Medicaid Claims Submission – Peter Sawchuk, UX

MEDICAID: CLAIMS & ELIGIBILITY

Information Design • Taskflow • Alerts & Notifications

Description

In the Fall of 2016, the New York Department of Health announced the termination of its contract with a third party Medicaid billing system. This meant that a completely new feature, Claims & Eligibility, would need to be implemented within our software, Medicaid Direct. With less than 4 months of lead time (by January of 2017) our team would need to build this new functionality or Frontline stood to loose 350+ customers.

My Role

I had recently joined Frontline Education as a Senior UX Designer when I was asked to participate in this initiative. The project manager had roughed out the task flows as well as providing mockups for some of the screens.

View: Claims & Eligibility prototype →

Goals

Retention of Medicaid Direct’s 350+ customers
Implementation of an MVP that meets all regulatory and user requirements
Opportunity to improve the experience and show customers that we are committed to the continuous improvement of software
Providing users a simple intuitive task flow with clear calls to action.
An interface that is easy to scan for the most important data
Rigorous alerts, notifications, and validations that instill confidence in the actions taken and data provided

Discovery

Coming into the project, I knew very little about the Medicaid billing process. I worked very closely with the SME as well as referencing 3rd party solutions to fully understand the process.

TASK FLOWS

Task flows were first rendered in OmniGraffle and then validated by stakeholders. We went through several iterations to refine and simplify the flows

INFORMATIONAL ORGANIZATION

My biggest challenge was sorting through the data that was provided to create a hierarchy that aligned with the primary tasks

Wireframing and Prototypes

Prototypes were used to validate flows with internal stakeholders and to play out various scenarios for confirmations and alerts

System Transparency Was Critical

While new functionality would automate many steps that were once carried out manually, we were fundamentally changing a familiar workflow. In the original process, much of the tasks were in the direct control of the designated claims clerk (files would be manually downloaded from our site, posted to a third party platform and then reviewed.) Thus not only did the data need to be accurate, the experience needed to instill user confidence. To this end, we enhanced system transparency by clear delineation of claims status, implementing well-considered validations and confirmations as well as clearly written alerts.

Claims & Eligibility_Landing Page_1 Alert

Claims & Eligibility_Landing Page_Alert and Warning

Landing Page_Amount not accepted_Alert rollover

Landing Page_Electronic Remittance error Rollover

Conclusion

With such a tight schedule close collaboration and communication with team members was required. User testing was done with internal stakeholders. And to ensure data hierarchy and scannability, I worked closely with my UI developer.

This new feature would need to be implemented by January of 2017 (in 4 months) or Frontline stood to loose 350+ customers!

—Medicaid Product Manager

In the end, we completed our v1 and met our deadlines. We were able to show the customer real value by providing an easier, more efficient workflow. And at the same time maintain if not improve confidence by providing enhanced system transparency.