual submissions that were missing key data needed for payment
WHY IT WORKS
- Because users select members from an existing dashboard, their information is autopopulated.
- Contextual help provided on page to guide users on the claims submission process. Guidance also provided on the Claims tab, where users might intuitively go to start the claims process. (Not shown)
- Because we know who the provider is, we could autopopulated their information, thus eliminating more manual entry.
- Settings allows users to complete administrative details once per member and save for future claims. The old form required this data to be input each time.
- Choice of submitting one claim for all selected members. Because atypical providers often provide a single service for many members, this allows them to create a claim once and bill for many.
- Adding transactions allows providers to bill for various services in the same session.
