Error Humanization

Error Humanization was a Blue Shield of California effort to add clarity and ensure the voice and tone of our error handling matches the logic and our brand.

Blue Shield of California

Role: Principal UX Designer and Strategist

BSC had been receiving a number of member complaints regarding error messages that were confusing and tone-deaf to our member's needs.

Background

Existing Process

The current process for claim adjudication can take from 3 months up to a year to find out the outcome of a rendered service. A claim is currently inputed by an individual in the back office from notes on a patients' chart. These claims processors require yearly training to keep up with industry changes.

Impact on Patient

Often these claims are processed long after a patient has completed the required care. Some providers have up to a year to submit their claims, resulting in the patient not receiving a bill for services rendered for up to 15 months.

Approach

Where we started

A proof of concept was created by the tech leads in 2018 as a test to see if they could create the capability to search by the medical numerical code and intake a claim into directly into the BSC systems.

Outdated processes

BSC and most of our competitors were still accepting faxed 837 forms. The only other alternative to submit a medical claim at the time of this writing was a digitally optimized PDF version of the paper form.

Goals

For Claims Processor

As a processor, I need an intuitive claims intake form with instant feedback that will result in an uptick of clean claim submission.

For Patient

As a patient, I need a way to estimate the cost of a service to make better decisions for my personal and financial health.

For Business

As a medical system administrator, I need claims processing and payment timeline to be accelerated to allow more time for to care for our patients and less time with back office requirements.

For BSC

As BSC claims adjudicator, I need a platform that removes the simple reasons that a claim gets denied so that I can focus on higher level claim situations.

Whiteboarding

User Flow

MVP Highlights

Dashboard

High-level overview of account status
Easily sortable table
Bulk claim submission
Transaction quick view
Saved services

Form

Inline validation
Human language to the codes
Auto-populated data on select fields

Claim feedback in seconds

End to dirty claim submissions
Near real-time validation
Cut the claim submission process from months to seconds
The patient will know their payment responsibility at the time of service

Real-Time Claims Demo

Single-line medical claim demo given to providers

If you would like to see additional information, please contact me directly.