Doctor's Visit

Real-Time Claims

Real-Time Claims is a Blue Shield of CA initiative to simplify and add transparency to the current claim submission process.
Blue Shield of California

Role: Principal UX Designer and Strategist

The claims submission and adjudication process at Blue Shield of California has been the same for the last 30+ years.  The Real-Time Claims (RTC) tool does away with paper forms, faxes, and months-long waits to determine whether or not a claim was submitted properly.  In seconds, a provider will know if they have submitted the claim properly, how much they will get paid, and the member's responsibility.

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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Outdated processes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.

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User Flow
MVP Highlights
  • High-level overview of account status

  • Easily sortable table

  • Bulk claim submission

  • Transaction quick view

  • Saved services

  • 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

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Real-Time Claims Demo

Single-line medical claim demo given to providers

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